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Zhang X, Zhao X, Jin L, Guo Q, Wei M, Li Z, Niu L, Liu Z, An C. The machine learning-based model for lateral lymph node metastasis of thyroid medullary carcinoma improved the prediction ability of occult metastasis. Cancer Med 2024; 13:e7155. [PMID: 38808852 PMCID: PMC11135018 DOI: 10.1002/cam4.7155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND For medullary thyroid carcinoma (MTC) with no positive findings in the lateral neck before surgery, whether prophylactic lateral neck dissection (LND) is needed remains controversial. A better way to predict occult metastasis in the lateral neck is needed. METHODS From January 2010 to January 2022, patients who were diagnosed with MTC and underwent primary surgery at our hospital were retrospectively reviewed. We collected the patients' baseline characteristics, surgical procedure, and rescored the ultrasound images of the primary lesions using American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Regularized logistic regression, 5-fold cross-validation and decision curve analysis was applied for lateral lymph node metastasis (LLNM) model's development and validation. Then, we tested the predictive ability of the LLNM model for occult LLNM in cN0-1a patients. RESULTS A total of 218 patients were enrolled. Five baseline characteristics and two TI-RADS features were identified as high-risk factors for LLNM: gender, baseline calcitonin (Ctn), tumor size, multifocality, and central lymph node (CLN) status, as well as TI-RADS margin and level. A LLNM model was developed and showed a good discrimination with 5-fold cross-validation mean area under curve (AUC) = 0.92 ± 0.03 in the test dataset. Among cN0-1a patients, our LLNM model achieved an AUC of 0.91 (95% CI, 0.88-0.94) for predicting occult LLNM, which was significantly higher than the AUCs of baseline Ctn (0.83) and CLN status (0.64). CONCLUSIONS We developed a LLNM prediction model for MTC using machine learning based on clinical baseline characteristics and TI-RADS. Our model can predict occult LLNM for cN0-1a patients more accurately, then benefit the decision of prophylactic LND.
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Affiliation(s)
- Xiwei Zhang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiaohui Zhao
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lichao Jin
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qianqian Guo
- Department of UltrasoundQilu Hospital of Shandong UniversityJinanChina
| | - Minghui Wei
- Department of Head and Neck Surgical OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhengjiang Li
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lijuan Niu
- Department of UltrasoundNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhiqiang Liu
- Department of Radiation OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Changming An
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Cohen O, Tzelnick S, Randolph G, Rinaldo A, Álvarez F, Rodrigo JP, Saba NF, Nuyts S, Corry J, Mäkitie AA, Vander Poorten V, Nathan CA, Piazza C, Ferlito A. Initial surgical management of sporadic medullary thyroid cancer: Guidelines based optimal care - A systematic review. Clin Endocrinol (Oxf) 2024; 100:468-476. [PMID: 38472743 DOI: 10.1111/cen.15041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/02/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor from parafollicular cells that produce calcitonin (Ct). Despite several existing guidelines for the surgical management of sporadic MTC (sMTC), optimal initial surgical management of the thyroid, the central and the lateral neck remains a matter of debate. METHODS A systematic review in PubMed and Scopus for current guidelines addressing the surgical management of sMTC and its referenced citations was conducted as per the PRISMA guidelines. RESULTS Two-hundred and one articles were identified, of which 7 met the inclusion criteria. Overall, guidelines vary significantly in their recommendations for the surgical management of sMTC. Only one guideline recommended partial thyroidectomy for limited disease, but the possibility to avoid completion thyroidectomy in selected cases is acknowledged in 42% (3/7) of the remaining guidelines. The majority of guidelines (71.4%; 5/7) recommended prophylactic central neck dissection (CND) for all patients while the remaining two guidelines recommended CND based on Ct level and tumor size. The role of prophylactic lateral neck dissection based on preoperative Ct levels was recommended by 42% (3/7) of guidelines. Overall, these guidelines are based on low-quality evidence, mostly single-center retrospective series, some of which are over 20 years old. CONCLUSION Current surgical management guidelines of sMTC should be revised, and ought to be based on updated data challenging current recommendations, which are based on historic, low-quality evidence. Partial thyroidectomy may become a viable option for small, limited tumors. Prospective, multi-center studies may be useful to conclude whether prophylactic ND is necessary in all sMTC patients.
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Affiliation(s)
- Oded Cohen
- Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Sharon Tzelnick
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA
| | | | - Fernando Álvarez
- Department of Otolaryngology, Hospital Universitario Central Asturias, Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Asturias, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central Asturias, Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Asturias, Spain
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - June Corry
- Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Vander Poorten
- Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - Cherie-Ann Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, Louisiana, USA
| | - Cesare Piazza
- Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Lin X, Huo J, Su H, Zhu C, Xu Y, Zhang F. Risk factors for cervical lymph node metastasis in the central or lateral cervical region in medullary thyroid carcinoma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:547-561. [PMID: 37801162 DOI: 10.1007/s00405-023-08249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Compared with other types of thyroid carcinoma, patients with medullary thyroid carcinoma (MTC) are more likely to develop cervical lymph node metastasis. This study was conducted to clarify the risk factors for cervical lymph node metastasis (central lymph node metastasis or lateral cervical lymph node metastasis) in MTC by meta-analysis, and to provide evidence-based basis for the treatment and prognosis of MTC. METHODS The literatures related to cervical lymph node metastasis in medullary thyroid carcinoma were searched in PubMed, Embase, Web of Science, Cochrane, CNKI and Wanfang databases, and statistical analysis was performed using Revman 5.3 and Stata 14.0 software. RESULTS A total of 28 papers were included in this paper, and meta-analysis showed that the occurrence of central lymph node metastasis (CLNM) in MTC patients was significantly associated with tumor size (OR = 3.07, 95%CI: 2.04-4.63, P < 0.00001), multifocality (OR = 0.29, 95%CI: 0.19-0.44, P < 0.00001), bilaterality (OR = 3.75, 95% CI: 1.95-7.14, P < 0.0001), capsular invasion (OR = 9.88, 95% CI: 5.93-16.45, P < 0.00001) and extrathyroidal extension (OR = 5.48, 95% CI: 2.61-11.51, P < 0.00001). While the occurrence of lateral cervical lymph node metastasis (LLNM) in MTC patients was strongly correlated with gender (OR = 2.97, 95%CI: 2.46-3.58, P < 0.00001), tumor size (OR = 3.88, 95%CI: 1.90-7.92, P = 0.0002 < 0.05), multifocality (OR = 0.43, 95%CI: 0.35-0.51, P < 0.00001), bilaterality (OR = 2.93, 95% CI: 1.72-4.98, P < 0.0001), capsular invasion (OR = 8.44, 95% CI: 6.11-11.64, P < 0.00001), extrathyroidal extension (OR = 7.04, 95% CI: 5.54-8.94, P < 0.00001), margin of the tumor (OR = 4.47, 95% CI: 2.37-8.44, P < 0.00001), shape of the tumor (OR = 6.81, 95% CI: 3.64-12.73, P < 0.00001), preoperative calcitonin level (SMD = 1.39, 95% CI: 0.98-1.80, P < 0.00001), preoperative carcinoembryonic antigen level (SMD = 0.97, 95% CI: 0.74-1.20, P < 0.00001) and CLNM (OR = 19.70, 95% CI: 14.16-27.43, P < 0.00001). CONCLUSION Tumor size, multifocality, bilaterality, capsular invasion and extrathyroidal extension are the main risk factors for developing CLNM in MTC patients; And risk factors for developing LLNM in MTC patients include: gender, tumor size, multifocality, bilaterality, capsular invasion, extrathyroidal extension, margin of the tumor, shape of the tumor, preoperative calcitonin level, preoperative carcinoembryonic antigen level and central lymph node metastasis. These risk factors can guide the individualized treatment plan and improve the prognosis of MTC patients.
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Affiliation(s)
- Xunyi Lin
- Department of Thyroid and Breast Surgery, Hebei General Hospital Affiliated to Hebei North University, Shijiazhuang, 050051, Hebei Province, China
| | - Jiaxing Huo
- Department of Thyroid and Breast Surgery, Hebei General Hospital Affiliated to Hebei Medicine University, Shijiazhuang, 050051, Hebei Province, China
| | - Hang Su
- Department of Thyroid and Breast Surgery, Hebei General Hospital Affiliated to North China University of Science and Technology, Shijiazhuang, 050051, Hebei Province, China
| | - Chunyue Zhu
- Department of Thyroid and Breast Surgery, Hebei General Hospital, No. 348 Peace West Road, Shijiazhuang, 050051, Hebei Province, China
| | - Yanbo Xu
- Department of Thyroid and Breast Surgery, Hebei General Hospital Affiliated to North China University of Science and Technology, Shijiazhuang, 050051, Hebei Province, China
| | - Fenghua Zhang
- Department of Thyroid and Breast Surgery, Hebei General Hospital, No. 348 Peace West Road, Shijiazhuang, 050051, Hebei Province, China.
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Binter T, Baumgartner-Parzer S, Schernthaner-Reiter MH, Arikan M, Hargitai L, Niederle MB, Niederle B, Scheuba C, Riss P. Does Genotype-Specific Phenotype in Patients with Multiple Endocrine Neoplasia Type 2 Occur as Current Guidelines Predict? Cancers (Basel) 2024; 16:494. [PMID: 38339246 PMCID: PMC10854710 DOI: 10.3390/cancers16030494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The clinical manifestation of multiple endocrine neoplasia type 2 (MEN2) in terms of developing medullary thyroid cancer (MTC), pheochromocytoma (PCC), and/or primary hyperparathyroidism (PHPT) is related to the respective pathogenic variant of the RET proto-oncogene. The aim of this study is to retrospectively analyze the individual, genotype-dependent clinical manifestations of a large cohort of MEN2 patients. By comparing their clinical profile with currently existing evidence-based knowledge, an optimal therapy and prevention strategy in terms of prophylactic thyroidectomy and clinical follow-up could be ensured. This is a retrospective single-center study of 158 MEN2 patients who were diagnosed and/or surgically treated at a tertiary referral care center between 1990 and 2022. All participants were categorized according to their pathogenic variant of the RET proto-oncogene. Subsequently, the clinical manifestation of the disease and its time of occurrence was documented. Our analysis showed results in line with existing studies, except for a considerably lower-than-predicted occurrence of PCC in patients with V804M/L mutations. This study supports the current recommendation regarding the pathogenic variant-dependent management of this rare cancer-associated syndrome.
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Affiliation(s)
- Teresa Binter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria; (T.B.); (M.A.); (L.H.); (M.B.N.); (B.N.); (C.S.)
| | - Sabina Baumgartner-Parzer
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria; (S.B.-P.); (M.H.S.-R.)
| | - Marie Helene Schernthaner-Reiter
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, 1090 Vienna, Austria; (S.B.-P.); (M.H.S.-R.)
| | - Melisa Arikan
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria; (T.B.); (M.A.); (L.H.); (M.B.N.); (B.N.); (C.S.)
| | - Lindsay Hargitai
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria; (T.B.); (M.A.); (L.H.); (M.B.N.); (B.N.); (C.S.)
| | - Martin Bruno Niederle
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria; (T.B.); (M.A.); (L.H.); (M.B.N.); (B.N.); (C.S.)
| | - Bruno Niederle
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria; (T.B.); (M.A.); (L.H.); (M.B.N.); (B.N.); (C.S.)
| | - Christian Scheuba
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria; (T.B.); (M.A.); (L.H.); (M.B.N.); (B.N.); (C.S.)
| | - Philipp Riss
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria; (T.B.); (M.A.); (L.H.); (M.B.N.); (B.N.); (C.S.)
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Russell MD, Shonka DC, Noel J, Karcioglu AS, Ahmed AH, Angelos P, Atkins K, Bischoff L, Buczek E, Caulley L, Freeman J, Kroeker T, Liddy W, McIver B, McMullen C, Nikiforov Y, Orloff L, Scharpf J, Shah J, Shaha A, Singer M, Tolley N, Tuttle RM, Witterick I, Randolph GW. Preoperative Evaluation of Thyroid Cancer: A Review of Current Best Practices. Endocr Pract 2023; 29:811-821. [PMID: 37236353 DOI: 10.1016/j.eprac.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The incidence of thyroid cancer has significantly increased in recent decades. Although most thyroid cancers are small and carry an excellent prognosis, a subset of patients present with advanced thyroid cancer, which is associated with increased rates of morbidity and mortality. The management of thyroid cancer requires a thoughtful individualized approach to optimize oncologic outcomes and minimize morbidity associated with treatment. Because endocrinologists usually play a key role in the initial diagnosis and evaluation of thyroid cancers, a thorough understanding of the critical components of the preoperative evaluation facilitates the development of a timely and comprehensive management plan. The following review outlines considerations in the preoperative evaluation of patients with thyroid cancer. METHODS A clinical review based on current literature was generated by a multidisciplinary author panel. RESULTS A review of considerations in the preoperative evaluation of thyroid cancer is provided. The topic areas include initial clinical evaluation, imaging modalities, cytologic evaluation, and the evolving role of mutational testing. Special considerations in the management of advanced thyroid cancer are discussed. CONCLUSION Thorough and thoughtful preoperative evaluation is critical for formulating an appropriate treatment strategy in the management of thyroid cancer.
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Affiliation(s)
- Marika D Russell
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Julia Noel
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Amanda Silver Karcioglu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Amr H Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kristen Atkins
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Lindsay Bischoff
- Division of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Erin Buczek
- Department of Otolaryngology-Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Yuri Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Orloff
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jatin Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Neil Tolley
- Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Robert Michael Tuttle
- Endocrine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Hao W, Zhao J, Guo F, Zhang J, Gu P, Ruan X, Zhang W, Zheng X, Gao M. The survival outcomes of prophylactic lateral neck dissection for medullary thyroid carcinoma, a retrospective cohort study. Clin Otolaryngol 2023; 48:734-739. [PMID: 37366234 DOI: 10.1111/coa.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 03/05/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the benefits of prophylactic lymph node dissection in medullary thyroid carcinoma (MTC) patients without radiographically lateral neck metastases. DESIGN Retrospective cohort study. SETTING Tianjin Medical University Cancer Institute and Hospital. PARTICIPANTS Patients who underwent primary surgery for MTC between 2011 and 2019 and without structural disease of the lateral neck preoperatively. MAIN OUTCOME MEASURES Locoregional recurrence, disease-free survival (DFS), and overall survival (OS) were examined. RESULTS The patients were divided into two groups: the central lymph node dissection (CLND) only group and the prophylactic lateral lymph node dissection (PLND) group, which included CLND and ipsilateral lateral lymph node dissection (LLND). A total of 89 patients were included: 71 patients in the CLND group and 18 patients in the PLND group. Although there were no significant differences in age, gender, multifocality, capsule invasion or TNM stage between the two groups, the tumour size and preoperative median calcitonin levels were different. The recurrence rate was 4.2% for the CLND group and 5.6% for the PLND group (p > 0.05). DFS among the CLND and PLND groups was 95.4% and 94.4%, and OS among the groups was 100% and 94.1% (p > 0.05) at 5 years. The biochemical cure rates were similar. CONCLUSIONS PLND in the absence of structural disease of the lateral neck preoperatively is not associated with improved survival in patients with sporadic MTC.
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Affiliation(s)
- Weijing Hao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
- Department of Head and Neck Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, 300308, China
| | - Jingzhu Zhao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
| | - Fengli Guo
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, 256603, China
| | - Jinming Zhang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
| | - Pengfei Gu
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
| | - Xianhui Ruan
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
| | - Wei Zhang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China
- Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin, 300121, China
- Tianjin Key Laboratory of General Surgery Inconstruction, Tianjin Union Medical Center, Tianjin, 300121, China
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Chen DW, Lang BHH, McLeod DSA, Newbold K, Haymart MR. Thyroid cancer. Lancet 2023; 401:1531-1544. [PMID: 37023783 DOI: 10.1016/s0140-6736(23)00020-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 04/08/2023]
Abstract
The past 5-10 years have brought in a new era in the care of patients with thyroid cancer, with the introduction of transformative diagnostic and management options. Several international ultrasound-based thyroid nodule risk stratification systems have been developed with the goal of reducing unnecessary biopsies. Less invasive alternatives to surgery for low-risk thyroid cancer, such as active surveillance and minimally invasive interventions, are being explored. New systemic therapies are now available for patients with advanced thyroid cancer. However, in the setting of these advances, disparities exist in the diagnosis and management of thyroid cancer. As new management options are becoming available for thyroid cancer, it is essential to support population-based studies and randomised clinical trials that will inform evidence-based clinical practice guidelines on the management of thyroid cancer, and to include diverse patient populations in research to better understand and subsequently address existing barriers to equitable thyroid cancer care.
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Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian H H Lang
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Donald S A McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kate Newbold
- Thyroid Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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López F, Al Ghuzlan A, Zafereo M, Vander Poorten V, Robbins KT, Hamoir M, Nixon IJ, Tufano RP, Randolph G, Pace-Asciak P, Angelos P, Coca-Pelaz A, Khafif A, Ronen O, Rodrigo JP, Sanabria Á, Palme CE, Mäkitie AA, Kowalski LP, Rinaldo A, Ferlito A. Neck Surgery for Non-Well Differentiated Thyroid Malignancies: Variations in Strategy According to Histopathology. Cancers (Basel) 2023; 15:cancers15041255. [PMID: 36831604 PMCID: PMC9954150 DOI: 10.3390/cancers15041255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer.
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Affiliation(s)
- Fernando López
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
- Correspondence: ; Tel.: +34-985108000
| | - Abir Al Ghuzlan
- Department of Biology and Pathology, Gustave Roussy Cancer Campus, University Paris-Saclay, 91190 Villejuif, France
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery and Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
- European Reference Network for Rare Adult Solid Cancers (EURACAN), 69008 Lyon, France
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62702, USA
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium
| | - Iain J. Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh EH1 3EG, UK
| | - Ralph P. Tufano
- FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, FL 34239, USA
| | - Gregory Randolph
- Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA 02138, USA
| | - Pia Pace-Asciak
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON M5S, Canada
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL 60637, USA
| | - Andrés Coca-Pelaz
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Avi Khafif
- A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv 8410501, Israel
| | - Ohad Ronen
- Department of Otolaryngology—Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
| | - Juan Pablo Rodrigo
- Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, University of Oviedo, CIBERONC, 330011 Oviedo, Spain
| | - Álvaro Sanabria
- Department of Surgery, Universidad de Antioquia, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia
| | - Carsten E. Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health Sciences, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 01246-903, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo 01509-001, Brazil
| | | | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, 35125 Padua, Italy
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9
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Machens A, Lorenz K, Weber F, Dralle H. Superiority of metastatic lymph node ratio over number of node metastases and TNM/AJCC N classification in predicting cancer-specific survival in medullary thyroid cancer. Head Neck 2022; 44:2717-2726. [PMID: 36065717 DOI: 10.1002/hed.27181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In medullary thyroid cancer (MTC), it is unclear which nodal classification system, metastatic lymph node ratio (MLNR), number of node metastases, or TNM/AJCC N classification, predicts cancer-specific survival best. METHODS Kaplan-Maier analysis of cancer-specific survival after operation at a tertiary center. RESULTS Included were 505 MTC patients. The spread of the survival curves was greatest after stratification by MLNR (in 0.20 increments), followed by number of node metastases (in 10-node and 20-node increments) and TNM/AJCC classification (N0, N1a, N1b). After collapsing overlapping survival curves, all adjacent curves (MLNRs ≤0.20 vs. 0.21-0.60 vs. >0.60; 0 vs. 1-20 vs. >20 node metastases; and TNM/AJCC N classification N0/N1a vs. N1b) significantly differed between each other. CONCLUSIONS In MTC, MLNR, reflecting intensity of lymphatic spread, predicts cancer-specific survival better than number of node metastases or TNM/AJCC N classification. The applicability of these findings to patients with limited neck dissection requires more research.
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Affiliation(s)
- Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Henning Dralle
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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10
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Update on the Diagnosis and Management of Medullary Thyroid Cancer: What Has Changed in Recent Years? Cancers (Basel) 2022; 14:cancers14153643. [PMID: 35892901 PMCID: PMC9332800 DOI: 10.3390/cancers14153643] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/10/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) is a neoplasm originating from parafollicular C cells. MTC is a rare disease, but its prognosis is less favorable than that of well-differentiated thyroid cancers. To improve the prognosis of patients with MTC, early diagnosis and prompt therapeutic management are crucial. In the following paper, recent advances in laboratory and imaging diagnostics and also pharmacological and surgical therapies of MTC are discussed. Currently, a thriving direction of development for laboratory diagnostics is immunohistochemistry. The primary imaging modality in the diagnosis of MTC is the ultrasound, but opportunities for development are seen primarily in nuclear medicine techniques. Surgical management is the primary method of treating MTCs. There are numerous publications concerning the stratification of particular lymph node compartments for removal. With the introduction of more effective methods of intraoperative parathyroid identification, the complication rate of surgical treatment may be reduced. The currently used pharmacotherapy is characterized by high toxicity. Moreover, the main limitation of current pharmacotherapy is the development of drug resistance. Currently, there is ongoing research on the use of tyrosine kinase inhibitors (TKIs), highly specific RET inhibitors, radiotherapy and immunotherapy. These new therapies may improve the prognosis of patients with MTCs.
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11
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Walgama E, Busaidy N, Zafereo M. Novel Therapeutics and Treatment Strategies for Medullary Thyroid Cancer. Endocrinol Metab Clin North Am 2022; 51:379-389. [PMID: 35662447 DOI: 10.1016/j.ecl.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medullary thyroid cancer is a rare thyroid malignancy with unique management considerations. In general, small intrathyroidal tumors are cured by total thyroidectomy with central compartment dissection, while large tumors and those with disease spread to regional lymph nodes and distant organs (most commonly lung, liver, and bone) are more difficult to cure. The last decade has seen significant progress in the treatment of advanced MTC, largely due to the discovery and availability of novel targeted therapies, including new drugs specifically targeting the RET protooncogone.
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Affiliation(s)
- Evan Walgama
- Saint John's Cancer Institute & Pacific Neuroscience Institute, Providence Health System, 2125 Arizona Avenue, Santa Monica, CA 90404, USA
| | - Naifa Busaidy
- Department of Endocrine Neoplasia, MD Anderson Cancer Center, 1515 Holcombe Boulevard #853, Houston, TX 77030, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard Unit 1445, Houston, TX 77030, USA.
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12
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Wu F, Zhou T, Lu K, Pan T, Ni Y, Zhao L, Jiang K, Zhang Y, Luo D. Risk factors for lateral cervical lymph node metastasis in medullary thyroid carcinoma. Zhejiang Da Xue Xue Bao Yi Xue Ban 2021; 50:730-740. [PMID: 35347916 PMCID: PMC8931621 DOI: 10.3724/zdxbyxb-2021-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
: To investigate risk factors of lateral cervical lymph node metastasis (LLNM) in patients with medullary thyroid carcinoma (MTC). : Published studies regarding clinicopathological factors of LLNM in MTC were searched in PubMed, Web of Science, Embase, Cochrane library, Wanfang date and CNKI. Statistical analysis was performed using Stata 14.0 software. The mean and standard deviation from the sample size, range, median, and interquartile range was estimated. Odds ratio () or standard mean difference () with 95% confidence interval () of related factors were analyzed by fixed/random-effects models. Egger's test and Begg's test were applied to assess the publication bias of the literature. This study was registered with PROSPERO (CRD42021254955). : Fifteen studies involving 1424 patients were included in the analysis, among whom 543 cases had LLNM (38.13%). Meta-analysis revealed that an increased risk of LLNM was associated with male gender (1.64, 95%: 1.29-2.09, 4.06, 0.01), tumor diameter≥1cm (5.09, 95%: 2.43-10.67, 4.31, 0.01), multifocality (2.55, 95%: 1.79-3.61, 5.22, 0.01), capsule invasion (7.80, 95%: 4.84-12.55, 8.46, 0.01), extracapsular extension (9.46, : 5.66-15.81, 8.58, 0.01), cervical central lymph node metastasis (23.58, : 9.44-58.87, 6.77, 0.01), elevated preoperative calcitonin (1.17,95%: 0.67-1.67, 4.56, 0.01), spiculated margin on ultrasonography (4.32, 95%: 2.43-7.68, 4.99, 0.01), irregular shape on ultrasonography (6.81, : 3.64-12.73, 6.01, 0.01); while age ≥ 45 years (=1.22, 95%: 0.65-2.29, 0.62, >0.05), elevated preoperative carcinoembryonic antigen (0.95, : -0.48-2.38, 1.30, >0.05) and calcification on ultrasonography (1.28, 95%: 0.75-2.18, 0.92, >0.05) were not associated with LLNM. : Male gender, tumor diameter≥multifocality, capsule invasion, extracapsular extension, central lymph node metastasis, elevated preoperative calcitonin, spiculated margin and irregular shape on ultrasonography are risk factors for LLNM in MTC, when these clinical and ultrasonic features are present, lateral neck lymph node dissection is recommended.
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Affiliation(s)
- Fan Wu
- 1. The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Tianhan Zhou
- 1. The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Kaining Lu
- 2. Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ting Pan
- 1. The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yeqin Ni
- 2. Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lingqian Zhao
- 1. The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Kecheng Jiang
- 1. The Fourth Clinical Medicine College, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yu Zhang
- 2. Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Dingcun Luo
- 2. Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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13
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Abstract
PURPOSE OF REVIEW To summarize recent developments in the diagnosis and management of patients with medullary thyroid cancer (MTC), with a focus on pathogenesis, systemic therapy, and future directions. RECENT FINDINGS The addition of mutational analysis to cytological assessment of thyroid nodules has improved the diagnostic accuracy of MTC. The discovery of new genomic alterations and overexpression of certain factors allows for improved prognostication in MTC and provides potentially new therapeutic agents. New data suggest that tumor environment may be more immunogenic than previously thought in a subset of MTCs with identification of a new MTC-specific antigen leading to a revival of investigating immune-based therapy for this disease. The newly approved selective rearranged during transfection (RET0-inhibitors, selpercatinib and pralsetinib, offer promising results, and tolerability for patients with RET-mutated MTC; however, the development of resistance mechanisms may be problematic. SUMMARY MTC has witnessed remarkable advancements in recent years. Our new understanding of some of the driver mutations in MTC allows for therapeutics with more tolerable adverse event profiles. However, there is still a need for more effective treatment strategies for subsets of patients without actionable mutations and for those who develop resistance to currently available therapies.
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Affiliation(s)
- Tania Jaber
- Division of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Vinh D, Zafereo M. Surgical Considerations in Thyroid Cancer: What the Radiologist Needs to Know. Neuroimaging Clin N Am 2021; 31:327-335. [PMID: 34243867 DOI: 10.1016/j.nic.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Management of thyroid cancer requires a multidisciplinary approach including head and neck/endocrine surgeons, endocrinologists, oncologists, and radiologists. The radiographic evaluation of thyroid cancer is critical for complete and precise staging and affects the surgical approach to address these cancers. The purpose of this article is to briefly review the common thyroid cancer pathologies and surgical considerations in thyroid cancer, focusing on the extent of surgery and the influence of preoperative imaging on surgical decision-making. This article assumes that a diagnosis of thyroid cancer has been made and does not discuss the workup or surveillance of thyroid nodules.
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Affiliation(s)
- Daniel Vinh
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Mark Zafereo
- Department of Otolaryngology - Head and Neck Surgery, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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15
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Kim MJ, Back K, Choe JH, Kim JH, Kim JS. Feasibility of lateral sentinel lymph node biopsy in medullary thyroid cancer: A surrogate tool for determining prophylactic lateral neck dissection-A pilot study. Head Neck 2021; 43:3276-3286. [PMID: 34288208 DOI: 10.1002/hed.26808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUNDS This study aimed to evaluate usefulness of lateral sentinel lymph node biopsy (SLNB) in determining lateral neck dissection (LND) of patients with medullary thyroid cancer (MTC). METHODS Sixteen patients with MTC were enrolled in the study from January 2013 to June 2019. Intratumoral injection of technetium (Tc)-99m phytate followed by lymphoscintigraphy was performed preoperatively. Lateral sentinel lymph nodes were detected by a collimated gamma probe and underwent frozen analysis. Ipsilateral LND was performed in all patients to assess lateral LN status. RESULTS The identification rate of sentinel lymph nodes (SLNs) detected by radioisotope was 87.5% (14 of 16 patients). The sensitivity, specificity, positive predictive value, and negative predictive value of frozen analyses were 66.7%, 100%, 100%, and 91.6%, respectively. Based on final histopathology, however, the diagnostic values of lateral SLNB were all 100%. CONCLUSIONS This study showed that lateral SLNB can be a promising surgical tool for decisions on LND in patients with MTC.
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Affiliation(s)
- Min Jhi Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Kyorim Back
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Ho Choe
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jee Soo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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16
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Szabo Yamashita T, Rogers RT, Foster TR, Lyden ML, Morris JC, Thompson GB, McKenzie T, Dy BM. Medullary thyroid cancer: What is the optimal management of the lateral neck in a node negative patient at index operation? Surgery 2021; 171:177-181. [PMID: 34284893 DOI: 10.1016/j.surg.2021.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Medullary thyroid cancer is a neuroendocrine malignancy that can occur sporadically or as the result of genomic rearranged during transfection mutations. Medullary thyroid cancer has a higher rate of metastasis than well-differentiated thyroid cancer. Lateral neck dissection is often performed, and its prophylactic use is controversial. METHODS Single-center, retrospective review (2000-2017) of patients undergoing primary surgical treatment for medullary thyroid cancer who had negative lateral neck imaging preoperatively. Demographics, genetic associations, clinical, and imaging findings were analyzed. Locoregional recurrence, overall recurrence, and overall survival were examined. RESULTS A total of 110 patients were identified, of which 18 underwent prophylactic lateral neck dissection and 92 did not. Age, sex distribution, preoperative calcitonin levels, and follow-up were similar among groups. Overall recurrence was 20% for no prophylactic lateral neck dissection and 39% for prophylactic lateral neck dissection (P = .46). Most recurrences were locoregional recurrence, 7.6% for no prophylactic lateral neck dissection versus 22% for prophylactic lateral neck dissection (P = .08), half of it being to the lateral neck in both groups. A total of 7 patients from the no prophylactic lateral neck dissection group required treatment for recurrences versus 4 patients in prophylactic lateral neck dissection group (P = .57). Overall survival at 5 years was similar, 43% the no prophylactic lateral neck dissection group and 31% for prophylactic lateral neck dissection group (P = .52). CONCLUSION Lateral neck dissection has no effect in decreasing locoregional or overall recurrences in medullary thyroid cancer and has no effect in overall survival when performed prophylactically at index surgical intervention.
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Affiliation(s)
| | | | | | | | | | | | | | - Benzon M Dy
- Department of Surgery, Mayo Clinic, Rochester, MN.
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17
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Ríos A, Mateu G, Torres M, Febrero B, Rodríguez JM. Surgical treatment of recurrent medullary thyroid carcinoma in a hospital with a high incidence of medullary carcinoma associated with MEN syndrome. Cir Esp 2020; 99:245-247. [PMID: 33234233 DOI: 10.1016/j.ciresp.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Antonio Ríos
- Departamento de Cirugía, Pediatría, Obstetricia y Ginecología, Universidad de Murcia, Murcia, España; Unidad de Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, IMIB, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - German Mateu
- Servicio de Cirugía, Hospital del Mar, Barcelona, España
| | - Miquel Torres
- Unidad de Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, IMIB, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Beatriz Febrero
- Unidad de Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, IMIB, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - José Manuel Rodríguez
- Departamento de Cirugía, Pediatría, Obstetricia y Ginecología, Universidad de Murcia, Murcia, España; Unidad de Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, IMIB, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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18
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Jozaghi Y, Zafereo M, Williams MD, Gule-Monroe MK, Wang J, Grubbs EG, Vaporciyan A, Hu MI, Busaidy N, Dadu R, Waguespack SG, Subbiah V, Cabanillas M. Neoadjuvant selpercatinib for advanced medullary thyroid cancer. Head Neck 2020; 43:E7-E12. [PMID: 33169506 PMCID: PMC7756223 DOI: 10.1002/hed.26527] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/22/2020] [Accepted: 10/22/2020] [Indexed: 01/21/2023] Open
Abstract
Background Targeted kinase inhibitors have been increasingly utilized in the treatment of advanced medullary thyroid cancer (MTC) over the last decade. Recently, highly potent next generation selective RET inhibitors have been clinically validated, and selpercatinib was recently Food and Drug Administration (FDA)‐approved for advanced MTC. The advent of highly selective, potent RET inhibitors is broadening the treatment options for patients with RET‐mutated cancers. Methods We report the first published case of neoadjuvant selpercatinib followed by surgery for a patient with initially unresectable, widely metastatic, RET‐mutated MTC who was treated on a single patient protocol. Results After greater than 50% RECIST response, the patient underwent complete surgical resection followed by selpercatinib resumption. He remains locoregionally disease‐free 21 months after starting therapy with stable metastatic disease (after initial partial response); and calcitonin/CEA continue to decline. Conclusion This novel treatment strategy for locoregionally advanced RET‐mutated MTC warrants further study in clinical trials.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Michelle D Williams
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maria K Gule-Monroe
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Wang
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Naifa Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maria Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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19
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Zafereo M, Yu J, Onakoya PA, Aswani J, Baidoo K, Bogale M, Cairncross L, Cordes S, Daniel A, Diom E, Maurice ME, Mohammed GM, Biadgelign MG, Koné FI, Itiere A, Koch W, Konney A, Kundiona I, Macharia C, Mashamba V, Moore MG, Mugabo RM, Noah P, Omutsani M, Orloff LA, Otiti J, Randolph GW, Sebelik M, Todsen T, Twier K, Fagan JJ. African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings. Head Neck 2020; 42:1746-1756. [PMID: 32144948 DOI: 10.1002/hed.26094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/11/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. METHODS Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. RESULTS Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. CONCLUSIONS Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.
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Affiliation(s)
- Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Justin Yu
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Paul A Onakoya
- Department of Otorhinolaryngology, University of Ibadan, Ibadan, Nigeria
| | - Joyce Aswani
- Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Kenneth Baidoo
- Department of Otolaryngology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mesele Bogale
- Department of Surgery, Adama Hospital Medical College, Adama, Ethiopia
| | - Lydia Cairncross
- Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Adekunle Daniel
- Department of Otorhinolaryngology, University of Ibadan, Ibadan, Nigeria
| | - Evelyne Diom
- Department of Otolaryngology, Assane Seck University, Ziguinchor, Senegal
| | - Mpessa E Maurice
- Department of Otolaryngology, University Hospital of Yopougon, Abidjan, Ivory Coast
| | - Garba M Mohammed
- Department of Otolaryngology, Kaduna State University, Kaduna, Nigeria
| | | | - Fatogoma I Koné
- Department of Head and Neck Surgery, Gabriel Touré University Hospital, Bamako, Mali
| | - Arnaud Itiere
- Department of Otorhinolaryngology, General Hospital of Brazzaville, Brazzaville, Congo
| | - Wayne Koch
- Department of ORL/Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Anna Konney
- Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Innocent Kundiona
- Department of Otolaryngology, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Chege Macharia
- Department of General Surgery, AIC Kijabe Hospital, Kenya
| | - Victor Mashamba
- Department of Otorhinolaryngology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Rajab M Mugabo
- Department of Otolaryngology, King Faisal Hospital, Kigali, Rwanda
| | - Patrick Noah
- Department of Surgery, University of Malawi, Zomba, Malawi
| | - Mary Omutsani
- Department of Otolaryngology-Head and Neck Surgery, Kenyatta National Hospital, Nairobi, Kenya
| | - Lisa A Orloff
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey Otiti
- Department of Otolaryngology, Uganda Cancer Institute, Kampala, Uganda
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Merry Sebelik
- Department of Otolaryngology, Head and Neck Surgery, Emory School of Medicine, Atlanta, Georgia
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Khaled Twier
- Department of Otohinolaryngology, University of Cape Town, Cape Town, South Africa
| | - Johannes J Fagan
- Department of Otohinolaryngology, University of Cape Town, Cape Town, South Africa
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Controversies in the surgical management of sporadic medullary thyroid carcinoma. Curr Opin Otolaryngol Head Neck Surg 2020; 28:68-73. [PMID: 32011397 DOI: 10.1097/moo.0000000000000612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Medullary thyroid carcinoma (MTC) represents a wide spectrum of tumours with differing biology, behaviour and natural history. The only current available curative treatment is surgery in the form of thyroidectomy with or without ipsilateral or bilateral neck dissection. There is a lack of consensus in the available published guidelines on the optimum extent of initial surgery, and there is significant variation in clinical practice. This review focuses on the most recently published evidence. RECENT FINDINGS Many patients with limited disease do not receive total thyroidectomy and central neck compartment dissection as recommended by international guidelines. Despite this, 5-year disease-specific survival is over 90% in those without distant metastases at presentation. Over 20% of patients may harbour occult lateral compartment nodal metastases, and baseline calcitonin alone (>1000 pg/ml) is not a good predictor of nodal metastasis. Although delayed lateral neck compartment dissection results in similar survival outcomes to prophylactic neck dissection for clinically node-negative patients, there is an underappreciated psychological effect of having biochemical evidence of persistent disease following limited surgery. SUMMARY No single currently available prognostic indicator is sufficient to predict disease behaviour and evidence of occult nodal metastases. In clinically ad radiologically node-negative patients, the extent of neck dissection at initial operation, therefore, needs to be planned and executed on an individual patient basis.
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21
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Abstract
The incidence of thyroid cancer is increasing, largely attributable to overdetection related to prevalent diagnostic and radiologic imaging modalities. Papillary thyroid cancer remains the most common thyroid malignancy. It has a high tendency for regional metastasis to the cervical lymph nodes. The optimal management of the neck in patients with thyroid carcinoma has long been an important topic of debate. This article addresses central and lateral neck dissection, providing a simplified guide to the most up-to-date and evidence-based practices.
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Affiliation(s)
- Ahmad M Eltelety
- Endocrine Head and Neck Surgery, Otolaryngology Department, Medical College of Georgia, Augusta University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA; Otolaryngology Department, Cairo University, ElManial, Cairo 11562, Arab Republic of Egypt
| | - David J Terris
- Otolaryngology Department, Augusta University, Thyroid and Parathyroid Center, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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22
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Fan W, Xiao C, Wu F. Analysis of risk factors for cervical lymph node metastases in patients with sporadic medullary thyroid carcinoma. J Int Med Res 2018; 46:1982-1989. [PMID: 29569965 PMCID: PMC5991226 DOI: 10.1177/0300060518762684] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Medullary thyroid carcinoma (MTC) is classified as either sporadic or inherited. This study was performed to analyze the risk factors for cervical lymph node metastases and predict the indication for prophylactic lateral neck dissection in patients with sporadic MTC. Methods Sixty-five patients with sporadic MTC were retrospectively reviewed. Univariate analysis with the chi-square test and multiple logistic regression analysis were applied to identify the clinicopathological features (sex, age, tumor size, number of tumor foci, capsule or vascular invasion, and others) associated with cervical lymph node metastases. Results The metastasis rates in the central and lateral compartments were 46.2% (30/65) and 40.0% (26/65), respectively. The incidence of cervical lymph node metastases was significantly higher in patients with a tumor size of >1 cm, tumor multifocality, and thyroid capsule invasion. Only thyroid capsule invasion was an independent predictive factor for central compartment metastases and lateral neck metastases. The possibility of central compartment metastases was significantly higher when the preoperative serum carcinoembryonic antigen concentration was >30 ng/mL (60.0% vs. 34.3%). Conclusions MTC is associated with a high incidence of cervical lymph node metastases. Prophylactic lateral node dissection is necessary in patients with thyroid capsule invasion or a high serum carcinoembryonic antigen concentration.
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Affiliation(s)
- Weina Fan
- 1 Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cheng Xiao
- 2 Department of Medical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fusheng Wu
- 1 Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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