Highlights
- •When screened with thyroid ultrasound (US), the incidence of thyroid cancer in irradiated childhood cancer survivors (CCS) is high (7.1%).
- •Clinical/histological features suggest that diagnosed tumours are clinically relevant.
- •In CCS irradiated to the thyroid gland US surveillance could be worthwhile.
Abstract
Introduction
The optimal surveillance strategy to screen for thyroid carcinoma childhood cancer
survivors (CCS) at increased risk is still debated. In our clinical practice, beside
neck palpation we routinely perform thyroid ultrasound (US). Here we describe the
results obtained using this approach.
Methods
We considered all CCS referred to our long term clinic from November 2001 to September
2014. One hundred and ninety-seven patients who had received radiation therapy involving
the thyroid gland underwent US surveillance. Thyroid US started 5 years after radiotherapy
and repeated every 3 years, if negative.
Results
Among 197 CCS previously irradiated to the thyroid gland, 74 patients (37.5%) developed
thyroid nodules, and fine-needle aspiration was performed in 35. In 11 patients the
cytological examination was suspicious or diagnostic for malignancy (TIR 4/5), whereas
a follicular lesion was diagnosed in nine. Patients with TIR 4/5 cytology were operated
and in all cases thyroid cancer diagnosis was confirmed. The nine patients with TIR
3 cytology also underwent surgery and a carcinoma was diagnosed in three of them.
Prevalence of thyroid cancer was 7.1%. Tumour size ranged between 4 and 25 mm, but
six (43%) were classified T3 because of extra-thyroidal extension. Six patients had
nodal metastases; in eight patients the tumour was multifocal. At the time of the
study all patients are disease free, without evidence of surgery complications.
Conclusion
Applying our US surveillance protocol, the prevalence of radiation-induced thyroid
cancer is high. Histological features of the thyroid cancers diagnosed in our cohort
suggest that most of them were clinically relevant tumours.
Keywords
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Article info
Publication history
Published online: January 14, 2016
Accepted:
December 6,
2015
Received in revised form:
November 4,
2015
Received:
August 5,
2015
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
