Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun City, China.
Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.
Front Endocrinol (Lausanne). 2022 Jul 11;13:875875. doi: 10.3389/fendo.2022.875875. eCollection 2022.
Optimized preoperative diagnostic tools with calcitonin tests, ultrasound features, functional imaging modalities, and genetic testing to detect hereditary forms have led to an increased rate of earlier diagnosis and surgery for medullary thyroid cancer (MTC). This helps to adapt the primary surgery to the tumor stage and avoid surgical overtreatment for localized tumor growth, i.e., deviating from the regularly recommended thyroidectomy with bilateral central lymph node dissection in favor of a limited unilateral approach. To limit primary surgical therapy, it is crucial that the MTC is clinically unifocal, sporadic, and confined to the thyroid, and that calcitonin levels indicate biochemical recovery after surgery. The main requirement for such a limited approach is the availability of frozen section studies that reliably indicate (i) R0 resection of the MTC, (ii) absence of infiltration of the organ capsule, (iii) lack of desmoplasia (i.e., evidence of the metastatic potential of the MTC), (iiii) absence of contralateral disease or precancerous lesions. Informed consent is mandatory from the patient, who has been fully informed of the advantages, disadvantages, and potential risks of not undergoing the "classic" surgical procedure. The aim of this article is to review the guidelines for the management of early-stage MTC.
优化的术前诊断工具，包括降钙素检测、超声特征、功能成像方式和基因检测，用于检测遗传性形式，已导致甲状腺髓样癌（MTC）的早期诊断和手术率增加。这有助于使主要手术适应肿瘤分期，并避免对局限性肿瘤生长进行过度手术治疗，即避免常规推荐的甲状腺全切除术和双侧中央淋巴结清扫术，而倾向于采用局限性单侧手术。为了限制原发性手术治疗，MTC 在临床上必须是单灶性、散发性的，局限于甲状腺，且降钙素水平表明手术后生化恢复。这种局限性手术方法的主要要求是提供可靠指示（i）MTC 的 R0 切除，（ii）器官包膜无浸润，（iii）无纤维组织增生（即 MTC 的转移潜能的证据），（iiii）对侧无疾病或癌前病变的冷冻切片研究。患者必须知情同意，并充分了解不接受“经典”手术程序的优点、缺点和潜在风险。本文的目的是回顾早期 MTC 的管理指南。
