Ultrasound is superior to palpation for thyroid cancer detection in high-risk childhood cancer and BMT survivors
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ORIGINAL ARTICLE
Ultrasound is superior to palpation for thyroid cancer detection in high-risk childhood cancer and BMT survivors Jennifer Hess 1 & Kristian Schafernak 2 & Dorothee Newbern 3 & Tamara Vern-Gross 4 & Janet Foote 5 & Dane Van Tassel 6 & Ramin Jamshidi 7 & Alexandra Walsh 1 Received: 19 September 2019 / Accepted: 2 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Thyroid cancer is a common subsequent malignant neoplasm in childhood cancer survivors (CCS). Patients who received radiotherapy (RT) to the head, neck, upper thorax, or total body irradiation (TBI) are considered to be at risk for subsequent thyroid cancer. Current Children’s Oncology Group screening guidelines recommend annual neck palpation. Our objective was to determine if ultrasound (US) is more sensitive and specific than palpation to detect thyroid cancer in high-risk CCS and bone marrow transplant (BMT) survivors. Methods Electronic medical records of patients followed in a longitudinal survivorship clinic from January 1, 2010 to December 31, 2017 were reviewed. Inclusion criteria included history of RT to the head, neck, upper thorax, or TBI for primary therapy or preparation for BMT prior to the age of 20 years. Results Two hundred and twenty-five patients had documented palpation and 144 (64%) also had US evaluation. Mean radiation dose was 28.6 Gy. Sixteen of 225 patients (7.1%) developed a subsequent thyroid cancer at a mean of 9.7 years from the completion of RT. Sensitivity of US was 100% compared with 12.5% for palpation. US demonstrated higher accuracy, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.87 versus 0.56 for palpation (P < 0.0001). Conclusion Routine screening with US was more sensitive than palpation for detection of subsequent thyroid cancer after highrisk RT in CCS and BMT survivors. Screening US may lead to earlier detection of thyroid cancer in this population. Earlier diagnosis has the potential to decrease operative complexity, and earlier definitive therapy reduces the likelihood of metastatic disease. Keywords Subsequent malignant neoplasm . Thyroid cancer . Screening . Late effects
Introduction * Jennifer Hess [email protected] 1
Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
2
Department of Pathology and Laboratory Medicine, Phoenix Children’s Hospital, Phoenix, AZ, USA
3
Department of Endocrinology, Phoenix Children’s Hospital, Phoenix, AZ, USA
4
Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
5
Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
6
Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA
7
Department of Pediatric Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA
Childhood cancer cure rates have increased dramatically over the past five decades with 5-year overall survival now nearing 85% in the USA [1]. Long-term survival for children after bone marrow tran
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