PURPOSE Thyroid cancer is a common subsequent malignant neoplasm in childhood cancer survivors (CCS). Patients who received radiotherapy (RT) to the head, neck, upper thorax, or total body irradiation (TBI) are considered to be at risk for subsequent thyroid cancer. Current Children's Oncology Group screening guidelines recommend annual neck palpation. Our objective was to determine if ultrasound (US) is more sensitive and specific than palpation to detect thyroid cancer in high-risk CCS and bone marrow transplant (BMT) survivors. METHODS Electronic medical records of patients followed in a longitudinal survivorship clinic from January 1, 2010 to December 31, 2017 were reviewed. Inclusion criteria included history of RT to the head, neck, upper thorax, or TBI for primary therapy or preparation for BMT prior to the age of 20 years. RESULTS Two hundred and twenty-five patients had documented palpation and 144 (64%) also had US evaluation. Mean radiation dose was 28.6 Gy. Sixteen of 225 patients (7.1%) developed a subsequent thyroid cancer at a mean of 9.7 years from the completion of RT. Sensitivity of US was 100% compared with 12.5% for palpation. US demonstrated higher accuracy, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.87 versus 0.56 for palpation (P < 0.0001). CONCLUSION Routine screening with US was more sensitive than palpation for detection of subsequent thyroid cancer after high-risk RT in CCS and BMT survivors. Screening US may lead to earlier detection of thyroid cancer in this population. Earlier diagnosis has the potential to decrease operative complexity, and earlier definitive therapy reduces the likelihood of metastatic disease.

中文翻译：

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在高危儿童期癌症和BMT幸存者中，超声检测优于甲状腺癌。

目的甲状腺癌是儿童癌症幸存者（CCS）中常见的随后恶性肿瘤。接受过头部，颈部，上胸部或全身放射线（TBI）放射治疗（RT）的患者被认为有随后发生甲状腺癌的风险。当前的儿童肿瘤小组筛查指南建议每年进行颈部触诊。我们的目标是确定在高危CCS和骨髓移植（BMT）幸存者中，超声检查是否比触诊更敏感，更特异性。方法回顾了2010年1月1日至2017年12月31日在纵向生存诊所就诊的患者的电子病历。纳入标准包括20岁之前进行主要治疗或准备BMT的头部，颈部，上胸或TBI的RT病史。结果225位患者有触诊记录，其中144位（64％）也接受了US评估。平均辐射剂量为28.6 Gy。225名患者中有16名（7.1％）在完成RT后平均在9.7年后患上了甲状腺癌。美国的敏感性为100％，而触诊的敏感性为12.5％。US展示了更高的精度，曲线下的接收器工作特性（ROC）面积（AUC）为0.87，触诊时为0.56（P <0.0001）。结论在CCS和BMT幸存者中进行高危放疗后，US常规筛查比触诊更敏感。筛查美国可能导致该人群中较早发现甲状腺癌。早期诊断有可能降低手术复杂性，