Thyroid Tumors in Children and Adolescents: Preoperative Study

Abstract

Several studies indicate that in young patients (less than 21 years of age at the time of diagnosis), the prognosis of thyroid carcinoma (TC) is more favorable than in older patients. However, a more radical treatment approach is recommended in children and adolescents due to the higher prevalence of local lymph-node involvement in these cases. Since the extent of primary surgical treatment is closely related to the overall prognosis, preoperative diagnosis becomes essential in the management of thyroid neoplasms in young patients. In this retrospective study (1987-1998), we analyzed a surgical series of 50 children and adolescents with thyroid nodules in an attempt to establish the role of diagnostic studies in detecting malignant lesions prior to surgery. Our diagnostic protocol for evaluating thyroid nodules was based on clinical evaluation, measurement of thyroid-hormone and thyroglobulin (TG) levels, anti-TG and anti-TPO antibody titers, calcitonin, CEA, and TPA levels, sonography, scintigraphy, and fine-needle aspiration cytology (FNAC) of the thyroid nodules and any enlarged lymph nodes. Eleven of the 15 cases of histologically confirmed carcinoma were preoperatively identified as malignant lesions with the aid of FNAC. The authors conclude that the preoperative work-up of children and adolescents with thyroid nodules requires the collaboration of an experienced team of professionals, and recommend FNAC as the initial test.

Pediatric thyroid fine-needle aspiration cytology: a meta-analysis

“…Few studies in this meta-analysis addressed the clinical presentation of the patients involved in their study. In 3 studies, the presentation was mentioned [8,13,36], but only one study stated that they included patients with nonpalpable thyroid nodules [8]. Thus, it is still uncertain if nonpalpable nodules deserve the same treatment or have the same success with FNA as palpable nodules.…”

“…From these abstracts, 69 full text articles were retrieved. Finally, 12 studies that had all necessary components were included in this review [8,9,13,15,17,19,[21][22][23][24]35,36]. The main reasons for exclusion were incorrect study population, lack of sufficient reference standard, study used, results admixed with fineneedle biopsies of other tumors, insufficient follow-up, no numbers or insufficient data given for calculation of diagnostic values, and case studies.…”

“…For example, 2 of the aforementioned preoperative tests, ultrasound and thyroid scintigraphy, have been shown to be poor at differentiating between benign and malignant disease in the pediatric population [8][9][10]. In addition, despite the current evidence against the routine use of thyroid scintigraphy as a diagnostic tool to differentiate benign from malignant nodules, in adult populations, 23% and 66% of North American and European endocrinologists, respectively, admitted to routinely ordering the test [11,12]a practice that is mirrored in pediatric populations [8,9,13].…”

“…The use of FNA for diagnosis of thyroid nodules in the pediatric population has been researched frequently in the last 2 decades [8,9,13,[17][18][19][20][21][22][23][24][25][26][27][28][29]. We performed a meta-analysis of the existing literature to determine the diagnostic value of FNA in determining malignancy in children presenting with a thyroid nodule.…”

Cancers différenciés de la thyroïde chez l'enfant et l'adolescent : stratégie thérapeutique adaptée à la présentation clinique

“…Dans ces formes évoluées, la spécificité et la sensibilité de la cytoponction pour affirmer le carcinome peuvent atteindre 100 % [9]. La cytoponction est également utile et peu invasive pour affirmer le caractère métastatique des adénopathies.…”