Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Department of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Head Neck. 2024 Nov;46(11):2843-2852. doi: 10.1002/hed.27827. Epub 2024 Jun 8.
Conceptually, thyroid tumor desmoplasia may be better suited for excluding node metastases in sporadic MTC than preoperative serum calcitonin levels.
This analysis included 181 patients with unilateral sporadic MTC graded on the 7-grade desmoplasia scale after thyroidectomy and neck dissection.
When thyroid tumor desmoplasia reached 1% and ≥50%, node metastases increased from 0% to 7% (median of 0 metastases) and 83% (median of 7.5 metastases), microscopic lymphatic invasion from 0% to 3% and 35%, extrathyroid extension from 0% to 5% and 22%, and extranodal growth from 0% to 0% and 44%, whereas biochemical cure declined from 100% to 95% and 25%. Thyroid tumor diameters and basal calcitonin overlapped widely among the seven desmoplasia groups, precluding differentiation by thyroid tumor size or serum calcitonin levels.
Thyroid tumor desmoplasia, unlike serum calcitonin levels, discriminates extremely well between node-negative and node-positive sporadic MTC, opening new avenues for precision surgery.
从概念上讲，甲状腺肿瘤纤维组织增生可能比术前降钙素水平更适合排除散发性 MTC 中的淋巴结转移。
本分析纳入了 181 例接受甲状腺切除术和颈部淋巴结清扫术的单侧散发性 MTC 患者，按 7 级纤维组织增生分级。
当甲状腺肿瘤纤维组织增生达到 1%和≥50%时，淋巴结转移从 0%增加到 7%（中位数为 0 个转移）和 83%（中位数为 7.5 个转移），镜下淋巴侵犯从 0%增加到 3%和 35%，甲状腺外侵犯从 0%增加到 5%和 22%，淋巴结外侵犯从 0%增加到 0%和 44%，而生化治愈从 100%下降到 95%和 25%。甲状腺肿瘤直径和基础降钙素在七个纤维组织增生组中广泛重叠，排除了通过甲状腺肿瘤大小或血清降钙素水平进行区分的可能性。
与血清降钙素水平不同，甲状腺肿瘤纤维组织增生可以极好地区分淋巴结阴性和阳性的散发性 MTC，为精准手术开辟了新途径。
