Precision Thyroidectomy in Sporadic Medullary Thyroid Cancer

The last decade has seen an interest in de-escalating management approaches in differentiated and medullary thyroid cancer, initially with a move toward less aggressive use of elective neck dissection for patients with medullary thyroid cancer without clinical, biochemical, or radiographic evidence of disease outside the thyroid gland at presentation, and now with a consideration of the potential advantages of thyroid lobectomy in patients with sporadic medullary thyroid cancer documented by preoperative germline genetic testing. In this issue of JAMA Otolaryngology –Head& Neck Surgery, Mao et al have published an interesting study pertaining to the prevalence of occult contralateral foci in sporadic medullary thyroid cancer. While previous studies have reported identifying medullary thyroid cancer foci in the contralateral thyroid lobe in up to 25% of patients undergoing total thyroidectomy as primary therapy, this article carefully describes the prevalence of occult disease in the contralateral lobe in the cohort of patients with no ultrasonographic evidence of disease in the contralateral lobe. In the absence of ultrasonographically identifiable disease, foci of medullary thyroid cancer were histologically identified in the contralateral thyroid lobe in 4 of 30 patients (13.3%) with hereditary medullary thyroid cancer, but in only 4 of 79 patients (5.0%) with sporadic medullary thyroid cancer. Based on this low prevalence rate, the authors suggest consideration of a ...
Source: JAMA Otolaryngology - Head and Neck Surgery - Category: ENT & OMF Source Type: research