Can Desmoplastic Stromal Reaction Guide the Extent of Lymph Node Surgery in Sporadic Medullary Thyroid Carcinoma?
World Journal of Surgery, vol.50, no.3, pp.650-659, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 50 Issue: 3
- Publication Date: 2026
- Doi Number: 10.1002/wjs.70282
- Journal Name: World Journal of Surgery
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, MEDLINE, Public Affairs Index
- Page Numbers: pp.650-659
- Keywords: biochemical cure, calcitonin, desmoplastic stromal reaction, lymph node dissection, medullary thyroid carcinoma
- Istanbul Gelisim University Affiliated: Yes
Abstract
Background: Medullary thyroid carcinoma (MTC) frequently presents with lymph node metastases (LNMs), and the extent of lymph node (LN) surgery remains controversial. The desmoplastic stromal reaction (DSR) has emerged as a potential histopathological predictor of metastatic spread. Methods: We retrospectively analyzed 63 patients with sporadic MTC treated between 2016 and 2025 at four tertiary centers. Histopathological specimens were re-evaluated for DSR, which was graded as absent, low, moderate, or high. Clinicopathological features, biochemical markers, and oncologic outcomes were compared across groups. Results: DSR was absent in 27.0% and present in 73% tumors. DSR positivity was significantly associated with higher calcitonin (Ctn) and carcinoembryonic antigen (CEA) levels, increased LNM (87% vs. 0%), lymphovascular invasion, advanced nodal stage, and stage IV disease. Biochemical cure was achieved in 94.1% of DSR-negative patients compared with 56.5% of DSR-positive patients. The extent of tumor desmoplasia levels correlated with higher metastatic burden. Conclusion: DSR negativity reliably identifies an indolent subgroup with negligible metastatic risk, whereas increasing desmoplasia stratifies patients into higher-risk categories. The incorporation of DSR alongside established biomarkers such as Ctn may refine surgical decision-making and may help tailor the extent of LN dissection in sporadic MTC.