Li Zhe, Franklin Jason, Zelcer Shayna, Sexton Tracy, Husein Murad
1 Schulich School of Medicine and Dentistry, University of Western Ontario , London, Ontario, Canada .
Thyroid. 2014 Dec;24(12):1796-805. doi: 10.1089/thy.2014.0132.
Survivors of childhood cancer (SCC) who have received radiotherapy to the head, neck, and upper thorax are at higher risk of developing subsequent thyroid malignancies. As part of the post treatment long-term follow-up protocol, the current Children's Oncology Group guideline recommends surveillance by annual palpation; however, thyroid nodules are difficult to detect by physical examinations alone, and potentially malignancy-harboring nodules may be undetected. Since thyroid ultrasound is a sensitive and noninvasive procedure, it was incorporated in our institutional follow-up protocol. The aim of this study was to examine the outcome of ultrasound screening in this high-risk population. The following describes our experience from 2007 to 2013.
A retrospective chart review was conducted on survivors enrolled in our follow-up program. SCC who have received direct or scattered radiation to the thyroid gland, and who were ≥10 years from the diagnosis of primary childhood cancer were considered to be at-risk.
Seventy-eight survivors met the inclusion criteria and were screened. Thyroid ultrasound detected thyroid nodule(s) in 46 patients (59%), 17 of which had nodule(s) between 5 and 10 mm (22%), and 15 patients had nodules ≥10 mm (19%). Fourteen patients (18%) underwent fine-needle aspiration biopsy. Six patients (8%) underwent surgery, and 5 (6%) had confirmed papillary carcinoma. At the time of the first ultrasound, thyroid nodules of various sizes were found. However, over time, these nodules demonstrated slow growth rates.
Incorporation of thyroid ultrasound into routine follow-up of high-risk SCC may aid in the detection of thyroid malignancies that are not clinically apparent. The use of ultrasound allows detailed characterization of the thyroid nodule and reliable monitoring of nodule progression. In SCC without suspicious nodule(s), it may be reasonable to perform screening ultrasounds less frequently due to the slow growth rate of thyroid nodules. However, in those with suspicious features, surgical work-up resulted in the removal of a high number of malignancies, with few unnecessary surgeries and complications.
接受过头颈部及上胸部放疗的儿童癌症幸存者（SCC）发生后续甲状腺恶性肿瘤的风险较高。作为治疗后长期随访方案的一部分，目前儿童肿瘤学组指南建议通过每年触诊进行监测；然而，仅通过体格检查很难发现甲状腺结节，可能存在恶性病变的结节可能无法被检测到。由于甲状腺超声是一种敏感且无创的检查方法，因此被纳入我们机构的随访方案中。本研究的目的是检查在这一高危人群中超声筛查的结果。以下介绍我们2007年至2013年的经验。
对纳入我们随访项目的幸存者进行回顾性病历审查。接受过甲状腺直接或散射辐射且自原发性儿童癌症诊断起≥10年的SCC被视为高危人群。
78名幸存者符合纳入标准并接受了筛查。甲状腺超声在46例患者（59%）中检测到甲状腺结节，其中17例（22%）的结节大小在5至10毫米之间，15例患者（19%）的结节≥10毫米。14例患者（18%）接受了细针穿刺活检。6例患者（8%）接受了手术，5例（6%）确诊为乳头状癌。在首次超声检查时，发现了各种大小的甲状腺结节。然而，随着时间的推移，这些结节显示出缓慢的生长速度。
将甲状腺超声纳入高危SCC的常规随访中可能有助于发现临床上不明显的甲状腺恶性肿瘤。超声检查的使用可以对甲状腺结节进行详细的特征描述，并可靠地监测结节的进展。在没有可疑结节的SCC中，由于甲状腺结节生长缓慢，减少筛查超声的频率可能是合理的。然而，在那些具有可疑特征的患者中，手术检查导致大量恶性肿瘤被切除，不必要的手术和并发症很少。
