Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2012) 29 P1791

ICEECE2012 Poster Presentations Thyroid cancer (108 abstracts)

Desmoplastic stromal reaction and extrathyroidal invasion predict lymph node involvement in sporadic macro medullary thyroid cancer

A. Berdelou , S. Aubert , F. Pattou , P. Pigny , V. Gnemmi , B. Carnaille , M. D’Herbomez , J. Wémeau & C. Do Cao


University hospital, Lille, France.


Background: Locoregional nodal metastases are the first step of tumor spread in MTC and have been shown to be a prognostic factor for survival. Neither palpation nor neck ultrasound can estimate nodal staging accurately.

Aim: To identify predictive factors for LNI in MTC through a retrospective study on 142 consecutive patients operated in Lille University Hospital between 1995 and 2010.

Methods: Analyses were carried on 54 patients (median age=52 (41–61), M/F ratio=0.54; mean tumor size=25 mm (15–35), median calcitonin (CT) value=1177 pg/ml (304–3470)) after exclusion of familial MTC (n=38) and microMTC (n=27). Total thyroidectomy plus LN dissection was performed in 98%. Pathologic slides were reviewed. Pre and postoperative CT (pre/postCT) were all available.

Results: Twenty-six (48%) patients with a sporadic macroCMT had LNI, 6 (23%) of whom had a curative resection confirmed by undetectable postCT. All LN free cases had accordingly undetectable postCT. Thirty three percent of MTC with preCT>2000 pg/ml were unexpectedly LN free with undetectable postCT. Under univariate analysis, age and tumor size did not influence LN status. Male patients (P=0.027) and higher preCT level (P=0.001) were more likely associated with LNI. Positive correlation was observed between LNI and DSR (P=0.001), no peritumoral capsule (P=0.001), peritumoral invasion (P=0.00004), vascular invasion (P=0.0004) and ETI (P=0.003). Multivariate analysis showed both DSR (OR=131.67; P<0.0001) and ETI (OR=255.03; P=0.01) to be independent factors for LNI. The rate of RET somatic mutation found in 45% of 29 analyzed tumors was not significantly higher in MTC with LNI.

Conclusion: At surgery, 52% of sporadic macro CMT was LN free. Though higher preCT may be indicative of LNI no threshold can be set. Since no preoperative factor can ascertain nodal status, a systematic LN dissection is still requiered. ETI and DSR are strong predictors of LNI: their impact should be addressed on further survival studies.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Figure 1 Invasive MTC with an important DSR.

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Volume 29

15th International & 14th European Congress of Endocrinology

European Society of Endocrinology 

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