PROPHYLACTIC
LYMPH NODE DISSECTION IN MEDULLARY THYROID CANCER (MTC)
WHEN IS IT INDICATED
AND HOW EXTENSIVE SHOULD BE?
Bilateral
central prophylactic lymph node dissection is indicated in almost all patients
with MTC confined to the neck and no evidence of involved cervical lymph nodes
on preoperative ultrasonography, since metastases to these lymph nodes are seen
in approximately 50 % of patients with MTC (both sporadic and hereditary) at
the time of diagnosis. Prophylactic lateral neck dissection is not indicated in
this case. However, if central lymph node involvement is documented during
surgery – despite the negative preoperative ultrasonography – concomitant ipsilateral
lateral lymph node dissection should also be performed.
Prophylactic
central lymph node dissection is not required in patients with small
intrathyroid MTC with very low preoperative calcitonin levels (<20 pg/ml), since
metastatic lymphadenopathy is very rare in this case.
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