Lorenz K, Machens A, Siebolts U, Dralle H
Klinik für Viszeral‑, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Martin-Luther Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle an der Saale, Deutschland.
Institut für Pathologie, Universitätsklinikum Halle, Martin-Luther Universität Halle-Wittenberg, Halle an der Saale, Deutschland.
Chirurg. 2020 Dec;91(12):1017-1024. doi: 10.1007/s00104-020-01274-9.
Improvements in preoperative diagnostic modalities in conjunction with highly sensitive calcitonin assays, ultrasound and functional imaging modalities and differentiated genetic testing for detection of hereditary forms, have enabled detection and resection of medullary thyroid carcinoma at an increasingly earlier stage. These developments open up possibilities to deescalate primary surgery adapted to these stages and avoid surgical overtreatment in locally limited tumor growth: thus, promoting a shift from routinely recommended total thyroidectomy with bilateral central lymph node dissection in favor of limited unilateral thyroid resection. Prerequisites for limited thyroid resection include clinical evidence that the tumor is sporadic, unifocal and confined to the thyroid. Corresponding calcitonin levels should also indicate that a biochemical cure will be achieved after unilateral resection. A decisive structural prerequisite for such a limited concept is the low threshold availability of intraoperative frozen section analysis that reliably detects and evaluates a medullary thyroid carcinoma and can assess a breach of the thyroid capsule and desmoplasia with certainty.
术前诊断方式的改进，结合高敏降钙素检测、超声和功能成像方式以及用于检测遗传性形式的差异化基因检测，已能够在越来越早的阶段检测和切除甲状腺髓样癌。这些进展为根据这些阶段调整初次手术范围、避免对局部局限肿瘤生长进行过度手术开辟了可能性：因此，推动了从常规推荐的全甲状腺切除加双侧中央淋巴结清扫向有限的单侧甲状腺切除的转变。有限甲状腺切除的前提条件包括临床证据表明肿瘤是散发性、单灶性且局限于甲状腺。相应的降钙素水平也应表明单侧切除后将实现生化治愈。这种有限概念的决定性结构前提是术中冰冻切片分析的低阈值可用性，它能可靠地检测和评估甲状腺髓样癌，并能确定评估甲状腺包膜破裂和纤维组织增生。
