Vali Reza, Rachmiel Marianna, Hamilton Jill, El Zein Mohamad, Wasserman Jonathan, Costantini Danny L, Charron Martin, Daneman Alan
Department of Diagnostic Imaging, Division of Nuclear Medicine, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON, Canada, M5G 1X8,
Pediatr Radiol. 2015 Jul;45(7):1039-45. doi: 10.1007/s00247-014-3261-0. Epub 2014 Dec 19.
Thyroid cancer is the most common endocrine malignancy with relatively good prognosis in children. However, unlike adults, children usually present with more advanced disease and have a higher local recurrence and distant metastases. Thus surveillance for recurrence is a major goal of long-term follow-up.
This retrospective study evaluates the diagnostic value of ultrasound (US) imaging in the post-therapy surveillance of children with differentiated thyroid cancer.
We reviewed the charts of 54 children (40 girls; mean age 14.3 ± 3.6 years) with differentiated thyroid cancer treated with total or near-total thyroidectomy. Forty children (29 girls and 11 boys) who had routine follow-up US examinations (112 studies) were included for the evaluation of US accuracy in the follow-up of pediatric differentiated thyroid cancer. Histopathology, stimulated thyroglobulin determination, post-therapy whole-body iodine scan and clinical follow-up were used as the standards of reference.
Mean period of follow-up was 34 months. The frequency of recurrence was 42% (17/40). Seventeen percent of the children had lung metastases either at presentation or on follow-up. In all cases of lung metastases, stimulated thyroglobulin level was greater than 10 ng/ml. The sensitivity was 85.7%, specificity 89.4%, negative predictive value 94.4% and positive predictive value 75% for US in detecting loco-regional recurrence in follow-up studies of pediatric differentiated thyroid cancer. In 17.3% (18/104) of studies, the results of stimulated thyroglobulin and US were discordant.
US showed very good sensitivity and specificity and a high negative predictive value for evaluation of loco-regional involvement in follow-up of pediatric differentiated thyroid cancer. Diagnostic whole-body iodine scan is indicated when serum anti-thyroglobulin Ab is high, or in cases of discordant findings between US and stimulated thyroglobulin levels, or when stimulated thyroglobulin levels are >10 ng/ml (to evaluate for lung metastasis).
甲状腺癌是儿童中最常见的内分泌恶性肿瘤，预后相对较好。然而，与成人不同的是，儿童通常表现为病情更晚期，局部复发和远处转移的发生率更高。因此，复发监测是长期随访的主要目标。
本回顾性研究评估超声（US）成像在分化型甲状腺癌儿童治疗后监测中的诊断价值。
我们回顾了54例接受全甲状腺切除或近全甲状腺切除治疗的分化型甲状腺癌儿童（40名女孩；平均年龄14.3±3.6岁）的病历。纳入40例（29名女孩和11名男孩）进行常规随访超声检查（112项研究）的儿童，以评估超声在小儿分化型甲状腺癌随访中的准确性。组织病理学、刺激后甲状腺球蛋白测定、治疗后全身碘扫描和临床随访用作参考标准。
平均随访时间为34个月。复发率为42%（17/40）。17%的儿童在初诊时或随访时有肺转移。在所有肺转移病例中，刺激后甲状腺球蛋白水平均大于10 ng/ml。在小儿分化型甲状腺癌随访研究中，超声检测局部区域复发的敏感性为85.7%，特异性为89.4%，阴性预测值为94.4%，阳性预测值为75%。在17.3%（18/104）的研究中，刺激后甲状腺球蛋白和超声的结果不一致。
超声在评估小儿分化型甲状腺癌随访中的局部区域受累情况时显示出非常好的敏感性和特异性以及较高的阴性预测值。当血清抗甲状腺球蛋白抗体较高时，或超声与刺激后甲状腺球蛋白水平结果不一致时，或刺激后甲状腺球蛋白水平>10 ng/ml（用于评估肺转移）时，应进行诊断性全身碘扫描。
