Bal C S, Kumar Ajay, Chandra Prem, Dwivedi S N, Mukhopadhyaya S
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Thyroid. 2004 Mar;14(3):217-25. doi: 10.1089/105072504773297894.
We reviewed the clinical characteristics, pattern of disease at presentation, histopathologic subtype, treatment, course, and outcome of differentiated thyroid cancer (DTT) in children and adolescents presenting with pulmonary metastasis and tried to assess the effectiveness of routine chest x-ray and high-resolution computed tomography (CT) scan of the chest vis-à-vis 131I whole-body scan (WBS) in revealing pulmonary metastasis. In our series of 1754 patients, 122 (7%) were 20 years of age or younger, of whom 28 (23%) had pulmonary metastasis. Mean age was 13.9 +/- 4.4 years (F:M ratio = 12:16). All but 2 patients had undergone near-total thyroidectomy with some form of neck dissection. Histopathologic examination was papillary in 89% and follicular in 11% cases, with confirmed nodal metastasis in all. Twenty-one (75%) patients had normal chest x-ray. However, WBS revealed pulmonary metastasis in all cases. In 15 (54%) children pulmonary metastasis was detected by first postsurgery 2-3 mCi 131I WBS and in 4 (14%) patients by postablation 131I WBS. Seven cases (25%) and 2 cases were detected by first and second posttherapy 131I WBS, respectively. No statistically significant difference was observed in any of the demographic or clinical parameters in patients in whom pulmonary metastasis was detected by first postsurgical low-dose WBS versus those in whom metastasis was discovered at a later stage. When chest x-ray-positive children were compared to x-ray-negative children, a statistically significant difference was observed only for mean first dose, cumulative dose, and total number of doses of 131I, which were significantly higher in x-ray-positive children. Eighteen of 21 children who had normal chest x-ray also underwent CT scan of the chest. CT could detect micronodular pulmonary shadows in 5 (28%) children only. Complete radioiodine treatment and outcome information was available in 20 patients. Mean first dose and cumulative doses of administered 131I were 75.4 +/- 39.5 mCi and 352 +/- 263 mCi, respectively. After an average number of 3.3 doses of (131)I and mean duration of 33.2 +/- 28.5 months, pulmonary lesions disappeared in 14 (70%) patients and thyroglobulin (Tg) becoming undetectable. In 4 children, however, there was no radiologic or scintigraphical evidence of pulmonary metastasis, Tg was high and in 2 patients, disease was persisting clinically. To conclude, a large majority of pediatric patients with DTC have x-ray- and even high-resolution-negative pulmonary metastasis. However, these metastases are 131I avid, and thus are amenable to detection and treatment with radioiodine. Therefore, postsurgical evaluation with 131I is recommended in all children and adolescents.
我们回顾了儿童和青少年分化型甲状腺癌（DTT）伴肺转移患者的临床特征、初诊时的疾病模式、组织病理学亚型、治疗、病程及预后，并试图评估常规胸部X线检查和胸部高分辨率计算机断层扫描（CT）相对于131I全身扫描（WBS）在发现肺转移方面的有效性。在我们的1754例患者系列中，122例（7%）年龄在20岁及以下，其中28例（23%）有肺转移。平均年龄为13.9±4.4岁（女性与男性比例为12:16）。除2例患者外，所有患者均接受了近全甲状腺切除术及某种形式的颈部清扫术。组织病理学检查显示，89%的病例为乳头状癌，11%为滤泡状癌，所有病例均证实有淋巴结转移。21例（75%）患者胸部X线检查正常。然而，WBS在所有病例中均显示有肺转移。15例（54%）儿童在术后首次2 - 3 mCi 131I WBS时检测到肺转移，4例（14%）患者在消融后131I WBS时检测到肺转移。分别有7例（25%）和2例在首次和第二次治疗后131I WBS时检测到肺转移。在首次术后低剂量WBS检测到肺转移的患者与后期发现转移的患者之间，在任何人口统计学或临床参数方面均未观察到统计学显著差异。将胸部X线检查阳性的儿童与X线检查阴性的儿童进行比较时，仅在131I的平均首次剂量、累积剂量和总剂量方面观察到统计学显著差异，X线检查阳性儿童的这些剂量明显更高。21例胸部X线检查正常的儿童中有18例也接受了胸部CT扫描。CT仅能在5例（28%）儿童中检测到微小结节状肺部阴影。20例患者有完整的放射性碘治疗及预后信息。给予的131I平均首次剂量和累积剂量分别为75.4±39.5 mCi和352±263 mCi。平均给予3.3剂（131）I，平均病程为33.2±28.5个月后，14例（70%）患者肺部病变消失，甲状腺球蛋白（Tg）变得无法检测到。然而，4例儿童没有肺转移的放射学或闪烁扫描证据，Tg升高，2例患者疾病仍在临床上持续存在。总之，大多数患有DTC的儿科患者有X线甚至高分辨率检查阴性的肺转移。然而，这些转移灶对131I摄取良好，因此适合用放射性碘进行检测和治疗。因此，建议对所有儿童和青少年进行术后131I评估。
