Can We Predict the Lateral Compartment Lymph Node Involvement in RET-Negative Patients with Medullary Thyroid Carcinoma?

• Published in: Annals of surgical oncology Vol. 23; no. 11; pp. 3653 - 3659
• Main Authors: Chandeze, Marie-Maelle, Noullet, Severine, Faron, Matthieu, Trésallet, Christophe, Godiris-Petit, Gaelle, Tissier, Frederique, Buffet, Camille, Leenhardt, Laurence, Chereau, Nathalie, Menegaux, Fabrice
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2016; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Calcitonin - blood; Carcinoma, Medullary - genetics; Carcinoma, Medullary - secondary; Carcinoma, Medullary - surgery; Disease-Free Survival; Endocrine Tumors; Female; Humans; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neck; Neck Dissection; Oncology; Proto-Oncogene Proteins c-ret - genetics; Risk Factors; Sex Factors; Surgery; Surgical Oncology; Thyroid Neoplasms - genetics; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy; Tumor Burden; Lymph Node Dissection; Medullary Thyroid Carcinoma; Lymph Node Metastasis; Total Thyroidectomy; Lymph Node Ratio
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5292-2

Background Lateral lymph node dissection (LND) in the absence of macroscopic nodal metastasis remains controversial in sporadic medullary thyroid carcinoma (MTC). Objectives The aims of our study were to determine the risk of lateral lymph node (LN) metastases with a focus on lateral contralateral N1, and to define a risk-adapted surgical treatment for these patients. Methods All patients who underwent surgery from 1980 to 2012 for previously untreated RET-negative MTC were reviewed. We focused on the lateral compartments of LN metastases and identified three groups: no lateral LN metastases, ipsilateral lateral (ILL)–LN metastases with no contralateral LN involvement, and contralateral lateral (CLL)–LN metastases. Results Overall, 131 patients underwent surgery for RET-negative MTC. A total thyroidectomy with LND was performed in 112 patients (85 %), including 97 patients who had an ILL–LND and 92 patients who had a CLL–LND. Lateral LN metastases (N1) occurred in 40 patients (37 %): 31 patients (32 %) had ILL–LN metastases with no contralateral LN involvement, and 9 patients (10 %) had CLL–LN metastases. The preoperative cut-offs for LN metastases in the ILL compartment were very low, with a smallest tumor size of 5 mm, and lowest serum calcitonin level of 38 pg/ml. Disease-free survival rates decreased from 92 % for patients with no lateral LN metastases to 41 % for patients with ILL–LN metastases and 0 % for patients with CLL–LN metastases. Conclusions ILL–LND should be performed in every patient and only a minority of MTC patients with small micro-MTC, and low serum calcitonin levels should not have a CLL–LND.