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Large sporadic thyroid medullary carcinomas: predictive factors for lymph node involvement.

Sébastien Aubert1,2,3, Amandine Berdelou4, Viviane Gnemmi5,6,7

  • 1Institut de Pathologie, Centre de Biologie Pathologie, CHRU de Lille, 59037, Lille, France. sebastien.aubert@chru-lille.fr.

Virchows Archiv : an International Journal of Pathology
|February 2, 2018
PubMed
Summary

Lymph node involvement (LNI) in medullary thyroid carcinoma (MTC) impacts survival. Desmoplastic stroma and high miR-21 levels predict LNI, potentially guiding surgical extent for large MTCs.

Keywords:
CarcinomaDesmoplasiaMedullaryMicroRNANodeThyroid

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Area of Science:

  • Oncology
  • Molecular Biology

Background:

  • Lymph node involvement (LNI) is a critical prognostic factor in medullary thyroid carcinoma (MTC), affecting patient survival.
  • LNI is prevalent in over 50% of sporadic MTCs at diagnosis, particularly in larger tumors, necessitating cervical lymph node dissection during surgery.

Purpose of the Study:

  • To identify clinical, biological, and pathological factors predicting LNI in large sporadic MTCs.
  • To potentially spare patients from extensive cervical dissection by identifying tumors unlikely to have LNI.

Main Methods:

  • Retrospective review of large (≥1 cm) sporadic MTC cases.
  • Quantitative PCR (qPCR) assessment of mature microRNA (miR) levels in paraffin-embedded tumor samples.
  • Analysis of clinical, pathological, and molecular data to identify predictors of LNI.

Main Results:

  • Of 54 MTCs, 26 had LNI and 28 were pN0. Patients with LNI showed higher preoperative basal calcitonin, infiltrative margins, lymphovascular invasion, extrathyroidal extension, higher pT stage, and more desmoplastic stroma.
  • Tumor expression of miR-21 and miR-183 was significantly higher in the LNI group.
  • Desmoplastic stroma abundance and miR-21 expression were independent predictors of LNI.

Conclusions:

  • Abundant desmoplastic stroma and high miR-21 expression are strong indicators of LNI in large sporadic MTCs.
  • These factors may assist surgeons in determining the appropriate extent of cervical lymph node dissection for MTCs lacking preoperative LNI indicators.