What Is New in Diagnostics and Management of Medullary Thyroid Carcinoma.

Q3 Medicine
Friedhelm Raue, Karin Frank-Raue
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Abstract

Medullary thyroid carcinoma (MTC) is a rare neoplasm originating from parafollicular C cells. It secretes calcitonin (Ctn), a highly sensitive and specific tumor marker, which allows for early diagnosis and defines postoperative cure or persistence/recurrence of MTC. Germline mutations in the RET proto-oncogene are responsible for the development of MTC in MEN2. Somatic RET mutations modify the behavior of MTC and are a target for systemic therapy with selective RET inhibitors. Recent advances in preoperative immunohistochemistry and molecular diagnostics in biopsies achieved by fine needle aspiration significantly improves diagnosis and allows classification in low and high risk MTC with important implications for treatment and prognosis. This personalized approach enables a less aggressive surgery in low risk MTC patients, reduces the incidence of complications and improves quality of life. Risk stratification in MEN2 patients based on genotype-phenotype correlation of the different RET mutations allows cure by personalized thyroidectomy. Postoperative imaging in patients with persistent or recurrent MTC with PET/CT using different radiopharmaceuticals proved to be sensitive and accurate in detecting MTC recurrences/metastases and assesses their biological and clinical aggressiveness. Molecular genetic classification of tumors enables personalized systemic therapies with multikinase inhibitors or selective RET inhibitors in patients with advanced metastasized and progressive disease. Despite the recent progress in diagnosis and treatment, confirmation of these new procedures and standardization of these approaches in MTC are required.

甲状腺髓样癌的诊断和治疗新进展。
甲状腺髓样癌(MTC)是一种罕见的肿瘤,起源于滤泡旁C细胞。它分泌降钙素(Ctn),这是一种高度敏感和特异性的肿瘤标志物,可以早期诊断并确定MTC的术后治愈或持续/复发。RET原癌基因的种系突变是MEN2中MTC发生的原因。体细胞RET突变改变MTC的行为,是选择性RET抑制剂全身治疗的目标。术前免疫组织化学和细针穿刺活检分子诊断的最新进展显著提高了诊断,并允许对低危和高风险MTC进行分类,对治疗和预后具有重要意义。这种个性化的方法可以减少低风险MTC患者的手术侵袭性,减少并发症的发生率,提高生活质量。基于不同RET突变基因型-表型相关性的MEN2患者风险分层允许通过个体化甲状腺切除术治疗。持续或复发性MTC患者的术后PET/CT成像使用不同的放射性药物被证明是敏感和准确的检测MTC复发/转移和评估其生物学和临床侵袭性。肿瘤的分子遗传分类使得多激酶抑制剂或选择性RET抑制剂对晚期转移和进展性疾病患者的个性化全身治疗成为可能。尽管最近在诊断和治疗方面取得了进展,但需要确认这些新程序并使这些方法在MTC中标准化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.60
自引率
0.00%
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