Ultrasound Screening for Thyroid Carcinoma in Childhood Cancer Survivors: A Case Series

Context: Childhood cancer survivors need regular monitoring into young adulthood and beyond, because they are at risk for developing late-onset complications of cancer therapy, including second malignancies. Objective: This study focuses on the use of thyroid ultrasound to screen for thyroid carcino...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2008-12, Vol.93 (12), p.4840-4843
Main Authors: Brignardello, Enrico, Corrias, Andrea, Isolato, Giuseppe, Palestini, Nicola, Cordero di Montezemolo, Luca, Fagioli, Franca, Boccuzzi, Giuseppe
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age of Onset
Biological and medical sciences
Biopsy, Fine-Needle
Carcinoma, Papillary, Follicular - diagnosis
Carcinoma, Papillary, Follicular - diagnostic imaging
Carcinoma, Papillary, Follicular - pathology
Child
Child, Preschool
Endocrinopathies
Feeding. Feeding behavior
Female
Follow-Up Studies
Fundamental and applied biological sciences. Psychology
Humans
Infant
Long-Term Care
Male
Malignant tumors
Medical sciences
Neoplasm Metastasis - pathology
Neoplasms - complications
Neoplasms - radiotherapy
Survivors
Thyroid Function Tests
Thyroid Neoplasms - diagnosis
Thyroid Neoplasms - diagnostic imaging
Thyroid Neoplasms - pathology
Thyroid Nodule - diagnostic imaging
Thyroid. Thyroid axis (diseases)
Thyroidectomy
Ultrasonography
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
Young Adult
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Summary:Context: Childhood cancer survivors need regular monitoring into young adulthood and beyond, because they are at risk for developing late-onset complications of cancer therapy, including second malignancies. Objective: This study focuses on the use of thyroid ultrasound to screen for thyroid carcinoma in a population of childhood cancer survivors. Patients: A total of 129 subjects who had received radiotherapy to the head, neck, or upper thorax for a pediatric cancer were studied in the setting of a long-term follow-up unit. Design: Thyroid ultrasound usually began 5 yr after radiotherapy and was repeated every third year, if negative. Median follow-up time since childhood cancer diagnosis was 15.8 yr (range 6.1–34.8 yr). Solid thyroid nodules were found in 35 patients. Fine-needle aspiration was performed in 19 patients, of which 14 had nodules above 1 cm. Main Outcome Measure: The main outcome measure was the finding of not palpable thyroid cancers. Results: Cytological examination of specimens diagnosed papillary carcinoma in five patients who underwent surgery. The cytological diagnosis of papillary thyroid carcinoma was confirmed in all cases by histological examination. Notably, only two of these patients had palpable nodules; the other three were smaller than 1 cm and were detected only by ultrasound. However, histological examination showed nodal metastases in two of these. Conclusions: Although ultrasound screening for thyroid cancer in the general population is not cost effective and could lead to unnecessary surgery, due to false positives, we believe that in childhood cancer survivors who received radiotherapy involving the head, neck, or upper thorax, it would be worthwhile. Ultrasound screening for thyroid carcinoma in childhood cancer survivors is worthy because it detects unpalpable thyroid cancers, some of which contain nodal metastases.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2008-1528