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Abstract Background Conceptually, thyroid tumor desmoplasia may be better suited for excluding node metastases in sporadic MTC than preoperative serum calcitonin levels. Methods This analysis included 181 patients with unilateral sporadic MTC graded on the 7‐grade desmoplasia scale after thyroidectomy and neck dissection. Results When thyroid tumor desmoplasia reached 1% and ≥50%, node metastases increased from 0% to 7% (median of 0 metastases) and 83% (median of 7.5 metastases), microscopic lymphatic invasion from 0% to 3% and 35%, extrathyroid extension from 0% to 5% and 22%, and extranodal growth from 0% to 0% and 44%, whereas biochemical cure declined from 100% to 95% and 25%. Thyroid tumor diameters and basal calcitonin overlapped widely among the seven desmoplasia groups, precluding differentiation by thyroid tumor size or serum calcitonin levels. Conclusions Thyroid tumor desmoplasia, unlike serum calcitonin levels, discriminates extremely well between node‐negative and node‐positive sporadic MTC, opening new avenues for precision surgery.
Machens et al. (Sat,) studied this question.