Multifocality in Sporadic Medullary Thyroid Carcinoma: An International Multicenter Study
Background: Current surgical standard of care in sporadic medullary thyroid carcinoma (sMTC) consists of a minimum of total thyroidectomy with central neck dissection. Some have suggested thyroid lobectomy with isthmusectomy and central neck dissection for patients with sMTC, given their lower frequ...
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| creator | Essig, Garth F. Porter, Kyle Schneider, David Arpaia, Debora Lindsey, Susan C. Busonero, Giulia Fineberg, Daniel Fruci, Barbara Boelaert, Kristien Smit, Johannes W. Meijer, Johannes Arnoldus Anthonius Duntas, Leonidas H. Sharma, Neil Costante, Giuseppe Filetti, Sebastiano Sippel, Rebecca S. Biondi, Bernadette Topliss, Duncan J. Pacini, Furio Maciel, Rui M.B. Walz, Patrick C. Kloos, Richard T. |
| description | Background:
Current surgical standard of care in sporadic medullary thyroid carcinoma (sMTC) consists of a minimum of total thyroidectomy with central neck dissection. Some have suggested thyroid lobectomy with isthmusectomy and central neck dissection for patients with sMTC, given their lower frequency of bilateral disease, although this topic has not been thoroughly studied. This study assessed the prevalence of multifocality in sMTC via a large international multi-institutional retrospective review to quantify this prevalence, including the impact of geography, to assess more accurately the risks associated with alternative surgical approaches.
Methods:
A retrospective chart review of sMTC patients from 11 institutions over 29 years (1983–2011) was undertaken. Data regarding focality, extent of disease,
RET
germline analysis plus family and clinical history for multiple endocrine neoplasia type 2 (MEN2), and demographic data were collected and analyzed.
Results:
Patients from four continents and seven countries were included in the sample. Data for 313 patients with documented sMTC were collected. Of these, 81.2% were confirmed with negative
RET
germline testing, while the remaining 18.8% demonstrated a negative family history and no manifestations of MEN2 syndromes other than MTC. Bilateral disease was identified in 17/306 (5.6%) patients, while multifocal disease was noted in 50/312 (16.0%) sMTC patients. When only accounting for germline negative patients, these rates were not significantly different (5.6% and 17%, respectively). Among them, when disease was unifocal in the ipsilateral lobe and isthmus, bilateral disease was present in 6/212 (2.8%) cases. When disease was multifocal in the ipsilateral lobe or isthmus, then bilateral disease was present in 8/37 (21.6%) cases (
p
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| doi_str_mv | 10.1089/thy.2016.0255 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6453487</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1834995606</sourcerecordid><originalsourceid>FETCH-LOGICAL-c501t-581b4e7ad0874154738707ff67ff8ab0cf23a758ff7822e8c8c8dc0502e375383</originalsourceid><addsrcrecordid>eNqFkc1PwyAYxonROJ0evRqOXjr5KIV6MDGLH0s0HpwHT4RR6jAdTEpN-t9L3TR6MoRAXn55eN73AeAEowlGojyPy35CEC4miDC2Aw4wYzwrEee76Y4YyjhhxQgctu0bSpjgdB-MCC9QXublAXh56Jpoa69VY2MPrYNPax9UZTV8MFXXNCr0cL7sg7cVnKqgrfMrdQGvHJy5aIJT0XqnGvilo81Qg0-xq_ojsFerpjXH23MMnm-u59O77P7xdja9us80QzhmTOBFbriqkOA5ZjmngiNe10XaQi2QrglVnIm65oIQI3RalU6NEUM5o4KOweVGd90tVqYaLATVyHWwq-RdemXl3xdnl_LVf8giZzRP8xiDs61A8O-daaNc2Vab1LozvmslFjQvS1agIqHZBtXBt20w9c83GMkhDpnikEMccogj8ae_vf3Q3_NPAN0AQ1k511izMCH-I_sJnl2ZUA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1834995606</pqid></control><display><type>article</type><title>Multifocality in Sporadic Medullary Thyroid Carcinoma: An International Multicenter Study</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Essig, Garth F. ; Porter, Kyle ; Schneider, David ; Arpaia, Debora ; Lindsey, Susan C. ; Busonero, Giulia ; Fineberg, Daniel ; Fruci, Barbara ; Boelaert, Kristien ; Smit, Johannes W. ; Meijer, Johannes Arnoldus Anthonius ; Duntas, Leonidas H. ; Sharma, Neil ; Costante, Giuseppe ; Filetti, Sebastiano ; Sippel, Rebecca S. ; Biondi, Bernadette ; Topliss, Duncan J. ; Pacini, Furio ; Maciel, Rui M.B. ; Walz, Patrick C. ; Kloos, Richard T.</creator><creatorcontrib>Essig, Garth F. ; Porter, Kyle ; Schneider, David ; Arpaia, Debora ; Lindsey, Susan C. ; Busonero, Giulia ; Fineberg, Daniel ; Fruci, Barbara ; Boelaert, Kristien ; Smit, Johannes W. ; Meijer, Johannes Arnoldus Anthonius ; Duntas, Leonidas H. ; Sharma, Neil ; Costante, Giuseppe ; Filetti, Sebastiano ; Sippel, Rebecca S. ; Biondi, Bernadette ; Topliss, Duncan J. ; Pacini, Furio ; Maciel, Rui M.B. ; Walz, Patrick C. ; Kloos, Richard T.</creatorcontrib><description>Background:
Current surgical standard of care in sporadic medullary thyroid carcinoma (sMTC) consists of a minimum of total thyroidectomy with central neck dissection. Some have suggested thyroid lobectomy with isthmusectomy and central neck dissection for patients with sMTC, given their lower frequency of bilateral disease, although this topic has not been thoroughly studied. This study assessed the prevalence of multifocality in sMTC via a large international multi-institutional retrospective review to quantify this prevalence, including the impact of geography, to assess more accurately the risks associated with alternative surgical approaches.
Methods:
A retrospective chart review of sMTC patients from 11 institutions over 29 years (1983–2011) was undertaken. Data regarding focality, extent of disease,
RET
germline analysis plus family and clinical history for multiple endocrine neoplasia type 2 (MEN2), and demographic data were collected and analyzed.
Results:
Patients from four continents and seven countries were included in the sample. Data for 313 patients with documented sMTC were collected. Of these, 81.2% were confirmed with negative
RET
germline testing, while the remaining 18.8% demonstrated a negative family history and no manifestations of MEN2 syndromes other than MTC. Bilateral disease was identified in 17/306 (5.6%) patients, while multifocal disease was noted in 50/312 (16.0%) sMTC patients. When only accounting for germline negative patients, these rates were not significantly different (5.6% and 17%, respectively). Among them, when disease was unifocal in the ipsilateral lobe and isthmus, bilateral disease was present in 6/212 (2.8%) cases. When disease was multifocal in the ipsilateral lobe or isthmus, then bilateral disease was present in 8/37 (21.6%) cases (
p
< 0.001). No geographic differences in focality were identified.
Conclusions:
The 5.6% prevalence of bilateral foci in sMTC suggests that total thyroidectomy should remain the standard of care for initial surgery, as less complete thyroid surgery may fail to address fully the primary site of disease. Whether ipsilateral tumor focality should be an independent factor determining the need for completion thyroidectomy when sMTC is diagnosed after hemithyroidectomy remains to be determined.</description><identifier>ISSN: 1050-7256</identifier><identifier>EISSN: 1557-9077</identifier><identifier>DOI: 10.1089/thy.2016.0255</identifier><identifier>PMID: 27604949</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Medullary - epidemiology ; Carcinoma, Medullary - pathology ; Carcinoma, Medullary - prevention & control ; Carcinoma, Medullary - surgery ; Carcinoma, Neuroendocrine - epidemiology ; Carcinoma, Neuroendocrine - pathology ; Carcinoma, Neuroendocrine - prevention & control ; Carcinoma, Neuroendocrine - surgery ; Cohort Studies ; Humans ; Middle Aged ; Neoplasm Recurrence, Local - epidemiology ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - prevention & control ; Neoplasm Staging ; Practice Guidelines as Topic ; Prevalence ; Retrospective Studies ; Thyroid Cancer and Nodules ; Thyroid Gland - pathology ; Thyroid Gland - surgery ; Thyroid Neoplasms - epidemiology ; Thyroid Neoplasms - pathology ; Thyroid Neoplasms - prevention & control ; Thyroid Neoplasms - surgery ; Thyroidectomy - adverse effects ; Tumor Burden ; Young Adult</subject><ispartof>Thyroid (New York, N.Y.), 2016-11, Vol.26 (11), p.1563-1572</ispartof><rights>2016, Mary Ann Liebert, Inc.</rights><rights>Copyright 2016, Mary Ann Liebert, Inc. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c501t-581b4e7ad0874154738707ff67ff8ab0cf23a758ff7822e8c8c8dc0502e375383</citedby><cites>FETCH-LOGICAL-c501t-581b4e7ad0874154738707ff67ff8ab0cf23a758ff7822e8c8c8dc0502e375383</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27604949$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Essig, Garth F.</creatorcontrib><creatorcontrib>Porter, Kyle</creatorcontrib><creatorcontrib>Schneider, David</creatorcontrib><creatorcontrib>Arpaia, Debora</creatorcontrib><creatorcontrib>Lindsey, Susan C.</creatorcontrib><creatorcontrib>Busonero, Giulia</creatorcontrib><creatorcontrib>Fineberg, Daniel</creatorcontrib><creatorcontrib>Fruci, Barbara</creatorcontrib><creatorcontrib>Boelaert, Kristien</creatorcontrib><creatorcontrib>Smit, Johannes W.</creatorcontrib><creatorcontrib>Meijer, Johannes Arnoldus Anthonius</creatorcontrib><creatorcontrib>Duntas, Leonidas H.</creatorcontrib><creatorcontrib>Sharma, Neil</creatorcontrib><creatorcontrib>Costante, Giuseppe</creatorcontrib><creatorcontrib>Filetti, Sebastiano</creatorcontrib><creatorcontrib>Sippel, Rebecca S.</creatorcontrib><creatorcontrib>Biondi, Bernadette</creatorcontrib><creatorcontrib>Topliss, Duncan J.</creatorcontrib><creatorcontrib>Pacini, Furio</creatorcontrib><creatorcontrib>Maciel, Rui M.B.</creatorcontrib><creatorcontrib>Walz, Patrick C.</creatorcontrib><creatorcontrib>Kloos, Richard T.</creatorcontrib><title>Multifocality in Sporadic Medullary Thyroid Carcinoma: An International Multicenter Study</title><title>Thyroid (New York, N.Y.)</title><addtitle>Thyroid</addtitle><description>Background:
Current surgical standard of care in sporadic medullary thyroid carcinoma (sMTC) consists of a minimum of total thyroidectomy with central neck dissection. Some have suggested thyroid lobectomy with isthmusectomy and central neck dissection for patients with sMTC, given their lower frequency of bilateral disease, although this topic has not been thoroughly studied. This study assessed the prevalence of multifocality in sMTC via a large international multi-institutional retrospective review to quantify this prevalence, including the impact of geography, to assess more accurately the risks associated with alternative surgical approaches.
Methods:
A retrospective chart review of sMTC patients from 11 institutions over 29 years (1983–2011) was undertaken. Data regarding focality, extent of disease,
RET
germline analysis plus family and clinical history for multiple endocrine neoplasia type 2 (MEN2), and demographic data were collected and analyzed.
Results:
Patients from four continents and seven countries were included in the sample. Data for 313 patients with documented sMTC were collected. Of these, 81.2% were confirmed with negative
RET
germline testing, while the remaining 18.8% demonstrated a negative family history and no manifestations of MEN2 syndromes other than MTC. Bilateral disease was identified in 17/306 (5.6%) patients, while multifocal disease was noted in 50/312 (16.0%) sMTC patients. When only accounting for germline negative patients, these rates were not significantly different (5.6% and 17%, respectively). Among them, when disease was unifocal in the ipsilateral lobe and isthmus, bilateral disease was present in 6/212 (2.8%) cases. When disease was multifocal in the ipsilateral lobe or isthmus, then bilateral disease was present in 8/37 (21.6%) cases (
p
< 0.001). No geographic differences in focality were identified.
Conclusions:
The 5.6% prevalence of bilateral foci in sMTC suggests that total thyroidectomy should remain the standard of care for initial surgery, as less complete thyroid surgery may fail to address fully the primary site of disease. Whether ipsilateral tumor focality should be an independent factor determining the need for completion thyroidectomy when sMTC is diagnosed after hemithyroidectomy remains to be determined.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biopsy</subject><subject>Carcinoma, Medullary - epidemiology</subject><subject>Carcinoma, Medullary - pathology</subject><subject>Carcinoma, Medullary - prevention & control</subject><subject>Carcinoma, Medullary - surgery</subject><subject>Carcinoma, Neuroendocrine - epidemiology</subject><subject>Carcinoma, Neuroendocrine - pathology</subject><subject>Carcinoma, Neuroendocrine - prevention & control</subject><subject>Carcinoma, Neuroendocrine - surgery</subject><subject>Cohort Studies</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - prevention & control</subject><subject>Neoplasm Staging</subject><subject>Practice Guidelines as Topic</subject><subject>Prevalence</subject><subject>Retrospective Studies</subject><subject>Thyroid Cancer and Nodules</subject><subject>Thyroid Gland - pathology</subject><subject>Thyroid Gland - surgery</subject><subject>Thyroid Neoplasms - epidemiology</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Neoplasms - prevention & control</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Thyroidectomy - adverse effects</subject><subject>Tumor Burden</subject><subject>Young Adult</subject><issn>1050-7256</issn><issn>1557-9077</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1PwyAYxonROJ0evRqOXjr5KIV6MDGLH0s0HpwHT4RR6jAdTEpN-t9L3TR6MoRAXn55eN73AeAEowlGojyPy35CEC4miDC2Aw4wYzwrEee76Y4YyjhhxQgctu0bSpjgdB-MCC9QXublAXh56Jpoa69VY2MPrYNPax9UZTV8MFXXNCr0cL7sg7cVnKqgrfMrdQGvHJy5aIJT0XqnGvilo81Qg0-xq_ojsFerpjXH23MMnm-u59O77P7xdja9us80QzhmTOBFbriqkOA5ZjmngiNe10XaQi2QrglVnIm65oIQI3RalU6NEUM5o4KOweVGd90tVqYaLATVyHWwq-RdemXl3xdnl_LVf8giZzRP8xiDs61A8O-daaNc2Vab1LozvmslFjQvS1agIqHZBtXBt20w9c83GMkhDpnikEMccogj8ae_vf3Q3_NPAN0AQ1k511izMCH-I_sJnl2ZUA</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Essig, Garth F.</creator><creator>Porter, Kyle</creator><creator>Schneider, David</creator><creator>Arpaia, Debora</creator><creator>Lindsey, Susan C.</creator><creator>Busonero, Giulia</creator><creator>Fineberg, Daniel</creator><creator>Fruci, Barbara</creator><creator>Boelaert, Kristien</creator><creator>Smit, Johannes W.</creator><creator>Meijer, Johannes Arnoldus Anthonius</creator><creator>Duntas, Leonidas H.</creator><creator>Sharma, Neil</creator><creator>Costante, Giuseppe</creator><creator>Filetti, Sebastiano</creator><creator>Sippel, Rebecca S.</creator><creator>Biondi, Bernadette</creator><creator>Topliss, Duncan J.</creator><creator>Pacini, Furio</creator><creator>Maciel, Rui M.B.</creator><creator>Walz, Patrick C.</creator><creator>Kloos, Richard T.</creator><general>Mary Ann Liebert, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161101</creationdate><title>Multifocality in Sporadic Medullary Thyroid Carcinoma: An International Multicenter Study</title><author>Essig, Garth F. ; Porter, Kyle ; Schneider, David ; Arpaia, Debora ; Lindsey, Susan C. ; Busonero, Giulia ; Fineberg, Daniel ; Fruci, Barbara ; Boelaert, Kristien ; Smit, Johannes W. ; Meijer, Johannes Arnoldus Anthonius ; Duntas, Leonidas H. ; Sharma, Neil ; Costante, Giuseppe ; Filetti, Sebastiano ; Sippel, Rebecca S. ; Biondi, Bernadette ; Topliss, Duncan J. ; Pacini, Furio ; Maciel, Rui M.B. ; Walz, Patrick C. ; Kloos, Richard T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c501t-581b4e7ad0874154738707ff67ff8ab0cf23a758ff7822e8c8c8dc0502e375383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biopsy</topic><topic>Carcinoma, Medullary - epidemiology</topic><topic>Carcinoma, Medullary - pathology</topic><topic>Carcinoma, Medullary - prevention & control</topic><topic>Carcinoma, Medullary - surgery</topic><topic>Carcinoma, Neuroendocrine - epidemiology</topic><topic>Carcinoma, Neuroendocrine - pathology</topic><topic>Carcinoma, Neuroendocrine - prevention & control</topic><topic>Carcinoma, Neuroendocrine - surgery</topic><topic>Cohort Studies</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - prevention & control</topic><topic>Neoplasm Staging</topic><topic>Practice Guidelines as Topic</topic><topic>Prevalence</topic><topic>Retrospective Studies</topic><topic>Thyroid Cancer and Nodules</topic><topic>Thyroid Gland - pathology</topic><topic>Thyroid Gland - surgery</topic><topic>Thyroid Neoplasms - epidemiology</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Neoplasms - prevention & control</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Thyroidectomy - adverse effects</topic><topic>Tumor Burden</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Essig, Garth F.</creatorcontrib><creatorcontrib>Porter, Kyle</creatorcontrib><creatorcontrib>Schneider, David</creatorcontrib><creatorcontrib>Arpaia, Debora</creatorcontrib><creatorcontrib>Lindsey, Susan C.</creatorcontrib><creatorcontrib>Busonero, Giulia</creatorcontrib><creatorcontrib>Fineberg, Daniel</creatorcontrib><creatorcontrib>Fruci, Barbara</creatorcontrib><creatorcontrib>Boelaert, Kristien</creatorcontrib><creatorcontrib>Smit, Johannes W.</creatorcontrib><creatorcontrib>Meijer, Johannes Arnoldus Anthonius</creatorcontrib><creatorcontrib>Duntas, Leonidas H.</creatorcontrib><creatorcontrib>Sharma, Neil</creatorcontrib><creatorcontrib>Costante, Giuseppe</creatorcontrib><creatorcontrib>Filetti, Sebastiano</creatorcontrib><creatorcontrib>Sippel, Rebecca S.</creatorcontrib><creatorcontrib>Biondi, Bernadette</creatorcontrib><creatorcontrib>Topliss, Duncan J.</creatorcontrib><creatorcontrib>Pacini, Furio</creatorcontrib><creatorcontrib>Maciel, Rui M.B.</creatorcontrib><creatorcontrib>Walz, Patrick C.</creatorcontrib><creatorcontrib>Kloos, Richard T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Thyroid (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Essig, Garth F.</au><au>Porter, Kyle</au><au>Schneider, David</au><au>Arpaia, Debora</au><au>Lindsey, Susan C.</au><au>Busonero, Giulia</au><au>Fineberg, Daniel</au><au>Fruci, Barbara</au><au>Boelaert, Kristien</au><au>Smit, Johannes W.</au><au>Meijer, Johannes Arnoldus Anthonius</au><au>Duntas, Leonidas H.</au><au>Sharma, Neil</au><au>Costante, Giuseppe</au><au>Filetti, Sebastiano</au><au>Sippel, Rebecca S.</au><au>Biondi, Bernadette</au><au>Topliss, Duncan J.</au><au>Pacini, Furio</au><au>Maciel, Rui M.B.</au><au>Walz, Patrick C.</au><au>Kloos, Richard T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multifocality in Sporadic Medullary Thyroid Carcinoma: An International Multicenter Study</atitle><jtitle>Thyroid (New York, N.Y.)</jtitle><addtitle>Thyroid</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>26</volume><issue>11</issue><spage>1563</spage><epage>1572</epage><pages>1563-1572</pages><issn>1050-7256</issn><eissn>1557-9077</eissn><abstract>Background:
Current surgical standard of care in sporadic medullary thyroid carcinoma (sMTC) consists of a minimum of total thyroidectomy with central neck dissection. Some have suggested thyroid lobectomy with isthmusectomy and central neck dissection for patients with sMTC, given their lower frequency of bilateral disease, although this topic has not been thoroughly studied. This study assessed the prevalence of multifocality in sMTC via a large international multi-institutional retrospective review to quantify this prevalence, including the impact of geography, to assess more accurately the risks associated with alternative surgical approaches.
Methods:
A retrospective chart review of sMTC patients from 11 institutions over 29 years (1983–2011) was undertaken. Data regarding focality, extent of disease,
RET
germline analysis plus family and clinical history for multiple endocrine neoplasia type 2 (MEN2), and demographic data were collected and analyzed.
Results:
Patients from four continents and seven countries were included in the sample. Data for 313 patients with documented sMTC were collected. Of these, 81.2% were confirmed with negative
RET
germline testing, while the remaining 18.8% demonstrated a negative family history and no manifestations of MEN2 syndromes other than MTC. Bilateral disease was identified in 17/306 (5.6%) patients, while multifocal disease was noted in 50/312 (16.0%) sMTC patients. When only accounting for germline negative patients, these rates were not significantly different (5.6% and 17%, respectively). Among them, when disease was unifocal in the ipsilateral lobe and isthmus, bilateral disease was present in 6/212 (2.8%) cases. When disease was multifocal in the ipsilateral lobe or isthmus, then bilateral disease was present in 8/37 (21.6%) cases (
p
< 0.001). No geographic differences in focality were identified.
Conclusions:
The 5.6% prevalence of bilateral foci in sMTC suggests that total thyroidectomy should remain the standard of care for initial surgery, as less complete thyroid surgery may fail to address fully the primary site of disease. Whether ipsilateral tumor focality should be an independent factor determining the need for completion thyroidectomy when sMTC is diagnosed after hemithyroidectomy remains to be determined.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>27604949</pmid><doi>10.1089/thy.2016.0255</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1050-7256 |
| ispartof | Thyroid (New York, N.Y.), 2016-11, Vol.26 (11), p.1563-1572 |
| issn | 1050-7256 1557-9077 |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Biopsy Carcinoma, Medullary - epidemiology Carcinoma, Medullary - pathology Carcinoma, Medullary - prevention & control Carcinoma, Medullary - surgery Carcinoma, Neuroendocrine - epidemiology Carcinoma, Neuroendocrine - pathology Carcinoma, Neuroendocrine - prevention & control Carcinoma, Neuroendocrine - surgery Cohort Studies Humans Middle Aged Neoplasm Recurrence, Local - epidemiology Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - prevention & control Neoplasm Staging Practice Guidelines as Topic Prevalence Retrospective Studies Thyroid Cancer and Nodules Thyroid Gland - pathology Thyroid Gland - surgery Thyroid Neoplasms - epidemiology Thyroid Neoplasms - pathology Thyroid Neoplasms - prevention & control Thyroid Neoplasms - surgery Thyroidectomy - adverse effects Tumor Burden Young Adult |
| title | Multifocality in Sporadic Medullary Thyroid Carcinoma: An International Multicenter Study |
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