目的:本研究的目的是将自2015年美国甲状腺协会(ATA)儿童甲状腺癌指南工作组通过以来,在单个机构中出现甲状腺结节的儿童队列中,临床发现与分化型甲状腺癌(DTC)的发生率相关联。
方法:临床,射线照相,我们回顾性分析了2017年1月至2021年5月ICD-10编码为甲状腺结节和甲状腺癌的儿科队列(≤19岁)中的细胞病理学结果.
结果:我们分析了183例甲状腺结节患者。患者平均年龄为14岁(四分位距11-16),其中女性(79.2%)和白人白人(78.1%)占优势。我们的儿科患者队列中的整体DTC为12.6%(183个中的23个)。大多数恶性结节从1-4厘米(65.2%)测量,TI-RADS评分≥4(69.6%)。在细针抽吸结果中(n=49),DTC的频率最高的是恶性类别(16.33%),其次是可疑恶性肿瘤(6.12%),然后是不典型或意义不明的滤泡病变(8.16%),最后是滤泡性病变或肿瘤,良性病变分别为4.08%和2.04%。在接受手术干预的44个甲状腺结节中,甲状腺乳头状癌19例(43.18%)和滤泡性甲状腺癌4例(9.09%)。
结论:根据对东南地区单个机构的儿科队列的分析,采用2015年ATA指南可以提高检测DTC的准确性,同时减少需要干预的患者数量,如FNA活检和/或手术。Further,基于我们的小组,对甲状腺结节1厘米或更小的进行体检和超声检查是合理的,根据相关特征或父母共同的决策考虑进一步的治疗或诊断干预。
OBJECTIVE: The study purpose is to correlate clinical findings with rates of differentiated thyroid cancer (DTC) in a cohort of children presenting with thyroid nodules at a single institution since the adoption of the 2015 American Thyroid Association (ATA)
Guidelines Task Force on Pediatric Thyroid Cancer.
METHODS: Clinical, radiographic, and cytopathologic findings were retrospectively analyzed in a pediatric cohort (≤19 years) identified with ICD-10 codes for thyroid nodules and thyroid cancer from January 2017 until May 2021.
RESULTS: We analyzed 183 patients with thyroid nodules. The mean patient age was 14 years (interquartile range 11-16) with a female (79.2 %) and white Caucasian (78.1 %) predominance. The overall DTC in our pediatric patient cohort was 12.6 % (23 out of 183). Most of the malignant nodules measured from 1-4 cm (65.2 %) with TI-RADS score of ≥4 (69.6 %). Among the fine-needle aspiration results (n=49), the highest frequency of DTC was within the malignant category (16.33 %), followed by suspicious for malignancy (6.12 %), then atypia or follicular lesion of undetermined significance (8.16 %), and lastly follicular lesion or neoplasm and benign with 4.08 % and 2.04 % respectively. Of the forty-four thyroid nodules that underwent surgical intervention, pathology was remarkable for 19 papillary thyroid carcinoma (43.18 %) and 4 follicular thyroid carcinoma (9.09 %).
CONCLUSIONS: Based on the analysis of our pediatric cohort in the southeast region at a single institution, adoption of the 2015 ATA
guidelines could lead to an increased accuracy in detecting DTC while reducing the number of patients requiring interventions, such as FNA biopsy and/or surgeries. Further, based on our small cohort, it would be reasonable for thyroid nodules 1 cm or less to be monitored clinically with physical exam and ultrasonography, with further therapeutic or diagnostic intervention considered based on concerning features or parental shared decision making.