Progression of Nodular Thyroid Disease in Familial Adenomatous Polyposis Syndrome: Refined Surveillance Recommendations

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice Pub Date : 2024-08-01 DOI:10.1016/j.eprac.2024.05.007

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引用次数: 0

Abstract

Background

Patients with familial adenomatous polyposis (FAP) have an increased risk of thyroid nodular disease. Previous studies demonstrated that screening thyroid ultrasound (US) will allow detection of nodules in 38% and thyroid cancer in 2.6% of patients. The aim of this study is to define the value of serial US evaluation at identifying disease progression in patients with FAP.

Methods

Retrospective review from 2008 to 2023 at a single referral center. All patients with FAP and screening thyroid US were included. Patient demographics, initial US characteristics, follow-up regarding the development of new nodules and cancer were assessed using a Kaplan-Meier analysis.

Results

A total of 556 patients underwent screening. Fifty percent were male. Median age at first screening was 38 year old. Eighty percent underwent longitudinal follow-up for a median length of 7 years. At initial screening, 169 patients (30%) had nodules. For patients with normal baseline US, 14% developed a nodule overtime. A total of 20 patients (3.6%) were diagnosed with thyroid cancer. The cumulative incidence of initial and subsequent cancer was 4% by 5 years and 6% by 10 years, while the cumulative incidence of thyroid nodules was 40% and 48%, respectively.

Conclusions

Based on the Kaplan-Meier analysis, ongoing longitudinal screening is warranted for patients with FAP as they are prone to thyroid cancer and nodule development overtime even when presenting with a baseline normal US. Additionally, these data demonstrate a slow development of thyroid cancer from a normal US, thus it is reasonable to consider selectively extending the screening interval for this population.

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家族性腺瘤性息肉病综合征结节性甲状腺疾病的进展：完善的监测建议。

背景家族性腺瘤性息肉病（FAP）患者罹患甲状腺结节疾病的风险较高。以往的研究表明，甲状腺超声筛查（US）可发现 38% 的患者有甲状腺结节，2.6% 的患者有甲状腺癌。本研究旨在确定连续性甲状腺超声评估在识别FAP患者疾病进展方面的价值：方法：对一家转诊中心2008-2023年的研究进行回顾性分析。纳入了所有接受甲状腺 US 筛查的 FAP 患者。采用 Kaplan-Meier 分析法评估了患者的人口统计学特征、最初的 US 特征、有关新结节和癌症发展的随访情况：结果：共有556名患者接受了筛查。结果：共有 556 名患者接受了筛查，其中 51% 为男性。首次筛查的中位年龄为 38 岁。81%的患者接受了纵向随访，中位随访时间为 7 年。初次筛查时，169 名患者（30%）有结节。在基线 US 值正常的患者中，有 14% 的人在超时后出现了结节。共有 20 名患者（3.6%）被确诊为甲状腺癌。甲状腺结节的累积发病率分别为40%和48%：根据Kaplan-Meier分析，FAP患者即使在US检查基线正常的情况下也很容易发生甲状腺癌和甲状腺结节，因此有必要对FAP患者进行持续的纵向筛查。此外，这些数据还表明，甲状腺癌从正常的甲状腺组织检查发展而来的速度很慢，因此有理由考虑有选择性地延长这一人群的筛查间隔。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine Practice ENDOCRINOLOGY & METABOLISM-

CiteScore

7.60

自引率

2.40%

发文量

546

审稿时长

41 days

期刊介绍： Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.

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