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IF 5.8 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Thyroid Pub Date : 2025-01-31 DOI:10.1089/thy.2024.0624

Sanjay Rao, Mary C Frates, Carol B Benson, Christine E Cherella, Jessica R Smith, Ari J Wassner

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引用次数: 0

摘要

背景：分化型甲状腺癌（DTC分化型甲状腺癌（DTC）是最常见的儿科内分泌恶性肿瘤。初次治疗后超声（US）监测的效用尚未明确界定。我们试图评估在初次治疗后 1 年开始对甲状腺癌儿童患者进行超声检查以检测残留或复发疾病的临床实用性。方法：这是一项针对儿科患者的回顾性队列研究（结果：共有 112 名患者接受了为期 1 年的治疗）：共有112名患者的1年RTT结果为优秀（61人，占54.5%）或不确定（51人，占45.5%）。后续随访时间的中位数为 6.4 年（四分位间范围为 3.8-8.9 年）。总体而言，共进行了 683 次颈部 US 监测，平均（± 标准差）为每位患者每年 1.0 ± 0.4 次。在 61 名 RTT 良好的患者中，没有人在随访期间出现 SDN。有 18 名患者（29.5%）出现了假阳性的不确定或异常 US 发现。在 51 名 RTT 不确定的患者中，有 9 人（17.6%）在随访期间出现 SDN。其中 7/9 例（77.8%）通过 US 检测到 SDN。有两例（22.2%）患者通过 I-123 扫描检测到 SDN，但未通过 US 检测到，这两例患者的 Tg/TgAb 均异常。7/9（77.8%）例通过 Tg/TgAb 检测出 SDN。总体而言，17/112 例（15.2%）患者进行了细针穿刺术（FNA），6 例患者确诊为 SDN。总体而言，有 11/112 例患者（9.8%）接受了细针穿刺术，但未确诊为 SDN。结论对于初始治疗反应良好的小儿 DTC 患者，由于 SDN 风险较低，且 US 结果经常出现假阳性，因此连续 US 监测的效用受到了限制。在RTT不确定的儿童中，SDN的发生率很高，可通过US或异常Tg/TgAb水平检测到。这些患者可能会受益于 US 和生化监测的结合。

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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Utility of Ultrasound Surveillance for Thyroid Cancer in Children.

Background: Differentiated thyroid cancer (DTC) is the most common pediatric endocrine malignancy. The utility of ultrasound (US) surveillance after initial treatment has not been clearly delineated. We sought to evaluate the clinical utility of US for the detection of residual or recurrent disease in pediatric patients with thyroid cancer beginning 1 year after initial therapy. Methods: This is a retrospective cohort study of pediatric patients (<19 years) diagnosed with DTC between 1998 and 2022 whose response to therapy (RTT) one year after initial treatment (thyroidectomy ± radioactive iodine) was excellent or indeterminate. We evaluated the association between sonographic and biochemical findings (thyroglobulin [Tg] and Tg antibodies [TgAb]) at one year with the subsequent diagnosis of residual/recurrent structural disease in the neck (SDN). Results: In total, 112 patients had 1-year RTT that was excellent (n = 61, 54.5%) or indeterminate (n = 51, 45.5%). Median length of subsequent follow-up was 6.4 (interquartile range 3.8-8.9) years. Overall, 683 surveillance neck US were performed, with a mean ± standard deviation of 1.0 ± 0.4 US per patient per year. Of 61 patients with excellent RTT, none developed SDN during follow-up. Eighteen patients (29.5%) had a false-positive indeterminate or abnormal US finding. Of 51 patients with indeterminate RTT, 9 (17.6%) developed SDN during follow-up. SDN was detected by US in 7/9 cases (77.8%). SDN was detected by I-123 scan, but not by US, in two cases (22.2%), both with abnormal Tg/TgAb. 7/9 (77.8%) cases of SDN were detectable by Tg/TgAb. Overall, fine-needle aspiration (FNA) was performed in 17/112 (15.2%) patients and diagnosed SDN in six patients. Overall, 11/112 patients (9.8%) underwent FNA but were not diagnosed with SDN. Conclusions: In pediatric DTC patients with excellent response to initial therapy, the utility of serial US surveillance is limited by the low risk of SDN and frequent false-positive US findings. In children with indeterminate RTT, SDN occurs in a significant proportion and may be detected by US or by abnormal Tg/TgAb levels. These patients may benefit from the combination of US and biochemical surveillance.

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来源期刊

Thyroid 医学-内分泌学与代谢

CiteScore

12.30

自引率

6.10%

发文量

195

审稿时长

6 months

期刊介绍： This authoritative journal program, including the monthly flagship journal Thyroid, Clinical Thyroidology® (monthly), and VideoEndocrinology™ (quarterly), delivers in-depth coverage on topics from clinical application and primary care, to the latest advances in diagnostic imaging and surgical techniques and technologies, designed to optimize patient care and outcomes. Thyroid is the leading, peer-reviewed resource for original articles, patient-focused reports, and translational research on thyroid cancer and all thyroid related diseases. The Journal delivers the latest findings on topics from primary care to clinical application, and is the exclusive source for the authoritative and updated American Thyroid Association (ATA) Guidelines for Managing Thyroid Disease.