ESPE2022 Poster Category 1 Thyroid (44 abstracts)
Clinical Features, Risk Classifications and Long-Term Follow Up Of Childhood Differentiated Thyroid Cancer(DTC): A Single Reference-Center Experience
Zehra Aycan 1 , Sirmen Kızılcan Çetin 1 , Zeynep Şıklar 1 , Elif Özsu 1 , Suat Fitöz 2 , Koray Ceyhan 3 , Aydın Yağmurlu 4 , Gülnur Göllü Bahadır 4 , Emel Ünal 5 , Nurdan Taşyıldız 5 , Metin Kır 6 , Çiğdem Soydal 6 & Merih Berberoğlu 1
1Department of Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey; 2Department of Radiology, School of Medicine, Ankara University, Ankara, Turkey; 3Department of Cytopathology, School of Medicine, Ankara University, Ankara, Turkey; 4Department of Pediatric Surgery, School of Medicine, Ankara University, Ankara, Turkey; 5Department of Pediatric Oncology, School of Medicine, Ankara University, Ankara, Turkey; 6Department of Nuclear Medicine, School of Medicine, Ankara University, Ankara, Turkey
Background: Thyroid cancers are rare in childhood. ATA guideline (Pediatric section) has been applied in daily practice since 2015. It is very significant to accurately predict the risk in the management of differentiated thyroid cancer(DTC). For this purpose, we shared our single center-20-year-experience about the follow-up features and management of childhood and adolescent thyroid cancer. We aimed to evaluate the dynamic risk stratification (DRS) and the other prognostic factors of DTC in childhood.
Methods: This retrospective study identified 41cases with DTC (F/M:35/6) followed for a median of an estimated five years (range:1–15 years)after total thyroidectomy. We classified patients according to the response to treatment and the course of the disease, according to both the ATA guideline and DRS, which was used for adults. Pretreatment risks, clinical features, treatment, and follow-up characteristics were retrieved. DTC status was evaluated after the initial therapy and at the last follow-up visit(Table).
Results: 41patients aged 5.9–19.6 years were evaluated.25 had previous thyroid disease(4 congenital thyroid disease,17 chronic lymphocytic thyroiditis,1 graves disease,3 multinodular goiters).33 had papillary thyroid carcinomas. Tumor size was 1.2 cm (0.4-5), mostly localized on right lobe. 27 had cervical and one had distant metastasis at diagnosis. All underwent total thyroidectomy,16 had radioactive iodine treatment(30-200mCi). Lymph node dissection was performed in 68% (29.3% central±lateral, 14.6% berry picking). One patient needed residual tumor excision. Risk factors were classified according to ATA and DRS(Table).35 had in low risk according to ATA guideline, however they were classified as excellent response(n =32), indeterminate response(n = 4), biochemical incomplete response(n =4), structural incomplete response(n = 1) according to DRS.
Conclusion: Our study supported that the ATA staging was adequate for follow-up. In addition, DRS risk estimates contribute significantly to baseline and post-treatment follow-up.
| American Thyroid Association(ATA) | % |
| ATA initial risk classification,% | Benign:4.9% Low:34.2% Intermediate:39.% High: 22% |
| Histology,% | Papillary:80.5% Follicular:19.5% |
| Lymph node metastasis,% | N0:65.9% N1a:24.4% N1b:9.8% |
| Distant metastasis,% | 2.4% |
| TNM AJCC Stage% | Stage-I:97.5% Stage-II:2.5% |
| ATA postoperative risk classification,% | Low:85.4% Intermediate:12.2% High:2.4% |
| Dynamic Risk Stratification: | % |
| Response to therapy classification,% | Excellent:78.1% Acceptable: 17.1% Incomplete: 4.9% |
| Stimulated Tg done (first 2 years),% |
Yes:56.1% No: 43,9% |
| Clinical status after initial therapy,% | No evidence of disease:73.2% Biochemical evidence of persistent disease: 14.6% Structural evidence of persistent disease: 9.8% Recurrent disease: 2.4% |
| Status at final follow-up,% | No evidence of disease:95.1% Persistent/recurrent disease: 4.9% Death of disease:0 |
Conclusion: Our study supported that the ATA staging was adequate for follow-up. In addition, DRS risk estimates contribute significantly to baseline and post-treatment follow-up.
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