Brignardello Enrico, Corrias Andrea, Isolato Giuseppe, Palestini Nicola, Cordero di Montezemolo Luca, Fagioli Franca, Boccuzzi Giuseppe
Transition Unit for Childhood Cancer Survivors, San Giovanni Battista Hospital, 10126 Turin, Italy.
J Clin Endocrinol Metab. 2008 Dec;93(12):4840-3. doi: 10.1210/jc.2008-1528. Epub 2008 Sep 23.
Childhood cancer survivors need regular monitoring into young adulthood and beyond, because they are at risk for developing late-onset complications of cancer therapy, including second malignancies.
This study focuses on the use of thyroid ultrasound to screen for thyroid carcinoma in a population of childhood cancer survivors.
A total of 129 subjects who had received radiotherapy to the head, neck, or upper thorax for a pediatric cancer were studied in the setting of a long-term follow-up unit.
Thyroid ultrasound usually began 5 yr after radiotherapy and was repeated every third year, if negative. Median follow-up time since childhood cancer diagnosis was 15.8 yr (range 6.1-34.8 yr). Solid thyroid nodules were found in 35 patients. Fine-needle aspiration was performed in 19 patients, of which 14 had nodules above 1 cm.
The main outcome measure was the finding of not palpable thyroid cancers.
Cytological examination of specimens diagnosed papillary carcinoma in five patients who underwent surgery. The cytological diagnosis of papillary thyroid carcinoma was confirmed in all cases by histological examination. Notably, only two of these patients had palpable nodules; the other three were smaller than 1 cm and were detected only by ultrasound. However, histological examination showed nodal metastases in two of these.
Although ultrasound screening for thyroid cancer in the general population is not cost effective and could lead to unnecessary surgery, due to false positives, we believe that in childhood cancer survivors who received radiotherapy involving the head, neck, or upper thorax, it would be worthwhile.
儿童癌症幸存者在青年期及以后需要定期监测，因为他们有发生癌症治疗迟发性并发症的风险，包括二次恶性肿瘤。
本研究聚焦于在儿童癌症幸存者群体中使用甲状腺超声筛查甲状腺癌。
在一个长期随访机构中，对总共129名因儿童癌症接受过头颈部或上胸部放疗的受试者进行了研究。
甲状腺超声通常在放疗后5年开始，如果结果为阴性，则每三年重复一次。自儿童癌症诊断后的中位随访时间为15.8年（范围6.1 - 34.8年）。35名患者发现了实性甲状腺结节。19名患者进行了细针穿刺抽吸，其中14名患者的结节大于1厘米。
主要观察指标是发现不可触及的甲状腺癌。
对接受手术的5名患者的标本进行细胞学检查诊断为乳头状癌。所有病例经组织学检查均证实为甲状腺乳头状癌的细胞学诊断。值得注意的是，这些患者中只有两名有可触及的结节；另外三名结节小于1厘米，仅通过超声检测到。然而，组织学检查显示其中两名有淋巴结转移。
尽管在普通人群中超声筛查甲状腺癌不具有成本效益，并且可能因假阳性导致不必要的手术，但我们认为在接受过头颈部或上胸部放疗的儿童癌症幸存者中，这样做是值得的。
