Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar St, PO Box 208062, New Haven, CT.
Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON.
J Pediatr Surg. 2020 Nov;55(11):2273-2283. doi: 10.1016/j.jpedsurg.2020.05.003. Epub 2020 May 11.
Differentiated thyroid carcinomas (DTCs) are rare in young children but represent almost 10% of all malignancies diagnosed in older adolescents.
This article reviews the recent literature describing surgical therapeutic approaches to pediatric DTC, associated complications, and long-term recurrence and survival outcomes.
Similar to adult thyroid cancers, pediatric DTCs are more common in females and are associated with thyroid nodules, family history of thyroid cancer, radiation exposure, iodine deficiency, autoimmune thyroid disease, and genetic syndromes. Management of thyroid cancers in children involves ultrasound imaging, fine needle aspiration, and surgical resection with treatment decisions based on clinical and radiological features, cytology and risk assessment.
Total thyroidectomy and compartment based resection of clinically involved lymph node basins form the cornerstone of treatment of DTC. There is an evolving literature regarding the use of molecular genetics to inform treatment strategies and the use of targeted therapies to treat iodine refractory and surgically unresectable progressive disease.
Summary review.
This is a review article of previously published Level 1-5 articles that includes expert opinion (Level 5).
分化型甲状腺癌（DTC）在幼儿中较为罕见，但在年龄较大的青少年中，其几乎占所有恶性肿瘤的 10%。
本文回顾了近期描述儿科 DTC 手术治疗方法、相关并发症以及长期复发和生存结果的文献。
与成人甲状腺癌一样，儿科 DTC 在女性中更为常见，且与甲状腺结节、甲状腺癌家族史、辐射暴露、碘缺乏、自身免疫性甲状腺疾病和遗传综合征有关。儿童甲状腺癌的管理涉及超声成像、细针穿刺和手术切除，治疗决策基于临床和影像学特征、细胞学和风险评估。
全甲状腺切除术和基于临床受累淋巴结区域的分区切除术是 DTC 治疗的基石。目前有越来越多的文献探讨利用分子遗传学来指导治疗策略，以及利用靶向治疗来治疗碘难治性和手术不可切除的进展性疾病。
综述。
本文是一篇综述文章，包含了先前发表的 1-5 级文章中的专家意见（5 级）。
