Preoperative serum calcitonin may improve initial surgery for medullary thyroid cancer in patients with indeterminate cytology. Issue 6 (12th April 2022)

• Record Type: Journal Article
• Authors: Jassal, Karishma; Ravintharan, Nandhini; Prabhakaran, Swetha; Grodski, Simon; Serpell, Jonathan W.; Lee, James C.
• Is Part Of: ANZ journal of surgery. Volume 92:Issue 6(2022)
• Page Start: 1428
• Page End: 1433
• Publication Date: 2022-04-12
• Subjects: calcitonin -- thyroid carcinoma -- thyroidectomy; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.17690
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Medullary thyroid cancer (MTC) is rare, with poorer outcomes than differentiated thyroid cancer. We aimed to identify areas for improvement in the pre‐operative evaluation of patients with possible MTC in a high‐volume endocrine surgery unit in accordance with current practice guidelines. We hypothesised that the selective use of serum calcitonin (sCT) as a biomarker for possible MTC could guide the extent of initial surgical management. Methods: We recruited MTC patients between 2000 and 2020 from the Monash University Endocrine Surgery Unit database. Demographics, tumour characteristics, pre‐operative evaluation, operative management, and outcomes were analysed. Results: Of 1454 thyroid cancer patients, 43 (3%) had MTC. Pre‐operatively, 36 (84%) patients with MTC confirmed on cytology (28, 65%), elevated sCT (6, 14%) or RET mutation (2, 4%). Of these 36 patients, 31 (86%) had optimal extent of thyroidectomy and lymph node dissection (LND). Five (14%) had less than total thyroidectomy due to nerve injury. Thirty‐four patients had compartmental LND. In the 12 (27%) patients with indeterminate or non‐diagnostic cytology, 5 had elevated sCT and were managed as above. None of the remaining seven had LND, thus potentially suboptimal surgery. Conclusion: Our findings reflect the rarity of MTC, and the challenges of pre‐operative diagnosis. The addition of sCT may improve surgical planning in patients with indeterminate cytology. Abstract : Medullary thyroid cancer is a challenging and rare diagnosis. There are conflicting recommendations as to the use of sCT between different guidelines and so we hoped to identify the utility of serum calcitonin as a biomarker for possible MTC.