Table 2.

Research goals for future studies on pediatric DTC based on current gaps in literature

Research goals in pediatric DTC
Pediatric thyroid nodules To upgrade the level of evidence and to (more certainly) determine the prevalence of non-clinically relevant thyroid nodules in childhood.
Pre-operative management To determine the state of evidence upon measurement of calcitonin in the diagnostic work-up of a thyroid nodule. To determine the positive and negative predictive value of molecular testing in an FNB specimen of a thyroid nodule in a child for presence of DTC in a thyroid nodule. To determine the predictive value of suspicious neck ultrasound findings in a lymph for presence of a DTC metastasis. To determine whether other imaging modalities than neck ultrasound contribute to evaluating the presence of lymph node and or distant metastases pre-operatively.
Post-operative management To determine which histopathological criteria are related to distant/any metastases in childhood DTC. To determine if molecular testing in pediatric thyroid carcinoma tissue alters its management. To compare the difference in outcome of DTC in children treated with a prophylactic central and/or lateral lymph node dissection vs no prophylactic central and/ or lateral neck dissection. To evaluate the outcome of pediatric DTC patients with a small thyroid carcinoma and no suspicious lymph nodes, treated with partial thyroidectomy/lobectomies/isthmusectomies vs total thyroidectomy. To evaluate outcome of small pediatric DTC not treated with I-131 vs those treated with I-131. To determine the most optimal I-131 activity effect curve in treatment of pediatric DTC with least side effects. To determine the beneficial effect of upfront systemic therapy vs surgery.
Follow-up To determine the benefit of neck US in addition to measurement of serum Tg in the follow-up of pediatric DTC. To evaluate outcome in children with measurable but not rising Tg (incomplete biochemical response) treated with I-131 vs a wait-and-see approach. To evaluate outcome in children with recurrent disease/progressive thyroid cancer treated with additional I-131/surgery/other vs a wait-and-see approach. To determine the sensitivity of I-124, I-123, and FDG PET/CT for DTC/thyroid rest or recurrent disease in follow-up of pediatric DTC. To define the risk factors for and clinical impact of adverse effects of treatment for pediatric DTC.