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Incidence and distribution of neck node metastases in hereditary vs. sporadic medullary thyroid cancer at basal calcitonin serum levels ≤100 pg/ml: 30-year experience

  • 0Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, Saale, D-06097, Halle, Germany.
European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology +

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March 18, 2025

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March 18, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Neck node metastases in medullary thyroid cancer (MTC) are common even with low calcitonin levels. Central neck dissection may benefit patients with elevated calcitonin, and lateral neck exploration is advised if levels persist post-surgery.

Area Of Science

  • Oncology
  • Surgical Oncology
  • Endocrinology

Background

  • Neck node metastases are poorly understood in medullary thyroid cancer (MTC) patients with low preoperative calcitonin levels (≤100 pg/ml).
  • This includes both hereditary and sporadic forms of MTC.
  • Accurate data on metastasis patterns is crucial for treatment planning.

Purpose Of The Study

  • To define the frequency and distribution of neck node metastases in MTC patients with preoperative basal calcitonin levels ≤100 pg/ml.
  • To analyze metastasis patterns based on calcitonin levels and MTC type (hereditary vs. sporadic).
  • To inform surgical strategies for MTC management.

Main Methods

  • Retrospective analysis of 30-year data from a tertiary surgical center.
  • Inclusion of 256 previously untreated MTC patients with basal calcitonin levels ≤100 pg/ml.
  • Categorization of patients into hereditary (125) and sporadic (131) MTC groups.

Main Results

  • Node metastases were found in 7.2% of hereditary MTC and 13.0% of sporadic MTC patients.
  • Lower calcitonin levels (≤40 pg/ml) were associated with less frequent metastases (5-9%) compared to higher levels (>40 pg/ml, 14-18%).
  • Ipsilateral lateral neck metastases, sparing the central neck, occurred in 22-29% of node-positive cases.

Conclusions

  • Central neck dissection during thyroidectomy may be beneficial for MTC patients with elevated calcitonin levels (≤100 pg/ml).
  • Persistent elevated calcitonin after central neck dissection suggests potential benefit from ipsilateral lateral neck exploration.
  • These findings aid in refining surgical approaches for MTC based on preoperative calcitonin levels.

Keywords:

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