Multifocality in Sporadic Medullary Thyroid Carcinoma: An International Multicenter Study

Garth F Essig, Kyle Porter, David Schneider, Debora Arpaia, Susan C Lindsey, Giulia Busonero, Daniel Fineberg, Barbara Fruci, Kristien Boelaert, Johannes W Smit, Johannes Arnoldus Anthonius Meijer, Leonidas H Duntas, Neil Sharma, Giuseppe Costante, Sebastiano Filetti, Rebecca S Sippel, Bernadette Biondi, Duncan J Topliss, Furio Pacini, Rui M B MacielPatrick C Walz, Richard T Kloos

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8 Citations (Scopus)


BACKGROUND: Current surgical standard of care in sporadic medullary thyroid carcinoma (sMTC) consists of a minimum of total thyroidectomy with central neck dissection. Some have suggested thyroid lobectomy with isthmusectomy and central neck dissection for patients with sMTC, given their lower frequency of bilateral disease, although this topic has not been thoroughly studied. This study assessed the prevalence of multifocality in sMTC via a large international multi-institutional retrospective review to quantify this prevalence, including the impact of geography, to assess more accurately the risks associated with alternative surgical approaches.

METHODS: A retrospective chart review of sMTC patients from 11 institutions over 29 years (1983-2011) was undertaken. Data regarding focality, extent of disease, RET germline analysis plus family and clinical history for multiple endocrine neoplasia type 2 (MEN2), and demographic data were collected and analyzed.

RESULTS: Patients from four continents and seven countries were included in the sample. Data for 313 patients with documented sMTC were collected. Of these, 81.2% were confirmed with negative RET germline testing, while the remaining 18.8% demonstrated a negative family history and no manifestations of MEN2 syndromes other than MTC. Bilateral disease was identified in 17/306 (5.6%) patients, while multifocal disease was noted in 50/312 (16.0%) sMTC patients. When only accounting for germline negative patients, these rates were not significantly different (5.6% and 17%, respectively). Among them, when disease was unifocal in the ipsilateral lobe and isthmus, bilateral disease was present in 6/212 (2.8%) cases. When disease was multifocal in the ipsilateral lobe or isthmus, then bilateral disease was present in 8/37 (21.6%) cases (p < 0.001). No geographic differences in focality were identified.

CONCLUSIONS: The 5.6% prevalence of bilateral foci in sMTC suggests that total thyroidectomy should remain the standard of care for initial surgery, as less complete thyroid surgery may fail to address fully the primary site of disease. Whether ipsilateral tumor focality should be an independent factor determining the need for completion thyroidectomy when sMTC is diagnosed after hemithyroidectomy remains to be determined.

Original languageEnglish
Pages (from-to)1563-1572
Number of pages10
Issue number11
Early online date11 Oct 2016
Publication statusPublished - Nov 2016


  • Journal Article


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