Center for Cancer and Blood Disorders, Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ, 85016, USA.
Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA.
Support Care Cancer. 2020 Nov;28(11):5117-5124. doi: 10.1007/s00520-020-05340-0. Epub 2020 Feb 11.
Thyroid cancer is a common subsequent malignant neoplasm in childhood cancer survivors (CCS). Patients who received radiotherapy (RT) to the head, neck, upper thorax, or total body irradiation (TBI) are considered to be at risk for subsequent thyroid cancer. Current Children's Oncology Group screening guidelines recommend annual neck palpation. Our objective was to determine if ultrasound (US) is more sensitive and specific than palpation to detect thyroid cancer in high-risk CCS and bone marrow transplant (BMT) survivors.
Electronic medical records of patients followed in a longitudinal survivorship clinic from January 1, 2010 to December 31, 2017 were reviewed. Inclusion criteria included history of RT to the head, neck, upper thorax, or TBI for primary therapy or preparation for BMT prior to the age of 20 years.
Two hundred and twenty-five patients had documented palpation and 144 (64%) also had US evaluation. Mean radiation dose was 28.6 Gy. Sixteen of 225 patients (7.1%) developed a subsequent thyroid cancer at a mean of 9.7 years from the completion of RT. Sensitivity of US was 100% compared with 12.5% for palpation. US demonstrated higher accuracy, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.87 versus 0.56 for palpation (P < 0.0001).
Routine screening with US was more sensitive than palpation for detection of subsequent thyroid cancer after high-risk RT in CCS and BMT survivors. Screening US may lead to earlier detection of thyroid cancer in this population. Earlier diagnosis has the potential to decrease operative complexity, and earlier definitive therapy reduces the likelihood of metastatic disease.
甲状腺癌是儿童癌症幸存者（CCS）中常见的继发恶性肿瘤。接受头部、颈部、上胸部或全身照射（TBI）放疗（RT）的患者被认为有发生继发甲状腺癌的风险。目前儿童肿瘤学组的筛查指南建议每年进行颈部触诊。我们的目的是确定超声（US）是否比触诊更敏感和特异，以检测高危 CCS 和骨髓移植（BMT）幸存者中的甲状腺癌。
回顾 2010 年 1 月 1 日至 2017 年 12 月 31 日在纵向生存随访诊所就诊的患者的电子病历。纳入标准包括因原发性治疗或 BMT 准备而接受头部、颈部、上胸部或 TBI 放疗的病史，且在 20 岁之前接受治疗。
225 例患者有记录的触诊结果，144 例（64%）患者还进行了 US 评估。平均辐射剂量为 28.6Gy。225 例患者中有 16 例（7.1%）在完成 RT 后平均 9.7 年发展为继发甲状腺癌。US 的敏感性为 100%，而触诊的敏感性为 12.5%。US 的准确性更高，其接受者操作特征（ROC）曲线下面积（AUC）为 0.87，而触诊的 AUC 为 0.56（P<0.0001）。
在高危 RT 后的 CCS 和 BMT 幸存者中，常规 US 筛查比触诊更敏感，可检测出继发甲状腺癌。在该人群中，筛查 US 可能会更早地发现甲状腺癌。早期诊断有可能降低手术复杂性，早期确定性治疗可降低转移性疾病的发生概率。
