Ultrasound Surveillance for Thyroid Malignancies in Survivors of Childhood Cancer Following Radiotherapy: A Single Institutional Experience
Ultrasound Surveillance for Thyroid Malignancies in Survivors of Childhood Cancer Following Radiotherapy: A Single Institutional Experience
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DOI：
10.1089/thy.2014.0132
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发表时间：
2014-12-01
期刊：
影响因子：
6.6
通讯作者：
Husein, Murad
中科院分区：
文献类型：
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作者：
Li, Zhe;Franklin, Jason;Husein, Murad
背景资料：接受过头部、颈部和上胸部放疗的儿童癌症（SCC）幸存者发生后续甲状腺恶性肿瘤的风险更高。作为治疗后长期随访方案的一部分，目前的儿童肿瘤学小组指南建议通过每年触诊进行监测;然而，甲状腺结节很难单独通过体格检查检测，并且可能无法检测到潜在的恶性结节。由于甲状腺超声检查是一种敏感且无创的检查方法，因此将其纳入我们的机构随访方案。本研究的目的是检查超声筛查在这一高危人群中的结果。方法：回顾性分析2007 - 2013年我院收治的2007 - 2013年住院患者的病历资料。SCC谁收到了直接或分散辐射到甲状腺，谁是>= 10年的诊断原发性儿童癌被认为是在risk.Results：78名幸存者符合纳入标准，并进行了筛选。甲状腺超声检出甲状腺结节46例（59%），其中5 ~ 10 mm结节17例（22%），≥ 10 mm结节15例（19%）。14例患者（18%）接受了细针穿刺活检。6例患者（8%）接受了手术，5例（6%）确诊为乳头状癌。在第一次超声检查时，发现了各种大小的甲状腺结节。然而，随着时间的推移，这些结节表现出缓慢的生长rates.Conclusions：纳入甲状腺超声常规随访的高风险SCC可能有助于检测甲状腺恶性肿瘤，是不是临床上明显的。使用超声可以详细描述甲状腺结节的特征，并可靠地监测结节的进展。在没有可疑结节的SCC中，由于甲状腺结节的生长速度缓慢，因此可以合理地减少筛查超声的频率。然而，在那些有可疑特征的患者中，手术检查导致了大量恶性肿瘤的切除，几乎没有不必要的手术和并发症。
Background: Survivors of childhood cancer (SCC) who have received radiotherapy to the head, neck, and upper thorax are at higher risk of developing subsequent thyroid malignancies. As part of the post treatment long-term follow-up protocol, the current Children's Oncology Group guideline recommends surveillance by annual palpation; however, thyroid nodules are difficult to detect by physical examinations alone, and potentially malignancy-harboring nodules may be undetected. Since thyroid ultrasound is a sensitive and noninvasive procedure, it was incorporated in our institutional follow-up protocol. The aim of this study was to examine the outcome of ultrasound screening in this high-risk population. The following describes our experience from 2007 to 2013.Methods: A retrospective chart review was conducted on survivors enrolled in our follow-up program. SCC who have received direct or scattered radiation to the thyroid gland, and who were >= 10 years from the diagnosis of primary childhood cancer were considered to be at-risk.Results: Seventy-eight survivors met the inclusion criteria and were screened. Thyroid ultrasound detected thyroid nodule(s) in 46 patients (59%), 17 of which had nodule(s) between 5 and 10 mm (22%), and 15 patients had nodules >= 10 mm (19%). Fourteen patients (18%) underwent fine-needle aspiration biopsy. Six patients (8%) underwent surgery, and 5 (6%) had confirmed papillary carcinoma. At the time of the first ultrasound, thyroid nodules of various sizes were found. However, over time, these nodules demonstrated slow growth rates.Conclusions: Incorporation of thyroid ultrasound into routine follow-up of high-risk SCC may aid in the detection of thyroid malignancies that are not clinically apparent. The use of ultrasound allows detailed characterization of the thyroid nodule and reliable monitoring of nodule progression. In SCC without suspicious nodule(s), it may be reasonable to perform screening ultrasounds less frequently due to the slow growth rate of thyroid nodules. However, in those with suspicious features, surgical work-up resulted in the removal of a high number of malignancies, with few unnecessary surgeries and complications.