Characteristics and management strategies of superior mediastinal lymph node metastasis in medullary thyroid carcinoma
CHU Jun-jie
ZHANG De-guang
Abstract：Medullary thyroid carcinoma(MTC)is a distinct subtype of thyroid carcinoma with higher malignancy than differentiated thyroid carcinoma and regional lymph node metastasis can occur at an early stage.The incidence of superior mediastinal lymph node metastasis is reported to be 18.2％-27.5％.However,such metastases usually lack specific symptoms and are often overlooked due to obstruction by the sternum and clavicle,which limits the detection of lesions by routine ultrasound examination.Therefore,effective diagnostic and assessment modalities are of particular importance.Contrast-enhanced CT of the neck and chest can provide a reliable evaluation of superior mediastinal lymph node metastasis in MTC and its relationship with adjacent critical structures.The novel 68Ga-labeled CTR-FAPI positron emission tomography/computed tomography(68Ga-CTR-FAPI PET/CT)has shown promising diagnostic performance in detecting nodal and distant metastases of MTC.When superior mediastinal lymph node metastasis is present,standardized dissection of the superior mediastinum is currently the only potentially curative approach and has a direct impact on prognosis.Common surgical approaches include transcervical direct dissection,thoracotomy,transcervical endoscopic-assisted dissection,thoracoscopic dissection,and combined transcervical endoscopic-assisted thoracoscopic dissection.Endoscopic surgery offers the advantages of magnification,illumination and extended visualization,helping to overcome the limitations of open surgery imposed by the sternum and clavicle while avoiding the trauma of thoracotomy.For appropriately selected patients,transcervical endoscopic-assisted thoracoscopic or combined approaches can achieve standardized and minimally invasive superior mediastinal lymph node dissection with clinical value warranting further exploration and promotion.In addition,with the advent of novel targeted therapies,especially highly selective RET inhibitors such as pralsetinib and selpercatinib for RET mutations,new therapeutic opportunities have emerged for patients with MTC who were previously unsuitable for complete surgical resection.Preoperative neoadjuvant therapy guided by the patient's tumor mutation profile may yield favorable outcomes.
Keywords：medullary thyroid carcinomasuperior mediasti-nal metastasisvideo-assistedthoracoscopyneoadjuvant ther-apy
Publication Date：2025-09-01
Online Publishing Date：2025-10-22(First online date of this platform, not the publication date of the document)
Pages：5( 1041-1045 )