Results of Screening in Familial Non-Medullary Thyroid Cancer
Results of Screening in Familial Non-Medullary Thyroid Cancer
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DOI：
10.1089/thy.2016.0668
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发表时间：
2017-08-01
期刊：
影响因子：
6.6
通讯作者：
Kebebew, Electron
中科院分区：
文献类型：
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作者：
Klubo-Gwiezdzinska, Joanna;Yang, Lily;Kebebew, Electron
背景：虽然甲状腺癌家族史是甲状腺癌的主要危险因素之一，但筛查有甲状腺癌家族史的个体的益处尚不清楚。方法：对亲属被诊断为家族性非髓样甲状腺癌（FNMTC）的高危个体进行前瞻性队列研究，每年使用颈部超声和细针抽吸活检对>0.5 cm的甲状腺结节进行筛查。资格标准是两名或两名以上一级亲属患有甲状腺癌，且年龄超过七岁。共有 25 个亲属参与了这项研究（12 个家庭有 2 名成员受影响，13 个家庭在入组时有 3 名或以上成员受影响）。 结果：通过筛查，在有 2 名成员受影响的家庭中，4.6% (2/43) 的高危个体中发现了甲状腺癌，在有 3 名或更多患者受影响的家庭中，22.7% (15/66) 的高危成员中发现了甲状腺癌 (p = 0.01)。通过筛查检测到的 FNMTC 的特点是肿瘤尺寸较小（0.7+/-0.5 cm vs. 1.5+/-1.1 cm；p = 0.006）、中央颈淋巴结转移率较低（17.6% vs. 51.1%；p = 0.02）、手术范围较小（半甲状腺切除术 23.5% vs. 0%；p = 0.002）以及放射性水平较低与入组时受影响的患者相比，碘治疗（23.5% vs. 79%；p < 0.001）。结论：对高危家庭成员进行筛查可以更早地发现低风险 FNMTC，并且与不太积极的初始治疗相关。对于有 3 个或更多受 FNMTC 影响的家庭成员的亲属，应考虑进行甲状腺超声筛查。由于主动筛查可能与过度治疗的风险相关，因此应谨慎实施，特别是对于老年人。
Background: Although a family history of thyroid cancer is one of the main risk factors for thyroid cancer, the benefit of screening individuals with a family history of thyroid cancer is not known.Methods: A prospective cohort study was performed with yearly screening using neck ultrasound and fine-needle aspiration biopsy of thyroid nodule(s) >0.5 cm in at-risk individuals whose relatives were diagnosed with familial non-medullary thyroid cancer (FNMTC). The eligibility criteria were the presence of thyroid cancer in two or more first-degree relatives and being older than seven years of age. Twenty-five kindred were enrolled in the study (12 families with two members affected, and 13 with three or more members affected at enrollment).Results: Thyroid cancer was detected by screening in 4.6% (2/43) of at-risk individuals from families with two members affected, and in 22.7% (15/66) of at-risk members from families with three or more patients affected (p = 0.01). FNMTC detected by screening was characterized by a smaller tumor size (0.7+/-0.5 cm vs. 1.5+/-1.1 cm; p = 0.006), a lower rate of central neck lymph node metastases (17.6% vs. 51.1%; p = 0.02), less extensive surgery (hemithyroidectomy 23.5% vs. 0%; p = 0.002), and a lower rate of radioactive iodine therapy (23.5% vs. 79%; p < 0.001) compared to those affected at enrollment.Conclusions: Screening of at-risk family members resulted in earlier detection of low-risk FNMTC and was associated with a less aggressive initial treatment. Screening with thyroid ultrasound should be considered in kindred with three or more family members affected by FNMTC. Since active screening might be associated with the risk of overtreatment, it should be implemented with caution, specifically in elderly individuals.