ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2020) 17 9.12 | DOI: 10.1530/ey.17.9.12

ESPEYB17 9. Oncology and Chronic Disease Childhood Cancer, Radiation Therapy and Thyroid Disease (2 abstracts)

9.12. Ultrasound is superior to palpation for thyroid cancer detection in high-risk childhood cancer and BMT survivors

Hess J , Schafernak K , Newbern D , Vern-Gross T , Foote J , Van Tassel D , Jamshidi R & Walsh A



To read the full abstract: Support Care Cancer. 2020 Feb 11. Epub ahead of print. hess2@phoenixchildrens.com

The development of a second neoplasia is a major concern during the follow-up of childhood cancer survivors (CCS). Secondary cancers account for nearly 50% of non-relapse mortality at 5 years. Thyroid tumours represent 10-20% of subsequent neoplasia cases, due to the high sensitivity of the gland to irradiation. Patients treated with radiotherapy (RT) to the head, neck, upper thorax, or total body irradiation (TBI) are at higher risk for subsequent thyroid cancer. These tumours may occur many years after the completion of cancer treatment, with a dose-dependent response at doses <30 Gy, and an increased risk in younger patients. Current American Children’s Oncology Group screening guidelines recommend annual neck palpation as a screening test to detect thyroid nodules.

The purpose of this retrospective chart review was to determine if ultrasound (US) is better than palpation to detect thyroid cancer in high-risk CCS. Inclusion criteria were age <20 years at diagnosis and history of RT to the head, neck, upper thorax, or TBI for a primary malignancy, or as part of a conditioning regimen for hematopoietic stem cell transplantation (HSCT). 225 patients had documented palpation and 144 (64%) also had US evaluation. US identified 14 patients who had a final tissue diagnosis of thyroid cancer, with a sensitivity of 100%, while palpation alone identified only 2 of 16 cases, yielding a sensitivity of 12.5%. Screening US correctly identified cases without thyroid cancer with a specificity of 73.1%, while palpation yielded a specificity of 100%. US negative predictive value was 100%. None of the 95 patients who underwent at least one screening US and were not noted to have a suspected thyroid nodule, developed thyroid cancer in longitudinal follow-up.

The debate on whether the gold standard to detect secondary thyroid tumours is neck palpation or US has been active for a long time. This study has the limitation of neck palpation performed by different endocrinologists, but shows that US has much higher sensitivity. US is able to identify the thyroid neoplasm when it is still undetectable by neck palpation and presumably less invasive, and this should result in earlier and easier interventions. On the other hand, the use of thyroid US does not seem to be associated with a higher frequency of unnecessary invasive procedures, such as fine needle aspiration biopsy (FNAB). These findings, together with the low cost of the procedure, lead to consider US as the gold standard for thyroid nodule detection in CCS population.

References:

1. Children’s Oncology Group (2018) Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancer, version 5.0. www.survivorshipguidelines.org. Accessed October 2018.

2. Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules-2016 Update. Endocr Pract. 2016;22:622–39.

3. Clement SC, Kremer LC, Links TP, et al. Is outcome of differentiated thyroid carcinoma influenced by tumor stage at diagnosis? Cancer Treat Rev. 2015;41:9–16.

4. Clement SC, Kremer LCM, Verburg FA, Simmons JH, Goldfarb M, Peeters RP, Alexander EK, Bardi E, Clement SC, Kremer LCM, Verburg FA, et al. Balancing the benefits and harms of thyroid cancer surveillance in survivors of Childhood, adolescent and young adult cancer: Recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Cancer Treat Rev. 2018;63:28–39.

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