Thyroid cancer is the most common endocrine malignancy, accounting for approximately 1% of all newly diagnosed cancers worldwide. With advancements in technology and research, diagnosis of thyroid cancer has improved over the years.

Improved diagnosis has led to better treatment options and outcomes for both adult and pediatric patients.

Diagnosis in Adults

The diagnosis of thyroid cancer in adults involves a combination of clinical evaluation, imaging studies, and biopsy. Fine-needle aspiration biopsy (FNAB) is the gold standard for diagnosing thyroid nodules.

The use of ultrasound guidance during FNAB has improved its accuracy and reduced the incidence of non-diagnostic samples. Molecular testing of thyroid nodules has also proven to be helpful in identifying indeterminate nodules that have a higher risk of malignancy.

Advancements in Imaging Studies

The use of imaging studies has also improved the accuracy of diagnosis of thyroid cancer. High-resolution ultrasound has become the imaging modality of choice for evaluating thyroid nodules.

Ultrasound has the advantage of being non-invasive, readily available, and relatively low cost. Ultrasound can differentiate between solid and cystic nodules and can also detect micro-calcifications, which raise suspicion for malignancy.

Other imaging modalities such as CT and MRI may be used in cases where there is suspicion for local invasion or lymph node involvement.

Advancements in Molecular Testing

Molecular testing of thyroid nodules has also seen advancements in recent years. The use of gene expression tests such as the Afirma® gene expression classifier has improved the diagnosis of indeterminate thyroid nodules.

The gene expression classifier analyzes mRNA expression patterns in thyroid nodules and provides a risk of malignancy score. This reduces the need for diagnostic surgery in patients with indeterminate nodules.

Treatment Options for Thyroid Cancer

Treatment options for thyroid cancer include surgical resection, radioactive iodine therapy, and thyroid hormone replacement therapy. The extent of surgery and the need for radioactive iodine therapy depend on the type and stage of thyroid cancer.

Recently, less invasive surgical techniques such as endoscopic and robotic-assisted thyroidectomy have become available. These techniques offer improved cosmetic outcomes and reduced recovery times compared to traditional open thyroidectomy.

Diagnosis in Children

Thyroid cancer is rare in children, accounting for less than 1% of all pediatric cancers. The diagnosis of thyroid cancer in children is similar to that in adults, involving clinical evaluation, imaging studies, and biopsy.

The use of ultrasound guidance during FNAB has also improved the accuracy of diagnosis in children. The management of thyroid nodules that are indeterminate on initial biopsy is challenging in children.

Advancements in Imaging Studies in Children

Advances in imaging studies have improved the diagnosis and management of thyroid nodules in children. Multi-phase contrast-enhanced CT can help identify the presence of local invasion, lymph node involvement, and distant metastasis.

In children with indeterminate nodules, whole-body MRI has been shown to be a sensitive imaging modality for detecting disease elsewhere in the body. This can help avoid unnecessary surgery in children with benign nodules.

Treatment Options for Thyroid Cancer in Children

The treatment of thyroid cancer in children involves surgery, radioactive iodine therapy, and thyroid hormone replacement therapy. The extent of surgery and the use of radioactive iodine therapy depend on the type and stage of the cancer.

The use of radioactive iodine therapy in children is controversial due to concerns about its potential long-term effects on growth and development.

Conclusion

Advancements in the diagnosis and management of thyroid cancer have led to improved outcomes in both adult and pediatric patients.

The use of imaging studies and molecular testing, along with less invasive surgical techniques, have reduced the need for unnecessary surgeries and improved cosmetic outcomes. Future research in this field will likely focus on the discovery of new molecular markers and the development of novel targeted therapies.