Prophylactic thyroidectomy for MEN 2-related medullary thyroid carcinoma based on predictive testing for RET proto-oncogene mutation and basal serum calcitonin in China
| Autor: | Jin Hy, Zhao Jq, Qi Xp, Xian-Ning Zhang, Yong Zhao, Wang Jq, Fei J, Yang Rr, Hu-Ling Jiang, Xiao-Ling Chen, Jun Cheng, Ying Rb, Wen-Ting Liu, Chen Zg, Han Js, Zhenfang Du, Ma Jm, Yang Yp |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Calcitonin Male medicine.medical_specialty Pathology China Medullary cavity Adolescent medicine.medical_treatment Multiple endocrine neoplasia type 2 Multiple Endocrine Neoplasia Type 2a Gastroenterology Asymptomatic Proto-Oncogene Mas Metastasis Thyroid carcinoma Young Adult Asian People Internal medicine Medicine Humans Thyroid Neoplasms Child business.industry Proto-Oncogene Proteins c-ret Neck dissection General Medicine Hyperplasia Middle Aged medicine.disease Oncology Carcinoma Medullary Child Preschool Asymptomatic Diseases Mutation Thyroidectomy Neck Dissection Surgery Histopathology Female medicine.symptom business |
| Zdroj: | European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 39(9) |
| ISSN: | 1532-2157 |
| Popis: | Introduction: Early and normative surgery is the only curative method for multiple endocrine neoplasia type 2 (MEN 2)-related medullary thyroid carcinoma (MTC). Aims: To study the timing of prophylactic total thyroidectomy (TT) for MEN 2-related MTC with different RET mutations in a Chinese population, and to compare the sensitivity and accuracy of fully-automated chemiluminescence immunoassay (FACLIA) and radioimmunoassay (RIA) for serum calcitonin (Ct). Methods: We collected 24 asymptomatic individuals from 8 unrelated Chinese families with MEN 2, and analyzed RET mutation and Ct levels. Then we performed TT on 17 of the 24 individuals, including TT (2/17), TT with bilateral level VI lymph-node dissection (B-LND(VI); 12/17) and TT with B-LND(VI) þ modified unilateral/bilateral/local neck dissection (3/17). Results: Histopathology revealed bilateral/unilateral MTC in 15/17 (88.2%; median diameter, 1.0 cm) and bilateral C-cell hyperplasia in 2/17 (11.8%; p.V292M/R67H/R982C and p.C618Y). Lymph-node metastasis/fibro-adipose tissue invasion (p.C634R) or solely fibroadipose tissue invasion (p.C634Y) were found in 2/17 (11.8%). Elevated pre-surgical Ct (pre-Ct) was identified by FACLIA in 17/17 (median age, 24.0), while pre-Ct by RIAwas found in only 6/15 (P < 0.001). The median follow-up was 22.0 months, during which 16/17 had no abnormality (one p.C634R individual had elevated Ct), and another 7 carriers still had consistently undetectable Ct by FACLIA. Conclusions: Our study highlights the importance and feasibility of individualized prophylactic TT for MEN 2-related MTC, based on predictive integrated screening of RET and pre-Ct levels. Besides, we recommend FACLIA to measure Ct for earlier diagnosis, treatment and follow-up monitoring of MTC. 2013 Elsevier Ltd. All rights reserved. |
| Databáze: | OpenAIRE |
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