title: Ultrasound surveillance for radiation-induced thyroid carcinoma in adult survivors of childhood cancer.
abstract: BACKGROUND
  The optimal surveillance strategy to screen for thyroid carcinoma childhood cancer survivors (CCS) at increased risk is still debated. In our clinical practice, beside neck palpation we routinely perform thyroid ultrasound (US). Here we describe the results obtained using this approach.
  
  
  METHODS
  We considered all CCS referred to our long term clinic from November 2001 to September 2014. One hundred and ninety-seven patients who had received radiation therapy involving the thyroid gland underwent US surveillance. Thyroid US started 5 years after radiotherapy and repeated every 3 years, if negative.
  
  
  RESULTS
  Among 197 CCS previously irradiated to the thyroid gland, 74 patients (37.5%) developed thyroid nodules, and fine-needle aspiration was performed in 35. In 11 patients the cytological examination was suspicious or diagnostic for malignancy (TIR 4/5), whereas a follicular lesion was diagnosed in nine. Patients with TIR 4/5 cytology were operated and in all cases thyroid cancer diagnosis was confirmed. The nine patients with TIR 3 cytology also underwent surgery and a carcinoma was diagnosed in three of them. Prevalence of thyroid cancer was 7.1%. Tumour size ranged between 4 and 25 mm, but six (43%) were classified T3 because of extra-thyroidal extension. Six patients had nodal metastases; in eight patients the tumour was multifocal. At the time of the study all patients are disease free, without evidence of surgery complications.
  
  
  CONCLUSIONS
  Applying our US surveillance protocol, the prevalence of radiation-induced thyroid cancer is high. Histological features of the thyroid cancers diagnosed in our cohort suggest that most of them were clinically relevant tumours.
authors.affiliation: Transition Unit for Childhood Cancer Survivors, Department of Oncology, Città della Salute e della Scienza Hospital, Turin, Italy. Electronic address: ebrignardello@cittadellasalute.to.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brignardello
authors.affiliation: Transition Unit for Childhood Cancer Survivors, Department of Oncology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Felicetti
authors.affiliation: Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Castiglione
authors.affiliation: Oncological Endocrinology Unit, Department of Oncology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gallo
authors.affiliation: Pathology Unit, Department of Medical Sciences, University of Torino, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Maletta
authors.affiliation: Diagnostic Imaging Department, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Isolato
authors.affiliation: Pediatric Onco-Hematology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Biasin
authors.affiliation: Pediatric Onco-Hematology, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Fagioli
authors.affiliation: Pediatric Endocrinology Unit, Department of Pediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corrias
authors.affiliation: Department of Surgery, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Palestini
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000556:secondary / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D017741:Survivors; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014463:Ultrasonography; D014916:Whole-Body Irradiation / Q000009:adverse effects*; D055815:Young Adult
keywords: Childhood cancer survivors; Radiotherapy; Surveillance; Thyroid cancer; Ultrasound