Surgical Strategy for the Treatment of Medullary Thyroid Carcinoma

Fleming, Jason B.; Lee, Jeffrey E.; Bouvet, Michael; Schultz, Pamela N.; Sherman, Steven I.; Sellin, Rena V.; Friend, Keith; Burgess, Michael A.; Cote, Gilbert J.; Gagel, Robert F.; Evans, Douglas B.

doi:10.1097/00000658-199911000-00013

Cited by 139 publications

(93 citation statements)

References 20 publications

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“…Indeed, patients with a solitary isthmic nodule accounted for 6.4% of the whole NTD population recruited in the study. The female to male ratio of w4 to 1 is similar to that found in previous NTD prevalence studies (29). Nonetheless, the mean and median age of our patient group -46.2 years and 49 years respectively -averages that reported in other NTD series (29).…”

Section: The Thyroid Isthmus and Nonparafollicular C Cell-derived Tumorssupporting

confidence: 90%

Nodular disease and parafollicular C-cell distribution: results from a prospective and retrospective clinico-pathological study on the thyroid isthmus

Papi¹,

Rossi²,

Corsello³

et al. 2010

European Journal of Endocrinology

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Objective: The isthmus represents a peculiar, as yet partially unexplored, thyroid gland area. Aim of the study: To assess i) the prevalence and clinico-pathological features of solitary thyroid isthmic nodules (STIN); ii) the frequency of medullary thyroid carcinoma (MTC) arising from the isthmus; and iii) the C-cell distribution in the isthmus of patients with MTC and benign nodular thyroid disease (NTD). Subjects and methods: Patients referred from 2006 to 2008 for STIN were prospectively recruited, and underwent serum calcitonin (C t ) measurement and fine needle aspiration cytology (FNAC). MTCs diagnosed from 1993 to 2005 were retrospectively searched. Immunohistochemistry was performed using anti-C t antibodies on lateral lobes and isthmi of 50 benign NTD and 50 MTC cases. Results: From 1993 to 2005, 150 patients underwent surgery for MTC. All patients had the neoplasm located in lateral thyroid lobes, none in the isthmus. In the 3 years following, 192 STIN patients (40 (21%) males, 152 (79%) females; mean age: 46.2G7.1 years; 6.4% of NTD subjects) were recruited. All had normal C t concentrations. FNAC was malignant or suspicious for malignancy in 14 (7.3%) patients. Histology found malignancy in 17 (9%) cases, MTC in none. C cells were disclosed in lateral thyroid lobes of 100% MTC and 77% benign NTD patients; isthmi were free of C cells in either group. Conclusions: STINs are significantly less likely to be MTC in patients presenting with sporadic disease. Therefore, C t screening is not warranted in these subjects. Nonetheless, STINs are more likely to be neoplastic and deserve equal attention as those of the lateral lobes.

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Section: The Thyroid Isthmus and Nonparafollicular C Cell-derived Tumorssupporting

confidence: 90%

Nodular disease and parafollicular C-cell distribution: results from a prospective and retrospective clinico-pathological study on the thyroid isthmus

Papi¹,

Rossi²,

Corsello³

et al. 2010

European Journal of Endocrinology

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“…Measurement of serum CT levels in nodular thyroid diseases is not unanimously considered a routine procedure. Surgery is the most effective treatment for these tumors (4,5).…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of 140 cases of medullary thyroid carcinoma followed-up in a single institution

et al. 2016

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Abstract. Familial cases of medullary thyroid carcinoma (MTC) may be diagnosed by genetic screening, while in sporadic tumors the diagnosis relies mainly on fine-needle aspiration cytology. The aim of the present study was to determine the demographic, clinical and pathological characteristics of MTC patients followed-up at the Portuguese Institute of Oncology Francisco Gentil (Lisbon, Portugal). For that purpose, a retrospective analysis of 140 MTC patients diagnosed between 1990 and 2010 was performed. The results indicated that patients with hereditary MTC (11.4%) were significantly younger than patients with sporadic MTC. Of the latter, 34.3% had no clinical suspicion of MTC prior to surgery. The sensitivity of cytology and calcitonin (CT) assay in diagnosing MTC were 51.3 and 98.7%, respectively. All familial index cases and 69.0% of sporadic cases presented with advanced stage disease at the time of diagnosis, while 73.0% of familial MTC detected by genetic/pentagastrin screening were diagnosed at the early stage of the disease. Biochemical cure (BC) was achieved in 39.7% of patients and, of these, only 6.5% relapsed. The 5 and 10-year survival rates were 79.3 and 73.6%, respectively. Age >45 years (P=0.026), advanced stage at diagnosis (P<0.001) and absence of BC (P<0.001) were predictors of a worse prognosis on univariate analysis. However, when the patients detected by genetic/pentagastrin screening were excluded from the analysis, age was no longer a prognostic factor, although disease stage remained a significant prognostic factor. On multivariate analysis, BC was the only factor with a significant impact on prognosis (P= 0.031). In addition, the present study confirmed that the majority of patients were diagnosed at advanced stages, and CT determination was observed to be more sensitive than cytology to diagnose MTC. Patients at early stages were more prone to achieve BC, which was a favorable prognostic factor. To the best of our knowledge, the present study reports for the first time that age at diagnosis is not a predictor of survival for patients with MTC when cases diagnosed by genetic/pentagastrin screening (who are usually young patients at the initial stages of the disease), are excluded from the analysis.

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“…Despite the promising efforts in diagnosis and therapy of medullary carcinoma, only 35-49% 6,8 of the patients with clinically evident MTC are biochemically cured. The most probable explanation for the insufficient low cure rates of MTC is an early lymphogenic and hematogenic tumor spread of cancer cells, not detectable by current staging methods.…”

Section: Discussionmentioning

confidence: 99%

Detection of hematogenic and lymphogenic tumor cell dissemination in patients with medullary thyroid carcinoma by cytokeratin 20 and preprogastrin‐releasing peptide RT‐PCR

Weber

Lacroix

Wörner

et al. 2002

Intl Journal of Cancer

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Surgical Strategy for the Treatment of Medullary Thyroid Carcinoma

Cited by 139 publications

References 20 publications

Nodular disease and parafollicular C-cell distribution: results from a prospective and retrospective clinico-pathological study on the thyroid isthmus

Nodular disease and parafollicular C-cell distribution: results from a prospective and retrospective clinico-pathological study on the thyroid isthmus

Retrospective analysis of 140 cases of medullary thyroid carcinoma followed-up in a single institution

Detection of hematogenic and lymphogenic tumor cell dissemination in patients with medullary thyroid carcinoma by cytokeratin 20 and preprogastrin‐releasing peptide RT‐PCR

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