Ultrasound screening for thyroid carcinoma in childhood cancer survivors: a case series.
BACKGROUND
Childhood cancer survivors need regular monitoring into young adulthood and beyond, because they are at risk for developing late-onset complications of cancer therapy, including second malignancies.


OBJECTIVE
This study focuses on the use of thyroid ultrasound to screen for thyroid carcinoma in a population of childhood cancer survivors.


METHODS
A total of 129 subjects who had received radiotherapy to the head, neck, or upper thorax for a pediatric cancer were studied in the setting of a long-term follow-up unit.


METHODS
Thyroid ultrasound usually began 5 yr after radiotherapy and was repeated every third year, if negative. Median follow-up time since childhood cancer diagnosis was 15.8 yr (range 6.1-34.8 yr). Solid thyroid nodules were found in 35 patients. Fine-needle aspiration was performed in 19 patients, of which 14 had nodules above 1 cm.


METHODS
The main outcome measure was the finding of not palpable thyroid cancers.


RESULTS
Cytological examination of specimens diagnosed papillary carcinoma in five patients who underwent surgery. The cytological diagnosis of papillary thyroid carcinoma was confirmed in all cases by histological examination. Notably, only two of these patients had palpable nodules; the other three were smaller than 1 cm and were detected only by ultrasound. However, histological examination showed nodal metastases in two of these.


CONCLUSIONS
Although ultrasound screening for thyroid cancer in the general population is not cost effective and could lead to unnecessary surgery, due to false positives, we believe that in childhood cancer survivors who received radiotherapy involving the head, neck, or upper thorax, it would be worthwhile.
Brignardello
Enrico
E
Transition Unit for Childhood Cancer Survivors, San Giovanni Battista Hospital, 10126 Turin, Italy. ebrignardello@molinette.piemonte.it
Corrias
Andrea
A
Isolato
Giuseppe
G
Palestini
Nicola
N
Cordero di Montezemolo
Luca
L
Fagioli
Franca
F
Boccuzzi
Giuseppe
G
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D044963:Biopsy, Fine-Needle; D018265:Carcinoma, Papillary, Follicular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008134:Long-Term Care; D008297:Male; D009362:Neoplasm Metastasis / Q000473:pathology; D009369:Neoplasms / Q000150:complications* / Q000532:radiotherapy; D017741:Survivors; D013960:Thyroid Function Tests; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging; D013965:Thyroidectomy; D014463:Ultrasonography; D055815:Young Adult