{"title":"改变模式:散发性甲状腺髓样癌的肺叶切除术。","authors":"Marina Lugaresi, Claudia Moneta, Giulia Saruggia, Gianlorenzo Dionigi, Giacomo Gazzano, Laura Fugazzola","doi":"10.1530/ETJ-25-0040","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Total thyroidectomy is the treatment of choice for medullary thyroid cancer (MTC), although the sporadic forms are usually monocentric. Aim of the present study was to evaluate i) the performance of calcitonin (Ct) levels, ultrasound scans (US) and cytology in the preoperative identification of MTC and ii) the number of total thyroidectomies that could have been avoided being the location of the MTC diagnosed preoperatively.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 89 RET germline negative patients diagnosed with MTC in the past 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 bi-lateral goiter, we applied ex-post criteria for the presurgical identification of the lobe holding the MTC nodule.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":12159,"journal":{"name":"European Thyroid Journal","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020465/pdf/","citationCount":"0","resultStr":"{\"title\":\"Changing the paradigm: lobectomy for sporadic medullary thyroid cancer.\",\"authors\":\"Marina Lugaresi, Claudia Moneta, Giulia Saruggia, Gianlorenzo Dionigi, Giacomo Gazzano, Laura Fugazzola\",\"doi\":\"10.1530/ETJ-25-0040\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Total thyroidectomy is the treatment of choice for medullary thyroid cancer (MTC), although the sporadic forms are usually monocentric. Aim of the present study was to evaluate i) the performance of calcitonin (Ct) levels, ultrasound scans (US) and cytology in the preoperative identification of MTC and ii) the number of total thyroidectomies that could have been avoided being the location of the MTC diagnosed preoperatively.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 89 RET germline negative patients diagnosed with MTC in the past 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 bi-lateral goiter, we applied ex-post criteria for the presurgical identification of the lobe holding the MTC nodule.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":12159,\"journal\":{\"name\":\"European Thyroid Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-04-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020465/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Thyroid Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1530/ETJ-25-0040\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/1 0:00:00\",\"PubModel\":\"Print\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Thyroid Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1530/ETJ-25-0040","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/1 0:00:00","PubModel":"Print","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Changing the paradigm: lobectomy for sporadic medullary thyroid cancer.
Objectives: Total thyroidectomy is the treatment of choice for medullary thyroid cancer (MTC), although the sporadic forms are usually monocentric. Aim of the present study was to evaluate i) the performance of calcitonin (Ct) levels, ultrasound scans (US) and cytology in the preoperative identification of MTC and ii) the number of total thyroidectomies that could have been avoided being the location of the MTC diagnosed preoperatively.
Materials and methods: We retrospectively analyzed 89 RET germline negative patients diagnosed with MTC in the past 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 bi-lateral goiter, we applied ex-post criteria for the presurgical 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.
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.