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Cancers
Special Issues
Innovations in the Integrated Management of Pediatric Thyroid Cancer
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Innovations in the Integrated Management of Pediatric Thyroid Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: closed (10 March 2023) | Viewed by 12647

Special Issue Editors

Prof. Gianlorenzo Dionigi

E-Mail Website
Guest Editor
Division for Endocrine and Mininvasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125 Messina, Italy
Interests: thyroid surgery; endoscopy
Prof. Dr. Hui Sun

E-Mail Website
Guest Editor
Division of Thyroid Surgery, China–Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun, China
Interests: thyroid surgery; intraoperative neural monitoring
Dr. Hoon Yub Kim

E-Mail Website
Guest Editor
Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea
Interests: thyroid surgery; robotics

Special Issue Information

Dear Colleagues,

Thyroid cancer is acknowledged to be an international priority in healthcare. It is currently one of the most common cancers in women worldwide. Recent demographic trends indicate a continuous increase in incidence in childhood. Increasing efforts and resources have been devoted to the search for a systematic and optimized strategy for thyroid cancer diagnosis and treatment in children and adolescents. Currently, the Thyroid Cancer Center model is considered to be the gold standard, and its use ensures optimal patient-centered and research-based clinical services through multidisciplinary and integrated management. Surgical treatment has gradually evolved toward target approaches for children with the adoption of new technologies. The evolution of evidence-based guidelines has led to a steady improvement in the care of children. This Special Issue will highlight innovations in the integrated management of thyroid cancer in childhood, their potential advantages, and the many open issues that remain to be properly defined and addressed.

Prof. Gianlorenzo Dionigi
Prof. Hui Sun
Prof. Hoon Yub Kim
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thyroid
  • cancer
  • surgery
  • children

Published Papers (6 papers)

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Research

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12 pages, 1873 KiB  
Article
Optimal Monitoring Technology for Pediatric Thyroidectomy
by Daqi Zhang, Hui Sun, Hoon Yub Kim, Antonella Pino, Serena Patroniti, Francesco Frattini, Pietro Impellizzeri, Carmelo Romeo, Gregory William Randolph, Che-Wei Wu, Gianlorenzo Dionigi and Fausto Fama’
Cancers 2022, 14(11), 2586; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14112586 - 24 May 2022
Cited by 1 | Viewed by 1717
Abstract
This retrospective study aimed to describe, firstly, characteristics and outcomes of the intraoperative neural monitoring technology in the pediatric population, and secondarily the recurrent laryngeal nerve complication rate. Thirty-seven patients (age <18 years) operated on from 2015 to 2021 by conventional open thyroid [...] Read more.
This retrospective study aimed to describe, firstly, characteristics and outcomes of the intraoperative neural monitoring technology in the pediatric population, and secondarily the recurrent laryngeal nerve complication rate. Thirty-seven patients (age <18 years) operated on from 2015 to 2021 by conventional open thyroid surgery were included. Twenty-four (64.9%) total thyroidectomies and 13 (35.1%) lobectomies were performed. Seven central and six lateral lymph node dissections completed 13 bilateral procedures. Histology showed malignancy in 45.9% of the cases. The differences between the electromyographic profiles of endotracheal tubes or electrodes for continuous monitoring were not statistically significant. In our series of young patients, both adhesive (even in 4- or 5-year-olds) and embedded endotracheal tubes were used, while in patients 3 years old or younger, the use of a more invasive detection method with transcartilage placement recording electrodes was required. Overall, out of 61 total at-risk nerves, 5 (8.2%) recurrent laryngeal nerves were injured with consequent intraoperative loss of the signal; however, all these lesions were transient, restoring their normal functionality within 4 months from surgical procedure. To our knowledge, this is the first study of intraoperative neural monitoring management in a cohort of Italian pediatric patients. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Pediatric Thyroid Cancer)
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15 pages, 1498 KiB  
Article
Recurrent Laryngeal Nerve Preservation Strategies in Pediatric Thyroid Oncology: Continuous vs. Intermittent Nerve Monitoring
by Rick Schneider, Andreas Machens, Carsten Sekulla, Kerstin Lorenz and Henning Dralle
Cancers 2021, 13(17), 4333; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13174333 - 27 Aug 2021
Cited by 4 | Viewed by 1786
Abstract
(1) Background: Pediatric thyroidectomy is characterized by considerable space constraints, thinner nerves, a large thymus, and enlarged neck nodes, compromising surgical exposure. Given these challenges, risk-reduction surgery is of paramount importance in children, and even more so in pediatric thyroid oncology. (2) Methods: [...] Read more.
(1) Background: Pediatric thyroidectomy is characterized by considerable space constraints, thinner nerves, a large thymus, and enlarged neck nodes, compromising surgical exposure. Given these challenges, risk-reduction surgery is of paramount importance in children, and even more so in pediatric thyroid oncology. (2) Methods: Children aged ≤18 years who underwent thyroidectomy with or without central node dissection for suspected or proven thyroid cancer were evaluated regarding suitability of intermittent vs. continuous intraoperative neuromonitoring (IONM) for prevention of postoperative vocal cord palsy. (3) Results: There were 258 children for analysis, 170 girls and 88 boys, with 486 recurrent laryngeal nerves at risk (NAR). Altogether, loss of signal occurred in 2.9% (14 NAR), resulting in six early postoperative vocal cord palsies, one of which became permanent. Loss of signal (3.5 vs. 0%), early (1.5 vs. 0%), and permanent (0.3 vs. 0%) postoperative vocal cord palsies occurred exclusively with intermittent IONM. With continuous nerve stimulation, sensitivity, specificity, positive and negative predictive values, and accuracy reached 100% for prediction of early and permanent postoperative vocal cord palsy. With intermittent nerve stimulation, sensitivity, specificity, positive and negative predictive values, and accuracy were consistently lower for prediction of early and permanent postoperative vocal cord palsy, ranging from 78.6% to 99.8%, and much lower (54.2–57.9%) for sensitivity. (4) Conclusions: Within the limitations of the study, continuous IONM, which is feasible in children ≥3 years, was superior to intermittent IONM in preventing early and permanent postoperative vocal cord palsy. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Pediatric Thyroid Cancer)
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12 pages, 1232 KiB  
Article
Laryngeal Neural Monitoring during Pediatric Thyroid Cancer Surgery—Is Transcartilage Recording a Preferable Method?
by Tzu-Yen Huang, Hoon-Yub Kim, Gianlorenzo Dionigi, I-Cheng Lu, Pi-Ying Chang, Feng-Yu Chiang, Yi-Chu Lin, Hsin-Yi Tseng, Cheng-Hsin Liu and Che-Wei Wu
Cancers 2021, 13(16), 4051; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13164051 - 11 Aug 2021
Cited by 8 | Viewed by 1914
Abstract
The use of transcartilage (TC) intraoperative neuromonitoring (IONM) in a pediatric population has not been reported. This study evaluated the feasibility and the benefit of using TC-IONM for thyroid cancer surgery in a pediatric population. This retrospective single-center study enrolled 33 pediatric patients [...] Read more.
The use of transcartilage (TC) intraoperative neuromonitoring (IONM) in a pediatric population has not been reported. This study evaluated the feasibility and the benefit of using TC-IONM for thyroid cancer surgery in a pediatric population. This retrospective single-center study enrolled 33 pediatric patients who had received an IONM-assisted thyroidectomy. Demographic characteristics, standardized IONM laryngeal examinations and stimulation information (L1-V1-R1-R2-V2-L2) were compared between endotracheal tube (ET) and TC methods. In the 15 cancer patients (30 nerves), TC-IONM provided significant higher electromyography (EMG) amplitude (p < 0.001), signal stability (lower V1/V2 signal correlation, r = 0.955 vs. r = 0.484, p = 0.004), signal quality (higher ratio of V1 or V2 amplitude <500 µV, 0.0% vs. 43.8%, p = 0.005) and lower R1-R2p change (7.1% vs. 37.5%, p = 0.049) compared to ET-IONM. In the 18 benign patients (28 nerves), TC-IONM provided significantly higher EMG amplitude (p < 0.001), signal stability (r = 0.945 vs. r = 0.746, p = 0.0324) and non-significant higher signal quality and R1-R2p change. This report is the first to discuss the use of TC-IONM in pediatric thyroid surgery. In contrast with ET-IONM, TC-IONM had superior amplitude, stability and quality of EMG signals, which greatly facilitates the meticulous recurrent laryngeal nerve dissection in pediatric thyroidectomies. The TC-IONM method can be considered a feasible, effective and preferable method of monitored thyroidectomy in pediatric thyroid cancer. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Pediatric Thyroid Cancer)
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18 pages, 453 KiB  
Article
Differentiated Thyroid Cancer in Children and Adolescents: Long Term Outcome and Risk Factors for Persistent Disease
by Giulia Sapuppo, Dana Hartl, Brice Fresneau, Julien Hadoux, Ingrid Breuskin, Eric Baudin, Charlotte Rigaud, Joanne Guerlain, Abir Al Ghuzlan, Sophie Leboulleux, Martin Schlumberger and Livia Lamartina
Cancers 2021, 13(15), 3732; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13153732 - 24 Jul 2021
Cited by 14 | Viewed by 2436
Abstract
Background: Pediatric differentiated thyroid cancer (P-DTC) frequently presents with advanced disease. The study aim was to evaluate the outcome of P-DTC and a modified 2015 American Thyroid Association risk classification (ATA-R). Methods: A retrospective study of consecutive P-DTC patients was performed. The ATA-R [...] Read more.
Background: Pediatric differentiated thyroid cancer (P-DTC) frequently presents with advanced disease. The study aim was to evaluate the outcome of P-DTC and a modified 2015 American Thyroid Association risk classification (ATA-R). Methods: A retrospective study of consecutive P-DTC patients was performed. The ATA-R for P-DTC was used with a cut-off of ≤ 5 N1a for low-risk. The outcome could be excellent response (ER) (thyroglobulin < 1 ng/mL and no evidence of disease (EoD) at imaging), biochemical incomplete response (BIR) (thyroglobulin ≥ 1 ng/mL and no EoD at imaging) or structural incomplete response (SIR) (EoD at imaging). Results: We studied 260 P-DTC (70% females; median age at diagnosis 14 years; 93% total thyroidectomy and 82% lymph node dissection). The ATA-R was low in 30% cases, intermediate in 15% and high in 55%, including 31.5% with distant metastases. Radioiodine treatment was administered in 218 (83.8%), and further radioiodine and surgery was performed in 113 (52%) and 76 (29%) patients, respectively. After a median follow-up of 8.2 years, the outcome was ER in 193 (74.3%), BIR in 17 (6.5%) and SIR in 50 (19.2%). Independent predictors of SIR or BIR at first and last visits were ATA-R intermediate or high. Conclusion: P-DTC has an excellent prognosis. Modified ATA-R is a useful prognostic tool in P-DTC to guide management. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Pediatric Thyroid Cancer)
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11 pages, 418 KiB  
Article
Comparison of Surgical Outcomes between Robotic Transaxillary and Conventional Open Thyroidectomy in Pediatric Thyroid Cancer
by In A Lee, Kwangsoon Kim, Jin Kyong Kim, Sang-Wook Kang, Jandee Lee, Jong Ju Jeong, Kee-Hyun Nam and Woong Youn Chung
Cancers 2021, 13(13), 3293; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13133293 - 30 Jun 2021
Cited by 14 | Viewed by 1793
Abstract
Thyroid cancer in children is very uncommon. For pediatric thyroid cancer, robotic surgery has served as a minimally invasive surgical alternative to conventional open surgery. Our study aimed to evaluate the results of robotic versus open surgical treatment for patients with thyroid cancer [...] Read more.
Thyroid cancer in children is very uncommon. For pediatric thyroid cancer, robotic surgery has served as a minimally invasive surgical alternative to conventional open surgery. Our study aimed to evaluate the results of robotic versus open surgical treatment for patients with thyroid cancer younger than 20 years of age at the time of diagnosis. This retrospective review included 161 pediatric patients who underwent robotic transaxillary or conventional open thyroidectomy at our institution from 2008 to 2019. Of these patients, 99 comprised the robotic group and 62 the open group. Patient demographics, surgical outcomes, and disease-free survival rates were compared between the two groups. Patients in the open group were more likely to have advanced stage diseases with a larger tumor size and higher tumor-node-metastasis stage than those in the robotic group. Operation time and follow-up period were similar in both groups. Patients in the robotic group had a lower rate of postoperative complications and a shorter length of hospital stay, but they also had a lower average number of retrieved central lymph nodes. However, there were no significant between group differences in recurrence rates and disease-free survival. In the hands of an experienced surgeon, robotic thyroidectomy is a feasible and safe option for pediatric patients. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Pediatric Thyroid Cancer)
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Review

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9 pages, 498 KiB  
Review
Pediatric Thyroid Cancer: To Whom Do You Send the Referral?
by Allison Keane, Darrin V. Bann, Meghan N. Wilson and David Goldenberg
Cancers 2021, 13(17), 4416; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13174416 - 01 Sep 2021
Cited by 4 | Viewed by 1960
Abstract
Pediatric thyroid cancer is rare, but increasing in annual incidence. Differentiated thyroid cancer in pediatric patients is treated surgically. Pediatric thyroidectomies are performed by general surgeons, otolaryngologists, general pediatric surgeons, and pediatric otolaryngologists. In a comprehensive literature review, we discuss the evidence supporting [...] Read more.
Pediatric thyroid cancer is rare, but increasing in annual incidence. Differentiated thyroid cancer in pediatric patients is treated surgically. Pediatric thyroidectomies are performed by general surgeons, otolaryngologists, general pediatric surgeons, and pediatric otolaryngologists. In a comprehensive literature review, we discuss the evidence supporting the importance of surgeon subspecialty and surgeon volume on outcomes for pediatric thyroid cancer patients. Pediatric general surgeons and pediatric otolaryngologists perform most pediatric thyroidectomies. Certain subpopulations specifically benefit from a combined approach of a pediatric surgeon and a high-volume thyroid surgeon. The correlation between high-volume surgeons and lower complication rates in adult thyroid surgery applies to the pediatric population; however, the definition of high-volume for pediatric thyroidectomies requires further investigation. The development of dedicated pediatric thyroid malignancy centers and multidisciplinary or dual-surgeon approaches are advantageous. Full article
(This article belongs to the Special Issue Innovations in the Integrated Management of Pediatric Thyroid Cancer)
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