ArticleAnnals of surgical oncology2025
Tailored Surgery for Medullary Thyroid Cancer (MTC) Based on Pretherapeutic Basal Calcitonin and Intraoperative Diagnosis of Desmoplastic Stroma Reaction: A Proposal for a New Surgical Concept.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Covalent FAPI Imaging-Guided Precision Surgery in Patients with Medullary Thyroid Carcinoma: A Phase II Clinical Trial.Clinical cancer research : an official journal of the American Association for Cancer Research · 2026Trial
- The Management of Medullary Thyroid Cancer: A Review.Annals of surgical oncology · 2026Review
- Individualized survival prediction in medullary thyroid carcinoma using a least absolute shrinkage and selection operator-Cox-based nomogram.The Journal of international medical research · 2026Article
- Current Evidence, Selective Indications, and the Role of Lymph-Node Assessment in Intraoperative Frozen Section in Thyroid Cancer Surgery: A Literature Review.Journal of clinical medicine · 2026Review
- ASO Author Reflections: Combining Two Easily Available Parameters Can Help to Individualize Lymph Node Surgery in Medullary Thyroid Cancer (MTC) Without Compromising Cure Rates.Annals of surgical oncology · 2025Article
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Abstract
backgroundPretherapeutic sex-specific basal calcitonin (bCt) cutoff levels and intraoperative diagnosis of desmoplastic stroma reaction (DSR) by frozen section independently facilitate the prediction of lymph-node metastases (LNM) and long-term outcomes in patients with medullary thyroid cancer (MTC). The relevance of combining these two parameters to "tailor" lymph-node (LN) surgery has thus far not been analyzed. PATIENTS AND
methodsThis single-center analysis included 306 patients covered by a calcitonin screening program. A uniform surgical protocol [thyroidectomy, bilateral central neck dissection (CND), lateral neck dissection (LND)] was applied. Risk groups were subdivided on the basis of predefined bCt cutoffs ("minimal risk," "low risk," and "high risk"), and the intraoperative classification of DSR was correlated with LN involvement in each patient. Biochemical long-term outcomes (mean follow-up: 8.3 years) were documented with the endpoints "disease-free," "persistent," or "recurrent" disease.
resultsPatients in the "minimal risk" group (37.6%) and "low risk" group (16.3%) showed central but never lateral LNM in 2.6% and 6.0% of patients, respectively (cure rate: 98.2%). In the "high risk" group (46.1%), LNM (central and/or lateral) were found in 51.1% of the patients (cure rate: 60.9%). In all risk groups, DSR negativity (overall 20.6%) confirmed absence of LNM (cure rate:100%).
conclusionsThe analysis facilitates the recommendation to individualize the extent of LND combining pretherapeutic bCt and the presence of DSR. Independent of bCt levels (risk groups), LND can be avoided following thyroidectomy in patients with DSR-negative tumors. Patients with DSR-positive tumors should undergo thyroidectomy and bilateral CND. In addition, in "high risk" patients, unilateral LND is recommended in those with bCt < 350 pg/mL. Bilateral LND should be discussed in patients with M0 status and bCt > 350 pg/mL.
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