Preoperative Diagnosis Impact on Surgical Strategies and Outcomes in Patients with Medullary Thyroid Carcinoma
2Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University
3Institute of Endocrinology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University
4Department of Otolaryngology, Head and Neck Surgery, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem
5Department of Pathology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem
6Endocrine Unit, Wolfson Medical Center
7Department of Surgery, Mount Scopus, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem
Introduction:
Due to the difficulties with cytological identification of medullary thyroid carcinoma (MTC), the correct diagnosis is obtained postoperatively in a significant subset of patients.
Aim:
To investigate the impact of preoperative MTC misdiagnosis on management and outcomes.
Methods:
Retrospective series of MTC patients treated at three tertiary referral centers in Israel from January 2000 to June 2021. The included patients were grouped and compared based on the presence or absence of preoperative MTC diagnosis.
Results:
Ninety-four patients with histopathologically confirmed MTC were included (mean age 56.2±14.3 years, 43% males), of whom 41 (44%) were diagnosed with MTC postoperatively (i-MTC group), and 53 (56%) had preoperative MTC diagnosis (d-MTC group). The extent of surgery, including completion procedures, was as follows: total thyroidectomy in 82% vs. 100%, central lymph node dissection (LND) in 46% vs. 98%, ipsilateral lateral LND in 36% vs. 79%, and contralateral lateral LND in 17% vs. 28% of i-MTC vs. d-MTC patients, respectively. Histopathology revealed a median tumor size of 16±17.4 mm vs. 23±14.0 mm, the proportion of micro-MTC [size ≤ 10 mm] 31.7% vs. 15.1%, in i-MTC vs. d-MTC groups, respectively. Biochemical cure, defined as undetectable calcitonin at 3 months postoperatively, was reached in 57% of i-MTC patients vs. 64% of d-MTC patients (p=0.53). After exclusion of patients with micro-MTC, the biochemical cure was achieved in 37% vs. 62% (p=0.04) of i-MTC vs. d-MTC patients, respectively.
Conclusion:
Preoperative MTC misdiagnosis remains a relevant clinical scenario that may result in suboptimal surgical management and lower curative rates.
