Central neck dissection in the management of sporadic medullary thyroid microcarcinoma.
OBJECTIVE
Treatment of medullary thyroid carcinoma (MTC) includes total thyroidectomy with at least bilateral central neck dissection. Systematic measurement of thyrocalcitonin (CT) levels in thyroid nodules allows for early diagnosis of MTC. As central neck dissection (CND) is associated with high morbidity, the aim of this study was to investigate the necessity of this procedure in the treatment of sporadic medullary thyroid microcarcinoma (S-mMTC).


METHODS
Prospective multicentric study including 43 patients with sporadic micro-MTC who underwent CND between January 1991 and August 2001.


RESULTS
26 women and 17 men with sporadic micro-MTC, aged 28-87 (mean age was 58 years), without family history of multiple endocrine neoplasia, underwent surgery. Total thyroidectomy was performed in all patients and combined with 'picking' (n=7) or CND (n=36). Size of tumours ranged from 0.2 to 9mm (mean size was 4.1mm). Solitary (32/43 patients) and multiple S-mMTC lesions (11/43 patients) were seen. 601 lymph nodes from the 41 subclinical patients were analysed. Mean follow-up period for these patients was 32 months. No mutations in the RET oncogene were seen.


CONCLUSIONS
As lymph node involvement is uncommon in S-mMTC, systematic CND is of questionable value.
Hamy
A
A
Department of Surgery, University Hospital of Angers, Angers, France. anhamy@chu-angers.fr
Pessaux
P
P
Mirallié
E
E
Mucci-Hennekinne
S
S
Gibelin
H
H
Mor-Martinez
C
C
de Calan
L
L
Ronceray
J
J
Kraimps
J-L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018276:Carcinoma, Medullary / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011446:Prospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy