Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan.
Pediatr Int. 2020 May;62(5):562-568. doi: 10.1111/ped.14179.
The optimal method for thyroid cancer screening in childhood cancer survivors (CCSs) who received radiation involving the thyroid gland is still debated. We describe a case series of ultrasound surveillance for thyroid tumor in CCSs in our institute.
We conducted thyroid tumor surveillance for CCSs with a history of radiation therapy involving the thyroid. The basic screening method was palpation. Thyroid ultrasound was also performed for patients who agreed after its benefits and risks were explained to them. We surveyed CCSs who visited the long-term follow-up outpatient clinic in our institution between October 2014 and September 2018.
Of 82 CCSs who visited our institution during the study period, 44 were eligible for inclusion. None had a mass identified by palpation. Thyroid ultrasound was performed in 39 CCSs, and we identified thyroid nodules in 27. Four patients had a nodule with malignant echo features. Two of these cases received biopsies, and one patient was ultimately diagnosed with an early stage thyroid carcinoma.
Childhood cancer survivors irradiated in the thyroid had a higher prevalence of thyroid nodules than the general population. Ultrasound screening contributed to early detection of impalpable thyroid cancer and enabled us to perform minimal surgery. Thus, ultrasound appears to be a useful option for secondary thyroid cancer screening. The thyroid tumor surveillance modality should be considered according to the individual case, and the patient must receive a clear explanation of the benefits and risks. These results could help doctors consider how to screen for secondary thyroid cancer.
在曾接受过甲状腺放射性治疗的儿童癌症幸存者（CCS）中，甲状腺癌筛查的最佳方法仍存在争议。我们描述了本机构中一组接受超声监测甲状腺肿瘤的 CCS 病例系列。
我们对曾接受过涉及甲状腺的放射治疗的 CCS 进行甲状腺肿瘤监测。基本的筛查方法是触诊。在向患者解释了超声检查的益处和风险后，也对他们进行了甲状腺超声检查。我们调查了 2014 年 10 月至 2018 年 9 月期间在本机构长期随访门诊就诊的 CCS。
在研究期间，82 名 CCS 就诊于本机构，其中 44 名符合纳入标准。触诊均未发现肿块。对 39 名 CCS 进行了甲状腺超声检查，发现甲状腺结节 27 个。4 名患者的结节有恶性回声特征。其中 2 例进行了活检，其中 1 例最终诊断为甲状腺癌早期。
曾接受甲状腺放射性治疗的 CCS 甲状腺结节的患病率高于普通人群。超声筛查有助于早期发现触诊不可见的甲状腺癌，并使我们能够进行最小的手术。因此，超声检查似乎是继发性甲状腺癌筛查的一种有用选择。应根据具体情况考虑甲状腺肿瘤监测方式，并且必须向患者清楚地解释其益处和风险。这些结果可以帮助医生考虑如何对继发性甲状腺癌进行筛查。
