Background: This study aimed to evaluate the incidence of multifocality, bilaterality, and central compartment lymph node involvement (both ipsilateral and contralateral) in patients with apparently unifocal sporadic medullary thyroid carcinoma cN0. Methods: Patients with sporadic medullary thyroid carcinoma cN0 were prospectively enrolled between February 2022 and December 2024. To confirm the sporadic form of medullary thyroid carcinoma, the search for RET germline mutation was performed in all cases. All patients underwent total thyroidectomy with central compartment neck dissection. Ipsilateral and contralateral central compartment lymph nodes were harvested separately for histopathologic examination. Results: A total of 54 patients were included in the study. The median age was 60 years, with a female predominance of 55.6%. Preoperative median calcitonin levels were 112.5 pg/mL. Median tumor size was 1.1 cm. Three patients (5.6%) presented with multifocal sporadic medullary thyroid carcinoma, but only 1 had bilateral sporadic medullary thyroid carcinoma (1.9%). The median number of central compartment lymph nodes removed was 10. Twelve patients (22.2%) had lymph node metastasis, including 2 patients (3.7%) with lymph node metastases in both the ipsilateral and contralateral central compartments. All metastatic lymph nodes measured ≤5 mm. In multivariate analysis, no independent risk factor for lymph node metastasis was found among age (P = .589), sex (P = .069), calcitonin (P = .953), tumor size (P = .644), and desmoplasia >20% (P = .087). Conclusion: Sporadic medullary thyroid carcinoma cN0 harbors a unilateral disease in 94.4% of cases. Contralateral lymph node involvement is extremely rare in highly selected cases, although ipsilateral central compartment lymph node metastases occur in 22.2% of cases. In this cohort of patients, unilateral surgery (hemithyroidectomy with ipsilateral central compartment neck dissection) may be the treatment of choice.
Highly-selected sporadic, apparently unifocal cN0 MTC may benefit from unilateral surgery. A proof of concept in a high-volume institution
Rossi L.;Matrone A.;Torregrossa L.;Becucci C.;De Palma A.;Frustaci G.;Ambrosini C. E.;Ugolini C.;Materazzi G.;Elisei R.
2025-01-01
Abstract
Background: This study aimed to evaluate the incidence of multifocality, bilaterality, and central compartment lymph node involvement (both ipsilateral and contralateral) in patients with apparently unifocal sporadic medullary thyroid carcinoma cN0. Methods: Patients with sporadic medullary thyroid carcinoma cN0 were prospectively enrolled between February 2022 and December 2024. To confirm the sporadic form of medullary thyroid carcinoma, the search for RET germline mutation was performed in all cases. All patients underwent total thyroidectomy with central compartment neck dissection. Ipsilateral and contralateral central compartment lymph nodes were harvested separately for histopathologic examination. Results: A total of 54 patients were included in the study. The median age was 60 years, with a female predominance of 55.6%. Preoperative median calcitonin levels were 112.5 pg/mL. Median tumor size was 1.1 cm. Three patients (5.6%) presented with multifocal sporadic medullary thyroid carcinoma, but only 1 had bilateral sporadic medullary thyroid carcinoma (1.9%). The median number of central compartment lymph nodes removed was 10. Twelve patients (22.2%) had lymph node metastasis, including 2 patients (3.7%) with lymph node metastases in both the ipsilateral and contralateral central compartments. All metastatic lymph nodes measured ≤5 mm. In multivariate analysis, no independent risk factor for lymph node metastasis was found among age (P = .589), sex (P = .069), calcitonin (P = .953), tumor size (P = .644), and desmoplasia >20% (P = .087). Conclusion: Sporadic medullary thyroid carcinoma cN0 harbors a unilateral disease in 94.4% of cases. Contralateral lymph node involvement is extremely rare in highly selected cases, although ipsilateral central compartment lymph node metastases occur in 22.2% of cases. In this cohort of patients, unilateral surgery (hemithyroidectomy with ipsilateral central compartment neck dissection) may be the treatment of choice.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
