MEDULLARY
THYROID CANCER (MTC); WHAT’S THE ROLE OF PROPHYLACTIC LATERAL LYMPH NODE
DISSECTION (PLLND)?
PLLND in MTC
remains a controversial issue. In the absence of ultrasonographically detected
lymph node metastases, only prophylactic central lymph node dissection is typically
indicated (with very few exceptions). In the presence, however, of
intraoperative evidence of central lymph node involvement, ipsilateral PLLND should
strongly be considered (regardless of serum calcitonin levels).
The American
Thyroid Association (ATA) recommended that PLLND “may be considered based on
serum calcitonin levels”, without achieving a consensus agreement on this
topic. Some members recommended against routine PLLND if there was no evidence
of disease on preoperative ultrasonography, while others recommended
prophylactic ipsilateral central AND homolateral PLLND when basal serum
calcitonin levels were > 20 pg/ml and contralateral PLLND when serum
calcitonin > 200 pg/ml.
Currently, most
endocrine surgeons have adopted a more targeted surgical strategy, guided by
the findings of the detailed preoperative lymphatic mapping, recognizing that
some patients will have a biochemical incomplete response that could
potentially require additional therapy in the future, based on findings of postoperative
follow-up (imaging and trend in calcitonin / CEA levels)
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