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Papillary thyroid cancer in childhood: is parental screening helpful?
Carlos Stephenson1, Olov Norlen1, Albert Shun2
1Endocrine Surgical Unit, University of Sydney, Sydney, New South Wales, Australia.
Insights
Screening parents of children with papillary thyroid cancer (PTC) but no family history using ultrasound is not recommended. This approach does not reveal an increased incidence of familial non-medullary thyroid cancer (FNMTC).
Area of Science:
- Pediatric Endocrinology
- Oncology
- Genetics
Background:
- Familial non-medullary thyroid cancer (FNMTC) screening is standard for relatives.
- The necessity of screening pediatric thyroid cancer cases without a family history remains unaddressed.
Purpose of the Study:
- To evaluate the utility of routine ultrasound screening in parents of pediatric patients diagnosed with papillary thyroid cancer (PTC) who lack a family history.
Main Methods:
- A retrospective cohort study was performed on pediatric patients (≤18 years) who underwent surgery for PTC between 2008 and 2014.
- Parental screening involved thyroid ultrasounds, with subsequent fine-needle biopsy or surgical resection for suspicious findings.
Main Results:
- Out of 15 pediatric PTC cases, only one had a family history.
- Thyroid ultrasounds in 26 parents revealed nodular disease in eight; two underwent resection, yielding one benign adenoma and one papillary microcarcinoma with nodal metastasis.
Conclusions:
- Routine ultrasound screening of parents of pediatric PTC patients without a family history does not increase the detection rate of FNMTC.
- Screening is unlikely to be beneficial, as findings align with the background incidence of thyroid nodules and incidental microcarcinomas.
Background:
Familial non-medullary thyroid cancer (FNMTC) mandates family screening with ultrasound; however, the need for screening paediatric thyroid cancer with no family history has not been addressed.
Methods:
This study conducted a retrospective cohort study in a tertiary hospital. The study group is composed of patients ≤18 years undergoing surgery for papillary thyroid cancer (PTC) from 2008 to 2014.
Results:
During the study period, 15 paediatric patients had PTC. Only one patient had a prior family history of PTC involving two second-degree relatives. Of the 30 parents, four were lost to follow-up, with the remaining 26 undergoing screening thyroid ultrasound. Nodular thyroid disease was documented in eight ultrasounds performed. Subsequently, one has not undergone fine-needle biopsy, five were benign and two underwent surgical resection: one having a benign follicular adenoma and the other a papillary microcarcinoma with nodal micrometastasis.
Conclusions:
Routine ultrasound screening of parents of children presenting with PTC and no family history do not demonstrate an increased incidence of FNMTC. Screening of affected families is likely to demonstrate the expected background incidence of nodular thyroid disease and incidental papillary microcarcinoma. As such, it is unlikely to be useful.
