Cargando…

Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Zhang, Daqi, Colombo, Carla, Sun, Hui, Kim, Hoon Yub, Pino, Antonella, De Leo, Simone, Gazzano, Giacomo, Persani, Luca, Dionigi, Gianlorenzo, Fugazzola, Laura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9309363/
https://www.ncbi.nlm.nih.gov/pubmed/35898450
http://dx.doi.org/10.3389/fendo.2022.875875
_version_ 1784753144350113792
author Zhang, Daqi
Colombo, Carla
Sun, Hui
Kim, Hoon Yub
Pino, Antonella
De Leo, Simone
Gazzano, Giacomo
Persani, Luca
Dionigi, Gianlorenzo
Fugazzola, Laura
author_facet Zhang, Daqi
Colombo, Carla
Sun, Hui
Kim, Hoon Yub
Pino, Antonella
De Leo, Simone
Gazzano, Giacomo
Persani, Luca
Dionigi, Gianlorenzo
Fugazzola, Laura
author_sort Zhang, Daqi
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9309363
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-93093632022-07-26 Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines Zhang, Daqi Colombo, Carla Sun, Hui Kim, Hoon Yub Pino, Antonella De Leo, Simone Gazzano, Giacomo Persani, Luca Dionigi, Gianlorenzo Fugazzola, Laura Front Endocrinol (Lausanne) Endocrinology 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. Frontiers Media S.A. 2022-07-11 /pmc/articles/PMC9309363/ /pubmed/35898450 http://dx.doi.org/10.3389/fendo.2022.875875 Text en Copyright © 2022 Zhang, Colombo, Sun, Kim, Pino, De Leo, Gazzano, Persani, Dionigi and Fugazzola https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Zhang, Daqi
Colombo, Carla
Sun, Hui
Kim, Hoon Yub
Pino, Antonella
De Leo, Simone
Gazzano, Giacomo
Persani, Luca
Dionigi, Gianlorenzo
Fugazzola, Laura
Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines
title Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines
title_full Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines
title_fullStr Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines
title_full_unstemmed Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines
title_short Unilateral Surgery for Medullary Thyroid Carcinoma: Seeking for Clinical Practice Guidelines
title_sort unilateral surgery for medullary thyroid carcinoma: seeking for clinical practice guidelines
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9309363/
https://www.ncbi.nlm.nih.gov/pubmed/35898450
http://dx.doi.org/10.3389/fendo.2022.875875
work_keys_str_mv AT zhangdaqi unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT colombocarla unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT sunhui unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT kimhoonyub unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT pinoantonella unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT deleosimone unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT gazzanogiacomo unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT persaniluca unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT dionigigianlorenzo unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines
AT fugazzolalaura unilateralsurgeryformedullarythyroidcarcinomaseekingforclinicalpracticeguidelines