The usual ultrasonographic features of thyroid cancer are less frequent in small tumors that develop after a long latent period after the Chernobyl radiation release accident.
BACKGROUND
The Chernobyl accident resulted in an unprecedented number of radiation-induced thyroid cancers in young individuals as detected by national and international screening programs. The vast majority of thyroid malignancies were papillary carcinomas that, despite being similar by histopathology, displayed large variability in clinical course. The correlations between ultrasound (US) and clinicopathological features in young patients with radiation-induced thyroid cancer, however, have not been well studied. Because of the importance of US for deciding which subjects should have fine-needle aspiration biopsy, we assessed the US features of papillary thyroid carcinoma in patients exposed to Chernobyl fallouts.


METHODS
We performed a retrospective multivariate logistic regression analysis of US features, clinicopathological data, and the latency period between radiation exposure and the diagnosis of cancer in 94 patients who were 10.6-34.3 years old (16.5 +/- 6.2, mean +/- standard deviation) at the time of diagnosis and 0.1-18.0 years old (5.6 +/- 4.2) at the time of the Chernobyl accident.


RESULTS
Nodules greater than 10 mm were associated with the higher frequency of irregular margins (p = 0.001), longer period of latency (p = 0.016), and bilateral lymph node involvement (p = 0.025). Irregular tumor margins correlated with the shorter period of latency (p = 0.009) and unilateral nodal disease (p = 0.010). Hypoechoic nodules were observed more frequently in female patients (p = 0.012), in the absence of halo (p = 0.003) or calcifications (p = 0.005). Hypoechogenicity also correlated with the shorter latency (p = 0.015) and younger age of patients (p = 0.048).


CONCLUSIONS
Irregular nodule margins, a usual sign of malignancy, are less useful in detecting thyroid cancers in radiation-exposed patients with tumors less than 10 mm. Thyroid cancers that are detected after longer latent periods display less of the US features characteristic of a malignant process, while benign US features are observed more frequently. Therefore, we recommend fine-needle aspiration biopsy to ensure early diagnosis of thyroid cancer for patients with a history of radiation exposure, even if their nodules are less than 10 mm.
Drozd
Valentina M
VM
Department of Thyroid Disease Research, Belarusian Medical Academy for Postgraduate Education, Minsk, Republic of Belarus.
Lushchik
Maxim L
ML
Polyanskaya
Olga N
ON
Fridman
Michail V
MV
Demidchik
Yuri E
YE
Lyshchik
Andrej P
AP
Biko
Johannes
J
Reiners
Christoph
C
Shibata
Yoshisada
Y
Saenko
Vladimir A
VA
Yamashita
Shunichi
S
D000293:Adolescent; D000328:Adult; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D047852:Chernobyl Nuclear Accident; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D013997:Time Factors; D014463:Ultrasonography