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Sosnowska-Sienkiewicz P, Danielewicz D, Januszkiewicz-Lewandowska D, Rusak P, Anderko I, Rzepecki M, Niedziela M, Harasymczuk J, Mańkowski P. Thyroid diseases in children and adolescents requiring surgical treatment-indications, techniques, results, and complications based on 10 years of the single center's own experience. Front Endocrinol (Lausanne) 2024; 14:1301191. [PMID: 38283745 PMCID: PMC10811211 DOI: 10.3389/fendo.2023.1301191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Although thyroid abnormalities are observed less frequently in children than in adults, the increased incidence of thyroid cancer makes it mandatory for all pediatric surgeons to be knowledgeable about the disorders of this gland. Thyroid abnormalities can be associated with hyperthyroidism or hypothyroidism and euthyroidism and/or symmetric or asymmetric enlargement of the gland. Aim The present study was undertaken to retrospectively analyze the indications, surgical techniques used, results obtained, and complications found in the surgical treatment of thyroid diseases in children and adolescents in a surgical center for the macro-region of western Poland. Methods The data of 148 patients undergoing total or partial thyroidectomy between 2013 and 2022 were analyzed from the medical records of the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan, Poland. Results A total of 95 children underwent subtotal thyroidectomy and 64 underwent total thyroidectomy, of which the procedure was widened to include prophylactic removal of neck lymph nodes in 45 patients. There were 113 girls (76%) in the analyzed group, and the average age of the patients at the time of surgical treatment was 15 years. The average time from the diagnosis of thyroid disease to surgery was 4 months, ranging from 2 weeks to 3 years. Of the 64 patients undergoing total thyroid resection, 35 (54.69%) were diagnosed with thyroid cancer. Conclusions Collaboration within a multidisciplinary team ensures optimal surgical outcomes in children and adolescents with thyroid disease. With extreme caution, thyroid removal is a safe procedure with few complications, but the experience of the surgeon performing thyroid surgery in children remains crucial. Despite the absence of such a diagnosis in the first fine-needle aspiration biopsy, the high percentage of thyroid carcinomas in the analyzed group may be because the initial biopsy was performed in a less experienced center, also in terms of histopathological laboratory. Hence, we point out the necessity of performing a repeat fine-needle aspiration biopsy (according to the Bethesda classification) in a more experienced center before the final decision of thyroidectomy.
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Affiliation(s)
| | - Dajana Danielewicz
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Paulina Rusak
- Student Research Group of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Iwona Anderko
- Student Research Group of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Maciej Rzepecki
- Student Research Group of Pediatric Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Jerzy Harasymczuk
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznań, Poland
| | - Przemysław Mańkowski
- Department of Pediatric Surgery, Traumatology and Urology, Poznan University of Medical Sciences, Poznań, Poland
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LncRNA ATP1A1-AS1 inhibits cell proliferation and promotes cell apoptosis in thyroid carcinoma by regulating the miR-620/IRF2BP2 axis. Am J Med Sci 2023; 365:73-83. [PMID: 36002076 DOI: 10.1016/j.amjms.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/28/2022] [Accepted: 08/15/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Thyroid carcinoma (THCA) is a common malignancy of the endocrine system. Further understanding of the molecular mechanism underlying THCA is crucial to develop effective diagnostic therapy and improve its treatments. In this study, we intended to provide novel direction for THCA targeted therapy from the aspect of lncRNA-miRNA-mRNA interaction. We aimed to investigate the function and molecular mechanism of lncRNA ATP1A1-AS1 in THCA. METHODS Gene expression was assessed by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Cell growth was detected by CCK-8 and EdU assays. Flow cytometry was applied for analyzing cell apoptosis. The binding of ATP1A1-AS1 or IRF2BP2 to miR-620 was validated by RNA pulldown and luciferase reporter assays. The protein levels were examined by western blotting. RESULTS ATP1A1-AS1 was decreased in THCA cells and tissues. ATP1A1-AS1 overexpression attenuated cell growth and promoted apoptosis. MiR-620, which was upregulated in THCA, was identified as a direct target of ATP1A1-AS1. Furthermore, IRF2BP2 was discovered to be a target of miR-620, which displayed low expression in THCA cells and tissues. Importantly, IRF2BP2 knockdown reversed the influence of ATP1A1-AS1 overexpression on THCA cell proliferation and apoptosis. CONCLUSIONS LncRNA ATP1A1-AS1 inhibited cell growth and promotes apoptosis in THCA via the miR-620/IRF2BP2 axis.
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Martucci C, Crocoli A, De Pasquale MD, Spinelli C, Strambi S, Brazzarola P, Morelli E, Cassiani J, Mancera J, Luengas JP, Lobos P, Liberto D, Astori E, Sarnacki S, Couloigner V, Simon F, Lambert C, Abib SDCV, Cervantes O, Caran E, Delgado Lindman D, Jones MO, Shukla R, Losty PD, Inserra A. Thyroid cancer in children: A multicenter international study highlighting clinical features and surgical outcomes of primary and secondary tumors. Front Pediatr 2022; 10:914942. [PMID: 35935364 PMCID: PMC9354958 DOI: 10.3389/fped.2022.914942] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Thyroid gland malignancies are rare in pediatric patients (0.7% of tumors); only 1.8% are observed in patients aged <20 years, with a higher prevalence recorded in women and adolescents. Risk factors include genetic syndromes, MEN disorders, autoimmune diseases, and exposure to ionizing radiation. Radiotherapy is also associated with an increased risk of secondary thyroid cancer. This study describes the clinical features and surgical outcomes of primary and secondary thyroid tumors in pediatric patients. METHODS Institutional data were collected from eight international surgical oncology centers for pediatric patients with thyroid cancer between 2000 and 2020. Statistical analyses were performed using the GraphPad Prism software. RESULTS Among 255 total cases of thyroid cancer, only 13 (5.1%) were secondary tumors. Primary thyroid malignancies were more likely to be multifocal in origin (odds ratio [OR] 1.993, 95% confidence interval [CI].7466-5.132, p = 0.2323), have bilateral glandular location (OR 2.847, 95% CI.6835-12.68, p = 0.2648), and be metastatic at first diagnosis (OR 1.259, 95% CI.3267-5.696, p > 0.999). Secondary tumors showed a higher incidence of disease relapse (OR 1.556, 95% CI.4579-5.57, p = 0.4525) and surgical complications (OR 2.042, 95% CI 0.7917-5.221, p = 0.1614), including hypoparathyroidism and recurrent laryngeal nerve injury. The overall survival (OS) was 99% at 1 year and 97% after 10 years. No EFS differences were evident between the primary and secondary tumors (chi-square 0.7307, p = 0.39026). CONCLUSIONS This multicenter study demonstrated excellent survival in pediatric thyroid malignancies. Secondary tumors exhibited greater disease relapse (15.8 vs. 10.5%) and a higher incidence of surgical complications (36.8 vs. 22.2%).
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Affiliation(s)
- Cristina Martucci
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Crocoli
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Debora De Pasquale
- Department of Pediatric Hematology/Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudio Spinelli
- Department of Pediatric Surgery, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Department of Pediatric Surgery, University of Pisa, Pisa, Italy
| | - Paolo Brazzarola
- Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Eleonora Morelli
- Department of Surgery and Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Jessica Cassiani
- Department of Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Juliana Mancera
- Department of Pediatric Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Juan Pablo Luengas
- Department of Pediatric Oncology, National Cancer Institute, Liverpool, Colombia
| | - Pablo Lobos
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Liberto
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Estefanìa Astori
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Vincent Couloigner
- Department of Pediatric Otolaryngology, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - François Simon
- Department of Pediatric Otolaryngology, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Cassandre Lambert
- Department of Pediatric Otolaryngology, Necker-Enfants Malades Hospital, Université de Paris, Paris, France
| | - Simone de Campos Vieira Abib
- Department of Pediatric Oncology Surgery and Pediatric Oncology, Pediatric Oncology Institute-GRACC, Federal University of São Paulo, São Paulo, Brazil
| | - Onivaldo Cervantes
- Department of Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil
| | - Eliana Caran
- Department of Pediatric Oncology Surgery and Pediatric Oncology, Pediatric Oncology Institute-GRACC, Federal University of São Paulo, São Paulo, Brazil
| | - Diana Delgado Lindman
- Department of Pediatric Oncology Surgery and Pediatric Oncology, Pediatric Oncology Institute-GRACC, Federal University of São Paulo, São Paulo, Brazil
| | - Matthew O Jones
- Department of Pediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Rajeev Shukla
- Department of Pathology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Paul D Losty
- Department of Pediatric Surgery, Faculty of Health and Life Sciences, Alder Hey Children's Hospital NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Alessandro Inserra
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sepehrizadeh T, Jong I, DeVeer M, Malhotra A. PET/MRI in paediatric disease. Eur J Radiol 2021; 144:109987. [PMID: 34649143 DOI: 10.1016/j.ejrad.2021.109987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
Nuclear medicine and molecular imaging have a small but growing role in the management of paediatric and neonatal diseases. During the past decade, combined PET/MRI has emerged as a clinically important hybrid imaging modality in paediatric medicine due to diagnostic advantages and reduced radiation exposure compared to alternative techniques. The applications for nuclear medicine, radiopharmaceuticals and combined PET/MRI in paediatric diagnosis is broadly similar to adults, however there are some key differences. There are a variety of clinical applications for PET/MRI imaging in children including, but not limited to, oncology, neurology, cardiovascular, infection and chronic inflammatory diseases, and in renal-urological disorders. In this article, we review the applications of PET/MRI in paediatric and neonatal imaging, its current role, advantages and disadvantages over other hybrid imaging techniques such as PET/CT, and its future applications. Overall, PET/MRI is a powerful imaging technology in diagnostic medicine and paediatric diseases. Higher soft tissue contrasts and lower radiation dose of the MRI makes it the superior technology compared to other conventional techniques such as PET/CT or scintigraphy. However, this relatively new hybrid imaging has also some limitations. MRI based attenuation correction remains a challenge and although methodologies have improved significantly in the last decades, most remain under development.
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Affiliation(s)
| | - Ian Jong
- Department of diagnostic imaging, Monash Health, Melbourne, Australia
| | - Michael DeVeer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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Kim SM, Kim SY, Park CS, Chang HS, Park KC. Impact of Age-Related Genetic Differences on the Therapeutic Outcome of Papillary Thyroid Cancer. Cancers (Basel) 2020; 12:cancers12020448. [PMID: 32075109 PMCID: PMC7072359 DOI: 10.3390/cancers12020448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence of papillary thyroid carcinoma (PTC) has been increasing worldwide. PTC is the most common type of differentiated thyroid cancer and usually shows good prognosis. However, some PTC is driven to advanced stage by epithelial-mesenchymal transition (EMT)-mediated drug resistance, which is particularly noticeable in pediatric patients. There are limited options for systemic treatment, necessitating development of new clinical approaches. Here, we aimed to clarify genetic differences due to age of patients with PTC, and thereby aid in developing novel therapeutics. Patients with biochemically and histologically confirmed PTC were included in this study. PTC cells were acquired from young and older patients showing drug resistance, and were compared via microarray analysis. Cellular proliferation and other properties were determined after treatments with lenvatinib and sorafenib. In vivo, tumor volume and other properties were examined using a mouse xenograft model. Lenvatinib-treated group showed obvious suppression of markers of anti-apoptosis, EMT, and the FGFR signaling pathway, compared with control and Sorafenib-treated group. In the xenograft models, lenvatinib treatment induced significant tumor shrinkage and blocked the proto-oncogene Bcl-2 (B cell lymphoma/leukemia gene-2) and FGFR signaling pathway, along with reduced levels of EMT markers, compared with control and Sorafenib-treated group. Our findings clarify the age-dependent characteristics of pediatric PTC, giving insights into the relationship between young age and poor prognosis. Furthermore, it provides a basis for developing novel therapeutics tailored to the age at diagnosis.
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Affiliation(s)
- Seok-Mo Kim
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea; (S.-M.K.); (S.Y.K.); (C.S.P.); (H.-S.C.)
- Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul 135-720, Korea
| | - Soo Young Kim
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea; (S.-M.K.); (S.Y.K.); (C.S.P.); (H.-S.C.)
- Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul 135-720, Korea
| | - Cheong Soo Park
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea; (S.-M.K.); (S.Y.K.); (C.S.P.); (H.-S.C.)
- Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul 135-720, Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea; (S.-M.K.); (S.Y.K.); (C.S.P.); (H.-S.C.)
- Gangnam Severance Hospital, Department of Surgery, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul 135-720, Korea
| | - Ki Cheong Park
- Department of Surgery, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
- Correspondence: ; Tel.: +82-2-2228-2861; Fax: +82-2-362-8647
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Update on thyroid ultrasound: a narrative review from diagnostic criteria to artificial intelligence techniques. Chin Med J (Engl) 2020; 132:1974-1982. [PMID: 31348028 PMCID: PMC6708700 DOI: 10.1097/cm9.0000000000000346] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective Ultrasound imaging is well known to play an important role in the detection of thyroid disease, but the management of thyroid ultrasound remains inconsistent. Both standardized diagnostic criteria and new ultrasound technologies are essential for improving the accuracy of thyroid ultrasound. This study reviewed the global guidelines of thyroid ultrasound and analyzed their common characteristics for basic clinical screening. Advances in the application of a combination of thyroid ultrasound and artificial intelligence (AI) were also presented. Data sources An extensive search of the PubMed database was undertaken, focusing on research published after 2001 with keywords including thyroid ultrasound, guideline, AI, segmentation, image classification, and deep learning. Study selection Several types of articles, including original studies and literature reviews, were identified and reviewed to summarize the importance of standardization and new technology in thyroid ultrasound diagnosis. Results Ultrasound has become an important diagnostic technique in thyroid nodules. Both standardized diagnostic criteria and new ultrasound technologies are essential for improving the accuracy of thyroid ultrasound. In the standardization, since there are no global consensus exists, common characteristics such as a multi-feature diagnosis, the performance of lymph nodes, explicit indications of fine needle aspiration, and the diagnosis of special populations should be focused on. Besides, evidence suggests that AI technique has a good effect on the unavoidable limitations of traditional ultrasound, and the combination of diagnostic criteria and AI may lead to a great promotion in thyroid diagnosis. Conclusion Standardization and development of novel techniques are key factors to improving thyroid ultrasound, and both should be considered in normal clinical use.
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Patel VA, Khaku A, Carr MM. Pediatric Thyroidectomy: NSQIP-P Analysis of Adverse Perioperative Outcomes. Ann Otol Rhinol Laryngol 2019; 129:326-332. [DOI: 10.1177/0003489419889069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: This study identifies risk factors and 30-day adverse outcomes of pediatric patients undergoing thyroidectomy. Methods: Retrospective analysis utilizing the American College of Surgeons National Surgical Quality Improvement–Pediatric Database (2015-2016). Study population includes pediatric patients (≤18 years) who underwent hemithyroidectomy (HT), total thyroidectomy (TT), and total thyroidectomy with central neck dissection (TT+ND). Results: A total of 720 cases were identified; mean age at time of surgery was 14.1 years, with a female-to-male ratio of 3.4:1. Following hospital discharge, there were 10 related readmissions, with 1 patient requiring reoperation for neck hematoma evacuation. Regression analysis revealed anesthesia time had a significant impact on total length of stay ( P = .0020). Conclusion: Contemporary pediatric thyroidectomy has a low incidence of 30-day general surgical postoperative complications. Future research efforts are necessary once thyroidectomy specific variables are incorporated into ACS-NSQIP-P, which will provide further insights into managing this unique patient population.
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Affiliation(s)
- Vijay A. Patel
- Department of Otolaryngology—Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Aliasgher Khaku
- Department of Otolaryngology—Head and Neck Surgery, East Virginia Medical School, Norfolk, VA, USA
| | - Michele M. Carr
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, West Virginia University, Morgantown, WV, USA
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Surgical Management of Thyroid Disease in Children. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Essenmacher AC, Joyce PH, Kao SC, Epelman M, Pesce LM, D’Alessandro MP, Sato Y, Johnson CM, Podberesky DJ. Sonographic Evaluation of Pediatric Thyroid Nodules. Radiographics 2017; 37:1731-1752. [DOI: 10.1148/rg.2017170059] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Alex C. Essenmacher
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Peter H. Joyce
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Simon C. Kao
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Monica Epelman
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Liuska M. Pesce
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Michael P. D’Alessandro
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Yutaka Sato
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Craig M. Johnson
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
| | - Daniel J. Podberesky
- From the Department of Radiology (A.C.E., S.C.K., M.P.D., Y.S.) and Stead Family Department of Pediatrics (L.M.P.), University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52246; the University of Central Florida College of Medicine, Orlando, Fla (P.H.J.); and the Department of Radiology, Nemours Children’s Health System, Nemours Children’s Hospital, Orlando, Fla (M.E., C.M.J., D.J.P.)
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Abstract
Nuclear medicine has an important role in the management of many cancers in pediatric age group with multiple imaging modalities and radiopharmaceuticals targeting various biological uptake mechanisms. 18-Flourodeoxyglucose is the radiotracer of choice especially in patients with sarcoma and lymphoma. (18)FDG-PET, for sarcoma and lymphomas, is proved to be superior to conventional imaging in staging and therapy response. Although studies are limited in pediatric population, (18)FDG-PET/CT has found its way through international guidelines. Limitations and strengths of PET imaging must be noticed before adapting PET imaging in clinical protocols. Established new response criteria using multiple parameters derived from (18)FDG-PET would increase the accuracy and repeatability of response evaluation. Current data suggest that I-123 metaiodobenzylguanidine (MIBG) remains the tracer of choice in the evaluation of neuroblastoma (NB) because of its high sensitivity, specificity, diagnostic accuracy, and prognostic value. It is valuable in determining the response to therapy, surveillance for disease recurrence, and in selecting patients for I-131 therapy. SPECT/CT improves the diagnostic accuracy and the interpretation confidence of MIBG scans. (18)FDG-PET/CT is an important complementary to MIBG imaging despite its lack of specificity to NB. It is valuable in cases of negative or inconclusive MIBG scans and when MIBG findings underestimate the disease status as determined from clinical and radiological findings. F-18 DOPA is promising tracer that reflects catecholamine metabolism and is both sensitive and specific. F-18 DOPA scintigraphy provides the advantages of PET/CT imaging with early and short imaging times, high spatial resolution, inherent morphologic correlation with CT, and quantitation. Regulatory and production issues currently limit the tracer's availability. PET/CT with Ga-68 DOTA appears to be useful in NB imaging and may have a unique role in selecting patients for peptide receptor radionuclide therapy with somatostatin analogues. C-11 hydroxyephedrine PET/CT is a specific PET tracer for NB, but the C-11 label that requires an on-site cyclotron production and the high physiologic uptake in the liver and kidneys limit its use. I-124 MIBG is useful for I-131 MIBG pretherapeutic dosimetry planning. Its use for diagnostic imaging as well as the use of F-18 labeled MIBG analogues is currently experimental. PET/MR imaging is emerging and is likely to become an important tool in the evaluation. It provides metabolic and superior morphological data in one imaging session, expediting the diagnosis and lowering the radiation exposure. Radioactive iodines not only detect residual tissue and metastatic disease but also are used in the treatment of differentiated thyroid cancer. However, these are not well documented in pediatric age group like adult patients. Use of radioactivity in pediatric population is very important and strictly controlled because of the possibility of secondary malignities; therefore, management of oncological cases requires detailed literature knowledge. This article aims to review the literature on the use of radionuclide imaging and therapy in pediatric population with thyroid cancer, sarcomas, lymphoma, and NB.
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Affiliation(s)
- Pınar Özgen Kiratli
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Turkey.
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Turkey
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Petah Tikva, Israel
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Lim-Dunham JE, Erdem Toslak I, Alsabban K, Aziz A, Martin B, Okur G, Longo KC. Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Pediatr Radiol 2017; 47:429-436. [PMID: 28127634 DOI: 10.1007/s00247-017-3780-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/07/2016] [Accepted: 01/04/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA) Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer provides selection criteria for nodules prior to ultrasound-guided fine-needle aspiration biopsy. OBJECTIVE To evaluate the diagnostic performance of pediatric thyroid nodule risk stratification for predicting malignancy when applying the ultrasound (US) criteria recommended. MATERIALS AND METHODS US characteristics of 39 thyroid nodules in 33 pediatric patients who underwent US fine-needle aspiration biopsy were reviewed by two radiologists. Based on the aggregated US criteria from the ATA Guidelines, each nodule was assigned a level of malignancy risk. Kappa coefficients were estimated to assess intra- and interobserver reliability. Using each patient's largest nodule observation (n = 33), univariable exact logistic regression analyses of US parameters were then conducted to estimate the odds of a malignant pathology diagnosis. A penalized Firth correction was employed in the univariable models analyzing composition, shape and level of suspicion due to quasi-complete data separation. RESULTS Twenty-seven nodules in 21 patients (median age: 16 years; 17 female) were benign and 12 nodules in 12 patients (median age: 16.5 years; 11 female) were malignant. Intraobserver agreement was substantial to almost perfect for composition, echogenicity, shape and margins. Interobserver agreement was almost perfect for composite level of suspicion. High level of suspicion was assigned to all 12 malignant nodules versus 9/21 (43%) of the benign nodules. Level of suspicion, solid/predominantly solid composition, irregular margins and echogenic foci emerged as significant predictors of malignancy with odds ratios (OR) of 8.5 (95% confidence interval [CI]: 1.7-1,130, P = 0.001), 10.5 (95% CI: 1.1-1,417, P = 0.04), 53.2 (95% CI: 5.1-2,988, P < 0.0001) and 3.5 (95% CI: 1.1-23.2, P = 0.03), respectively. CONCLUSION The composite, US-based risk stratification criteria from the 2015 ATA Guidelines may provide an appropriate and reproducible method for estimating risk of malignancy for pediatric thyroid nodules.
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Affiliation(s)
- Jennifer E Lim-Dunham
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA.
| | - Iclal Erdem Toslak
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Khalid Alsabban
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Amany Aziz
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Brendan Martin
- Clinical Research Office, Loyola University Chicago Health Sciences Division, Loyola University Medical Center, Maywood, IL, USA
| | - Gokcan Okur
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Katherine C Longo
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
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Golpanian S, Perez EA, Tashiro J, Lew JI, Sola JE, Hogan AR. Pediatric papillary thyroid carcinoma: outcomes and survival predictors in 2504 surgical patients. Pediatr Surg Int 2016; 32:201-8. [PMID: 26717936 DOI: 10.1007/s00383-015-3855-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate outcomes and predictors of survival of pediatric thyroid carcinoma, specifically papillary thyroid carcinoma. METHODS SEER was searched for surgical pediatric cases (≤20 years old) of papillary thyroid carcinoma diagnosed between 1973 and 2011. Demographics, clinical characteristics, and survival outcomes were analyzed using standard statistical methods. All papillary types, including follicular variant, were included. RESULTS A total of 2504 cases were identified. Overall incidence was 0.483/100,000 persons per year with a significant annual percent change (APC) in occurrence of 2.07 % from baseline (P < 0.05). Mean age at diagnosis was 16 years and highest incidence was found in white, female patients ages 15-19. Patients with tumor sizes <1 cm more likely received lobectomies/isthmusectomies versus subtotal/total thyroidectomies [OR = 3.03 (2.12, 4.32); P < 0.001]. Patients with tumors ≥1 cm and lymph node-positive statuses [OR = 99.0 (12.5, 783); P < 0.001] more likely underwent subtotal/total thyroidectomy compared to lobectomy/isthmusectomy. Tumors ≥1 cm were more likely lymph node-positive [OR = 39.4 (16.6, 93.7); p < 0.001]. Mortality did not differ between procedures. Mean survival was 38.6 years and higher in those with regional disease. Disease-specific 30-year survival ranged from 99 to 100 %, regardless of tumor size or procedure. Lymph node sampling did not affect survival. CONCLUSIONS The incidence of pediatric papillary thyroid cancer is increasing. Females have a higher incidence, but similar survival to males. Tumors ≥1 cm were likely to be lymph node-positive. Although tumors ≥1 cm were more likely to be resected by subtotal/total thyroidectomy, survival was high and did not differ based on procedure.
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Affiliation(s)
- Samuel Golpanian
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA
| | - Anthony R Hogan
- Division of Pediatric Surgery, DeWitt Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine, 1120 N.W. 14th Street, Suite 450J, Miami, FL, 33136, USA.
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13
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Moudgil P, Vellody R, Heider A, Smith EA, Grove JJ, Jarboe MD, Bruch SW, Dillman JR. Ultrasound-guided fine-needle aspiration biopsy of pediatric thyroid nodules. Pediatr Radiol 2016; 46:365-71. [PMID: 26554855 DOI: 10.1007/s00247-015-3478-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/24/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of US-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules is not well-established in children. OBJECTIVE To retrospectively assess the utility of US-FNAB of pediatric thyroid nodules. MATERIALS AND METHODS We reviewed Department of Radiology records to identify children who underwent US-FNAB of the thyroid between 2005 and 2013. Two board-certified pediatric radiologists reviewed pre-procedural thyroid US exams and documented findings by consensus. We recorded cytopathology findings and compared them to surgical pathology diagnoses if the nodule was resected. We also recorded demographic information, use of sedation or general anesthesia, and presence of on-site cytopathological feedback. The Student's t-test was used to compare continuous data; the Fisher exact test was used to compare proportions. RESULTS US-FNAB was conducted on a total of 86 thyroid nodules in 70 children; 56 were girls (80%). Seventy-eight of the 86 (90.7%) US-FNAB procedures were diagnostic; 69/78 (88.5%) diagnostic specimens were benign (including six indeterminate follicular lesions that were proved at surgery to be benign) and 9/78 (11.5%) were malignant/suspicious for malignancy (all proved to be papillary carcinomas). There was no difference in size of benign vs. malignant lesions (P = 0.82) or diagnostic vs. non-diagnostic lesions (P = 0.87). Gender (P = 0.19), use of sedation/general anesthesia (P = 0.99), and presence of onsite cytopathological feedback (P = 0.99) did not affect diagnostic adequacy. Microcalcifications (P < 0.0001; odds ratio [OR] = 113.7) and coarse calcifications (P = 0.03; OR = 19.4) were associated with malignancy. Diagnoses at cytopathology and surgical pathology were concordant in 27/29 (93.1%) nodules; no US-FNAB procedure yielded false-positive or false-negative results for malignancy. CONCLUSION US-FNAB of pediatric thyroid nodules is feasible, allows diagnostic cytopathological evaluation, and correlates with surgical pathology results in resected nodules.
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Affiliation(s)
- Pranav Moudgil
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ranjith Vellody
- Department of Radiology, Division of Interventional Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Amer Heider
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ethan A Smith
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Jason J Grove
- Department of Radiology, Division of Interventional Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Marcus D Jarboe
- Department of Radiology, Division of Interventional Radiology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Health System, Section of Pediatric Surgery, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Steven W Bruch
- Department of Surgery, University of Michigan Health System, Section of Pediatric Surgery, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Jonathan R Dillman
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA. .,Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
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Volkan-Salancı B, Kıratlı PÖ. Nuclear Medicine in Thyroid Diseases in Pediatric and Adolescent Patients. Mol Imaging Radionucl Ther 2015; 24:47-59. [PMID: 26316469 PMCID: PMC4563170 DOI: 10.4274/mirt.76476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Both benign and malignant diseases of the thyroid are rare in the pediatric and adolescent population, except congenital hypothyroidism. Nuclear medicine plays a major role, both in the diagnosis and therapy of thyroid pathologies. Use of radioactivity in pediatric population is strictly controlled due to possible side effects such as secondary cancers; therefore, management of pediatric patients requires detailed literature knowledge. This article aims to overview current algorithms in the management of thyroid diseases and use of radionuclide therapy in pediatric and adolescent population.
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Affiliation(s)
| | - Pınar Özgen Kıratlı
- Hacettepe University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey Phone: +90 312 305 13 36 E-mail:
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15
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Jin X, Masterson L, Patel A, Hook L, Nicholson J, Jefferies S, Gaze M, Nassif R, Eller R, Hulse T, Jani P. Conservative or radical surgery for pediatric papillary thyroid carcinoma: A systematic review of the literature. Int J Pediatr Otorhinolaryngol 2015; 79:1620-4. [PMID: 26300408 DOI: 10.1016/j.ijporl.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pediatric papillary thyroid carcinoma (PTC) is characterized by an aggressive clinical course. Early diagnosis is a challenge and treatment consists principally of partial or total thyroidectomy±neck dissection and radioactive iodine therapy. Due to the rarity of PTC in children, there is no consensus on optimal surgical treatment. METHODS AND RESULTS A literature search was carried out using PubMed, Embase, Medline, Cochrane and Web of Science. Seven studies (489 patients) investigating the outcome of surgically managed pediatric PTC were identified. No clear advantage in survival or recurrence rate was found for total thyroidectomy compared to other surgical approaches. CONCLUSION Despite the aggressive behavior of PTC, prognosis is good, with low mortality. After removal of disease and prevention of recurrence, reduction of iatrogenic complications are a priority in this age group. Due to the paucity of available evidence, this review cannot recommend conservative or radical surgery for pediatric papillary thyroid carcinoma. To answer this question, we recommend the establishment of a randomized controlled trial with adequately matched baseline variables.
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Affiliation(s)
- Xi Jin
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Liam Masterson
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Anant Patel
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Liz Hook
- Department of Pathology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - James Nicholson
- Department of Pediatric Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Sarah Jefferies
- Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Mark Gaze
- Department of Oncology, University College Hospital, London NW1 2PG, UK
| | - Ramez Nassif
- Department of Head & Neck Oncology, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK
| | - Robert Eller
- US Air Force and Army Voice Center, San Antonio, TX, USA
| | - Tony Hulse
- Department of Paediatric Endocrinology, Guy's & St Thomas' Hospital, London SE1 7UH, UK
| | - Piyush Jani
- Department of Otolaryngology, Head and Neck Surgery, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Abstract
BACKGROUND AND AIMS Paediatric thyroid cancer is a rare disease, making diagnosis and treatment particularly challenging. Here we present the Scottish experience of thyroid cancer in the paediatric population and give an overview of how a child or adolescent that presents with a thyroid nodule should be investigated and managed. METHODS AND RESULTS Data has been obtained from ISD Scotland, giving population-based information on paediatric thyroid cancer. A literature review has been performed on the management and treatment of thyroid cancer in the younger population. Paediatric thyroid cancer in Scotland is a rare disease, although the incidence is increasing each year. In general, differentiated paediatric thyroid cancer carries a good prognosis, while the results are more mixed in the rarer pathologies such as medullary cancer. CONCLUSION Due to the small numbers of patients diagnosed each year in Scotland, it is imperative that these patients are discussed at a multidisciplinary thyroid MDT and managed in a tertiary referral centre by consultants and medical/nursing support staff who have experience in treating these patients.
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Affiliation(s)
- C M Douglas
- Department of Paediatric ENT, Royal Hospital for Sick Children, UK
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Abstract
PURPOSE OF REVIEW Paediatric thyroid cancer is a rare disease, but its incidence is rising in recent reports. This review aims at integrating recent findings into the current optimal diagnostic and therapeutic approach. RECENT FINDINGS The causal relationship of differentiated thyroid cancer (DTC) to radiation exposure is increasingly unravelled. Research progressively uncovers the genetic basis, such as RET (rearranged during transfection)/papillary thyroid cancer (PTC) rearrangement and RET-mutations. Knowledge of oncogenic signalling pathways nowadays starts to help finetuning diagnosis, prognosis and treatment. This knowledge complements the current state-of-the-art of paediatric thyroid cancer treatment. In childhood, DTC presents at a more advanced stage and implies higher recurrence rates, recurrences often occurring decades later. Treatment should minimize not only these recurrences but also long-term treatment sequelae. Total thyroidectomy and central compartment dissection by a high-volume surgeon and radioactive iodine is the preferred approach for most children with DTC. For children with medullary thyroid cancer within the MEN2 framework, when possible, prophylactic thyroidectomy is performed. Unfortunately, frequently, the diagnosis is still made at a later stage, and then requires total thyroidectomy with dissection of the central compartment and the lateral neck, when involved. SUMMARY The management complexity, the essential long-term follow-up and the lifetime burden of eventual complications demands management of paediatric thyroid cancer by physicians with the highest expertise. In such hands, excellent results can be obtained.
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