NEW YORK (Reuters Health), Dec 29 - While ultrasound screening for thyroid cancer in the general population is not cost-effective and may lead to unnecessary surgery, it is worthwhile in childhood cancer survivors who received radiotherapy involving the head, neck, or upper thorax, according to Italian researchers.
Dr. Giuseppe Boccuzzi, of the University of Turin, and colleagues examined the use of ultrasound screening for thyroid nodules in the long-term follow-up of 129 subjects who had received radiotherapy involving the head, neck, or upper thorax for pediatric cancer.
As reported in the December issue of the Journal of Clinical Endocrinology and Metabolism, the median follow-up time since initial childhood cancer diagnosis was 15.8 years. Thyroid ultrasound usually began five years after radiotherapy. The screening was repeated every third year if negative.
Solid thyroid nodules were found in 35 patients and fine needle aspiration was performed in 19 subjects. Cytological examination of the specimens revealed that five cases were papillary carcinoma and six were follicular neoplasm. The patients with papillary carcinoma underwent surgery, and the cytological diagnosis was confirmed in all cases by histological examination.
Only two of the five patients with papillary thyroid carcinoma had palpable nodules, while the other three patients had nodules that were smaller than 1 cm and were only detected by ultrasound. The authors note, however, that histological examination showed nodal metastases in two of these.
"In conclusion, we are well aware that ultrasound screening for thyroid cancer in the general population is not cost effective," Boccuzzi and colleagues write. "Nevertheless, in agreement with others, we believe that screening by ultrasound in the population of childhood cancer survivors previously treated by radiotherapy involving the head, neck, or upper thorax is worthwhile, because early detection could improve the outcome of thyroid cancer for these patients."
J Clin Endocrinol Metab 2008;93:4840-4843.
Last Updated: 2008-12-26 8:45:16 -0400 (Reuters Health)
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