High prevalence of multifocal disease highlighted for paediatric papillary thyroid carcinoma
By Lynda Williams, medwireNews Reporter
Research points to a high prevalence of multifocal disease in children with papillary thyroid carcinoma (PTC), with age and tumour stage possible risk factors for this diagnosis.
Maisie Shindo, from Oregon Health & Science University in Portland, USA, and colleagues report their findings in JAMA Otolaryngology – Head & Neck Surgery from a cohort study of 212 patients aged up to 18 years who underwent thyroidectomy at one of five US hospitals between 2010 and 2020.
The patients were aged an average of 14.1 years and the majority (82%) were female, 32% had a history of autoimmune thyroiditis and 12% had a family history of thyroid cancer.
Most patients had localised disease at stage T1 (40%), T2 (20%) or T3 (35%), while 5% had T4 disease. Just 27% had N0 disease and the remaining patients had nodal stage N1a (28%), ipsilateral N1b (17%), bilateral N1b (27%) or distant metastases (12%).
Overall, 46% of the patients had multifocal disease, with unilateral and bilateral multifocal disease in 12% and 34% of patients, respectively, the researchers say.
They highlight that preoperative prediction of multifocal disease comes with challenges, as evidenced by the low percentage predicted by imaging in their study, at just 28% of patients, including three false–positive cases. Multifocal disease was predicted in 36% of the patients diagnosed with unilateral multifocal disease and 66% of those with bilateral multifocal disease.
Multiple logistic regression analysis found only bilateral N1b staging to be significantly associated with the diagnosis of multifocal disease and bilateral multifocal disease, with odds ratios of 4.70 and 5.38, respectively.
However, the researchers note that least absolute shrinkage and selection operator analysis indicated that age 10 years or younger, T3 or N1b stage and distant metastases were associated with the presence of multifocal and bilateral multifocal disease, consistent with earlier research findings.
Shindo and co-authors observe that patients with advanced disease stage would undergo total thyroidectomy, therefore making the risk of multifocal disease “likely irrelevant”, but propose further research “to determine if age can be used as a criterion for more limited surgery in pediatric PTC.”
They conclude: “Ultimately, further large, multicenter studies are needed to overcome historic limitations in pediatric thyroid cancer research and guide the development of more nuanced, evidence-based recommendations.”
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JAMA Otolaryngol Head Neck Surg 2021; doi:10.1001/jamaoto.2021.3077