What Is the Treatment of the Lateral Neck in Clinically Localized Sporadic Medullary Thyroid Cancer?

Background

Sporadic medullary thyroid cancer has a high rate of regional and distant metastasis. Medullary thyroid cancer (MTC) is sporadic in 75% of cases, with the remainder being hereditary. Disease-free survival is 75 to 85 percent at five and 10 years.

The treatment of clinically or imaging-positive lateral metastasis, without distant metastasis, is lateral neck (levels IIA, III, IV and V) dissection. The treatment of the N0 neck has historically included advocates for central (level VI), ipsilateral and/or bilateral neck dissection. In the era of high-resolution neck imaging, can prophylactic lateral neck dissection be withheld for patients with negative pre-operative imaging? Can lateral neck dissection be withheld if imaging of the lateral neck is negative and there are positive central lymph nodes?

The American Thyroid Association (ATA) published guidelines for the management of differentiated thyroid cancer in 2006 and published an update in 2009. MTC-ATA guidelines were first published in 2009. This review will summarize these guidelines and the current relevant literature.

Best Practice

Lateral neck dissection can be withheld for sporadic MTC patients with negative pre-operative imaging. The present level of evidence cannot uniformly support or preclude the use of lateral neck dissection for central node-positive, lateral neck image-negative, sporadic MTC patients. Read the full article in The Laryngoscope.