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Forgoing Node Dissection for Desmoplasia-Negative Hereditary Medullary Thyroid Cancer
Andreas Machens1, Claudia Bensch2, Claudia Wickenhauser2
1Department of Visceral, Vascular and Endocrine Surgery and Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle (Saale), Germany.
Endocrine-Related Cancer
|August 10, 2026
Summary
Desmoplasia negativity in unilateral medullary thyroid cancer (MTC) among RET carriers indicates no lymph node metastases, potentially allowing patients to avoid neck dissection. This finding is crucial for hereditary MTC management.
Area of Science:
- Oncology
- Genetics
- Surgical Pathology
Background:
- Medullary thyroid cancer (MTC) management, particularly hereditary forms involving RET gene mutations, presents challenges in detecting lymph node metastases.
- Desmoplasia negativity is a recognized marker for node-negative disease, but its role in hereditary MTC requires further clarification.
Purpose of the Study:
- To investigate the clinical utility of desmoplasia negativity in predicting lymph node metastases in RET-altered hereditary MTC.
- To identify key clinical variables associated with nodal status in patients with MTC.
Main Methods:
- A cross-sectional study involving 124 RET carriers with MTC who underwent total thyroidectomy and neck dissection.
- Multivariable logistic regression and stratification analyses were performed on clinical variables, including desmoplasia, serum calcitonin, and RET category, in relation to nodal status.
Main Results:
- Desmoplasia (≤5% vs. >10%), basal serum calcitonin levels, and RET category (p.Met918Thr) were independently associated with lymph node metastases.
- In unilateral MTC, desmoplasia ≤5% consistently predicted absence of node metastases (0/15 patients).
- In bilateral MTC, predictive thresholds were less discriminatory, suggesting contralateral cross-contamination.
Conclusions:
- Desmoplasia-negative unilateral MTC in RET carriers is strongly associated with the absence of lymph node metastases.
- Patients with desmoplasia-negative unilateral MTC may potentially forgo prophylactic neck dissection at specialized centers.
- This finding supports personalized management strategies for hereditary medullary thyroid cancer based on pathological and biochemical markers.
