CHANGING THE PARADIGM: LOBECTOMY FOR SPORADIC MEDULLARY THYROID CANCER.

IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Marina Lugaresi, Claudia Moneta, Giulia Saruggia, Gianlorenzo Dionigi, Giacomo Gazzano, Laura Fugazzola
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Abstract

Objectives: Total thyroidectomy is the treatment of choice for medullary thyroid cancer (MTC) though the sporadic forms are usually monocentric. Aim of the present study was to evaluate a) the performance of calcitonin (Ct) levels, ultrasound scans (US), and cytology in the preoperative identification of MTC and b) the number of total thyroidectomies that could have been avoided being the location of the MTC diagnosed preoperatively.

Materials and methods: We retrospectively analysed 89 RET germline negative patients diagnosed with MTC in the last 30 years, treated with total thyroidectomy ± lymphadenectomy, and followed in our Tertiary Care Center. In a subgroup of 55 patients, divided in those with a mono- or bilateral goiter, we applied ex-post criteria for the pre-surgical identification of the lobe holding the MTC nodule.

Results: Only 2/89 patients (2.2%) had a bilateral MTC at histology. A strongly significant correlation was found between preoperative basal Ct levels and MTC size. According to the ex-post identification criteria, the 84.4% and 56.5% of the nodules would have been identified preoperatively as MTC, in monolateral and bilateral goiters respectively.

Conclusions: This is the first European study that aims to evaluate the feasibility of lobectomy as first line therapy for MTC based on the evaluation of thyroid US, and serum Ct levels. These tools have been shown to have a good accuracy in detecting the affected lobe and strongly support the possibility to perform a more conservative surgery to treat RET-negative patients with suspicious MTC and nodular goiter.

改变模式:散发性甲状腺髓样癌的肺叶切除术。
目的:甲状腺全切除术是治疗甲状腺髓样癌(MTC)的首选,尽管散发性形式通常是单中心的。本研究的目的是评估a)降钙素(Ct)水平、超声扫描(US)和细胞学检查在术前诊断MTC中的作用;b)术前诊断MTC的位置本可以避免全甲状腺切除术的数量。材料和方法:我们回顾性分析了近30年来诊断为MTC的89例RET生殖系阴性患者,接受甲状腺全切除术±淋巴结切除术,并在三级保健中心随访。在55名患者的亚组中,分为单侧甲状腺肿或双侧甲状腺肿,我们应用术后标准进行术前鉴定含有MTC结节的肺叶。结果:只有2/89(2.2%)的患者在组织学上有双侧MTC。术前基础Ct水平与MTC大小之间存在显著相关性。根据术后诊断标准,84.4%和56.5%的结节术前诊断为MTC,分别发生在单侧和双侧甲状腺。结论:这是欧洲首个基于甲状腺US和血清Ct水平评估肺叶切除术作为MTC一线治疗可行性的研究。这些工具已被证明在检测受影响的肺叶方面具有良好的准确性,并强烈支持对ret阴性的可疑MTC和结节性甲状腺肿患者进行更保守的手术治疗的可能性。
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来源期刊
European Thyroid Journal
European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.70
自引率
2.10%
发文量
156
期刊介绍: The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.
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