William J Hammond1, Todd E Heaton2, Benjamin A Farber1, Usman A Mahmood3, Jill S Gluskin4, Suzanne L Wolden5, Michael P La Quaglia1, Charles A Sklar6, Anita P Price4. 1. Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: heatont@mskcc.org. 3. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 6. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
PURPOSE: We performed a retrospective analysis to evaluate the risk of thyroid cancer in incidental thyroid nodules (ITNs) discovered on CT in patients with a history of pediatric cancer. METHODS: With IRB approval we reviewed the records of pediatric oncology patients age ≤21y with newly detected thyroid nodules on surveillance CT of the neck, chest, chest/abdomen/pelvis, or PET/CT performed between April 2008 and March 2015. Patients with <6months of follow-up after incidental findings, a history of primary thyroid malignancy, or incomplete records were excluded. RESULTS: The final cohort (N=68) included 35 females and 33 males (mean age 16.0±4.3[SD] years) with a mean follow-up time of 3.7±1.9[SD] years after CT detection of ITN(s). Twenty patients (29.4%) received a follow-up thyroid ultrasound, eleven (16.2%) of whom underwent fine needle aspiration (FNA) for cytopathologic diagnosis. Among these, six (8.8%) underwent thyroid resection, with final pathology demonstrating papillary carcinoma in five (7.4%) and benign pathology in one. CONCLUSIONS: Despite the low incidence of thyroid nodules and low risk of thyroid malignancy in the general pediatric population, we found a significant rate of malignancy in CT-detected ITNs in our pediatric oncology patients, and recommend ultrasound and FNA of these nodules in this high-risk population. LEVEL OF EVIDENCE: Level IV, retrospective study with no comparison group.
PURPOSE: We performed a retrospective analysis to evaluate the risk of thyroid cancer in incidental thyroid nodules (ITNs) discovered on CT in patients with a history of pediatric cancer. METHODS: With IRB approval we reviewed the records of pediatric oncology patients age ≤21y with newly detected thyroid nodules on surveillance CT of the neck, chest, chest/abdomen/pelvis, or PET/CT performed between April 2008 and March 2015. Patients with <6months of follow-up after incidental findings, a history of primary thyroid malignancy, or incomplete records were excluded. RESULTS: The final cohort (N=68) included 35 females and 33 males (mean age 16.0±4.3[SD] years) with a mean follow-up time of 3.7±1.9[SD] years after CT detection of ITN(s). Twenty patients (29.4%) received a follow-up thyroid ultrasound, eleven (16.2%) of whom underwent fine needle aspiration (FNA) for cytopathologic diagnosis. Among these, six (8.8%) underwent thyroid resection, with final pathology demonstrating papillary carcinoma in five (7.4%) and benign pathology in one. CONCLUSIONS: Despite the low incidence of thyroid nodules and low risk of thyroid malignancy in the general pediatric population, we found a significant rate of malignancy in CT-detected ITNs in our pediatric oncology patients, and recommend ultrasound and FNA of these nodules in this high-risk population. LEVEL OF EVIDENCE: Level IV, retrospective study with no comparison group.
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Authors: Leslie L Robison; Ann C Mertens; John D Boice; Norman E Breslow; Sarah S Donaldson; Daniel M Green; Frederic P Li; Anna T Meadows; John J Mulvihill; Joseph P Neglia; Mark E Nesbit; Roger J Packer; John D Potter; Charles A Sklar; Malcolm A Smith; Marilyn Stovall; Louise C Strong; Yutaka Yasui; Lonnie K Zeltzer Journal: Med Pediatr Oncol Date: 2002-04