OP20 – A Shifting Trend in the Presentation of Medullary Thyroid Carcinoma (MTC)

     

    Feibish, Nir1; Doweck, Ilana1, 2
    1 Department of Otolaryngology, Head and Neck Surgery, Lady Davis Carmel Medical Center, Haifa, Israel
    2 Technion, Israel Institute of Technology, Haifa, Israel


    Background/Purpose: 
    Medullary thyroid carcinoma (MTC) is a rare disease which accounts for 1%–2% of thyroid cancers. Recent changes in diagnostic approach result in early diagnosis of thyroid cancer.

    Objectives: 
    The aim of the study was to analyze changes in presentation of MTC lately.

    Methods: A retrospective cohort included patients with MTC between 1999-2016. Medical records were analyzed for stage, clinical and biochemical findings at presentation, treatment modality, pathological findings and outcome.

    Results: 
    Nineteen patients were diagnosed with MTC with mean age 53y, Mean follow-up 62m. M:F 7:11. All patients underwent total thyroidectomy and neck dissection (central or central & lateral). One patient had MTC on the contralateral lobe, whereas 5 patients(26%) had simultaneous papillary carcinoma. Between 1999-2010, 64%(7/11) of patients had clinical presentation, whereas since 2011, 75%(6/8) of patients had incidental findings by US or CT. Incidental MTC was found smaller both by US(1.43 Vs 3.56cm, p=0.015), by pathology (1.17 Vs 3.13cm, p=0.006) and had lower calcitonin level(362 Vs. 3269ng/L, p=0.01) compared to patients with clinically avid disease. Ten patients(53%) were presented with clinically negative(N0) neck, only one patient(10%) had occult metastasis. None of the patients with tumor ?1cm and cN0 had regional metastasis. There was a linear regression between calcitonin level and No. of pathological node: No. of pathological node=0.0027*calcitonin(p=0.0004).

    Discussion: 
    Our data shows a recent trend of early detection of incidental MTC, limited by size, stage, calcitonin level and regional metastasis. Our data suggests more conservative surgical approach in these patients. Further study needed to confirm our findings.

    References:

    1. National Comprehensive Cancer Network.  Thyroid carcinoma (Version 1.2016). https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.
    2. American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610.
    3. Machens A, Dralle H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab. 2010 Jun;95(6):2655-63.
    4. Boschin IM, Torresan F, Toniato A, Zane M, Ide EC, Pennelli G, Rampin L, Colletti PM, Rubello D, Pelizzo MR. Incidental medullary thyroid microcarcinoma revealed by mild increase of preoperative serum calcitonin levels: therapeutic implications. Endocrine. 2014 Apr;45(3):448-53.
    5. Scheuba C, Kaserer K, Bieglmayer C, Asari R, Riss P, Drosten R, Niederle B. Medullary thyroid microcarcinoma recommendations for treatment – a single-center experience. Surgery. 2007 Dec;142(6):1003-10.
    6. Kwon et al. Changing trends in the clinicopathological features and clinical outcomes of medullary thyroid carcinoma. J Surg Oncol. 2016 Feb;113(2):152-8.
    7. Roman S, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases. Cancer. 2006 Nov 1;107(9):2134-42.

 

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