Thyroid Program of the Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115, USA.
J Clin Endocrinol Metab. 2013 Aug;98(8):3238-45. doi: 10.1210/jc.2013-1796. Epub 2013 Jun 4.
Thyroid cancer is the most common endocrine malignancy, but due to its rare occurrence in the pediatric population, the cancer risk of childhood thyroid nodules is incompletely defined, and optimal management of children with suspected nodules is debated.
The aim was to study the presenting features and cancer risk of sporadic childhood thyroid nodules using a standardized clinical assessment and management plan.
Boston Children's Hospital and Brigham and Women's Hospital collaborated to create a multidisciplinary pediatric thyroid nodule clinic and implement a standardized assessment plan. Upon referral for a suspected nodule, serum TSH was measured and hypothyrotropinemic patients underwent (123)I scintigraphy. All others underwent thyroid ultrasonography, and if this confirmed nodule(s) ≥ 1 cm, ultrasound-guided fine-needle aspiration was performed. Medical records were retrospectively reviewed and compared to a control population of 2582 adults evaluated by identical methods.
Of 300 consecutive children referred for the initial evaluation of suspected thyroid nodules from 1997 to 2011, 17 were diagnosed with autonomous nodules by scintigraphy. Neck ultrasonography performed in the remainder revealed that biopsy was unnecessary in over half, either by documenting only sub-centimeter nodules or showing that no nodule was present. A total of 125 children met criteria for thyroid biopsy, which was performed without complication. Their rate of cancer was 22%, significantly higher than the adult rate of 14% (P = .02).
Neck ultrasonography and biopsy were key to the evaluation of children with suspected thyroid nodules. Although the relative cancer prevalence of sonographically confirmed nodules ≥ 1 cm is higher in pediatric patients than adults, most children referred for suspected nodules have benign conditions, and efforts to avoid unnecessary surgery in this majority are warranted.
甲状腺癌是最常见的内分泌系统恶性肿瘤，但由于儿童中罕见，儿童甲状腺结节的癌症风险尚未完全明确，且对疑似甲状腺结节患儿的最佳管理方式仍存在争议。
本研究旨在使用标准化临床评估和管理计划，研究散发性儿童甲状腺结节的临床表现和癌症风险。
波士顿儿童医院和布莱根妇女医院合作创建了一个多学科儿科甲状腺结节诊所，并实施了标准化评估计划。在疑似甲状腺结节患者转诊后，检测血清 TSH，促甲状腺素低下的患者进行放射性碘扫描。其余患者均行甲状腺超声检查，如果发现结节≥1cm，则行超声引导下细针抽吸活检。回顾性分析病历，并与 2582 例接受相同方法评估的成人对照人群进行比较。
1997 年至 2011 年期间，300 例连续就诊的疑似甲状腺结节患儿中，17 例通过放射性碘扫描诊断为自主性结节。对其余患者行颈部超声检查发现，超过一半的患者无需进行活检，或仅显示存在亚厘米结节，或不存在结节。共 125 例符合甲状腺活检标准的患儿进行了活检，且操作无并发症。其癌症发生率为 22%，显著高于成人的 14%（P=0.02）。
颈部超声和活检是评估疑似甲状腺结节患儿的关键。虽然经超声证实的结节≥1cm 的儿童癌症相对患病率高于成人，但大多数因疑似结节而就诊的儿童为良性疾病，因此值得努力避免对大多数儿童进行不必要的手术。
