Çetin Sirmen Kızılcan, Aycan Zehra, Şıklar Zeynep, Özsu Elif, Fitöz Suat, Ceyhan Koray, Yağmurlu Aydın, Bahadır Gülnur Göllü, Ünal Emel, Taşyıldız Nurdan, Kır Metin, Soydal Çiğdem, Berberoğlu Merih
Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey.
Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey.
Ann Pediatr Endocrinol Metab. 2025 Apr;30(2):86-94. doi: 10.6065/apem.2448100.050. Epub 2025 Apr 30.
Guidelines of the Pediatric American Thyroid Association (ATA) serve as a vital reference for managing the rare thyroid cancers in childhood. This study evaluates differentiated thyroid cancer (DTC) patients using the ATA guidelines, dynamic risk stratification (DRS), and other established risk classification systems.
Pediatric patients with DTC under observation after total thyroidectomy were included in the study. We assessed preoperative and postoperative features based on the ATA guidelines, other risk scoring systems (TNM; De Groot staging; metastasis, age, completeness of resection, invasion, and tumor size; and combined risk), and the DRS.
A total of 41 patients was enrolled in the study, with a median follow-up duration of 5.14±3.94 years. Of the patients who underwent total thyroidectomy, 33 were diagnosed with papillary carcinoma and 8 with follicular thyroid carcinoma. During follow-up, cervical metastases were detected in 27 patients, and one had distant metastasis. All patients underwent total thyroidectomy, and 68% received lymph node dissection. Additionally, 16 patients received radioactive iodine therapy. Of the postoperative patients, 85.3% were classified as low risk. Based on DRS, patients were classified as having no evidence of disease (n=29, 70.7%), biochemical evidence of persistent disease (n=5, 12.2%), structural evidence of persistent disease (n=6, 14.6%), and recurrent disease (n=1, 2.5%). Notably, 98% of the patients showed no evidence of disease during their latest follow-up.
Persistent disease in patients classified as low risk according to the ATA guidelines resolved following radioactive iodine therapy, emphasizing the importance of risk stratification in postoperative care.
美国儿科学会甲状腺协会（ATA）的指南是管理儿童罕见甲状腺癌的重要参考。本研究使用ATA指南、动态风险分层（DRS）和其他既定风险分类系统对分化型甲状腺癌（DTC）患者进行评估。
本研究纳入了全甲状腺切除术后接受观察的DTC儿科患者。我们根据ATA指南、其他风险评分系统（TNM；德格鲁特分期；转移、年龄、切除完整性、侵袭和肿瘤大小；以及综合风险）和DRS评估术前和术后特征。
本研究共纳入41例患者，中位随访时间为5.14±3.94年。在接受全甲状腺切除术的患者中，33例被诊断为乳头状癌，8例为滤泡状甲状腺癌。随访期间，27例患者检测到颈部转移，1例有远处转移。所有患者均接受了全甲状腺切除术，68%接受了淋巴结清扫。此外，16例患者接受了放射性碘治疗。术后患者中，85.3%被归类为低风险。根据DRS，患者被分类为无疾病证据（n=29，70.7%）、持续性疾病的生化证据（n=5，12.2%）、持续性疾病的结构证据（n=6，14.6%）和复发性疾病（n=1，2.5%）。值得注意的是，98%的患者在最近一次随访期间无疾病证据。
根据ATA指南分类为低风险的患者经放射性碘治疗后持续性疾病得到缓解，强调了风险分层在术后护理中的重要性。
