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Ultrasound is superior to palpation for thyroid cancer detection in high-risk childhood cancer and BMT survivors

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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 high-risk 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.

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The authors have full control of all primary data and agree to allow this journal to review data if requested.

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Authors and Affiliations

  1. Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, 1919 E Thomas Road, Phoenix, AZ, 85016, USA

    Jennifer Hess & Alexandra Walsh

  2. Department of Pathology and Laboratory Medicine, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Kristian Schafernak

  3. Department of Endocrinology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Dorothee Newbern

  4. Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA

    Tamara Vern-Gross

  5. Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA

    Janet Foote

  6. Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Dane Van Tassel

  7. Department of Pediatric Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Ramin Jamshidi

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  1. Jennifer Hess
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Correspondence to Jennifer Hess.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Hess, J., Schafernak, K., Newbern, D. et al. Ultrasound is superior to palpation for thyroid cancer detection in high-risk childhood cancer and BMT survivors. Support Care Cancer 28, 5117–5124 (2020). https://doi.org/10.1007/s00520-020-05340-0

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