Papillary thyroid carcinoma (PTC) accounts for 90% of childhood thyroid cancer cases. Proper risk classification of children with PTC is important to optimize treatment and avoid long-term side effects. In 2015, the American Thyroid Association (ATA) published guidelines for the management of children with PTC. Data from the Surveillance, Epidemiology, and End Results (SEER) populationbased program were used to describe the characteristics and outcomes of children and adolescents with PTC who were classified as low-risk per the ATA guidelines. Using SEER 18, we analyzed patients less than 20 years of age diagnosed with PTC between 2004 and 2014. TNM staging was used to categorize patients into the ATA pediatric low-risk group, which was defined as T1, T2, T3, or Tx with N0, Nx, or N1a in situ, and no distant metastases. Of 1861 patients with PTC, 887 (48%) were classified as low-risk. Of these, 748 (84%) were female, and 717 (81%) were between 15 and 19 years of age at diagnosis. Sixty-one percent of patients were non-Hispanic White, 23% were Hispanic, and 6% were non-Hispanic Black. Of the 875 patients who had surgery, 81% underwent a total thyroidectomy and 11% had a lobectomy and/or isthmectomy. A total of 409 (46%) patients received irradiation. Eight patients (0.9%) developed a second malignancy. Six patients (0.6%) died from causes other than their thyroid malignancy. The 5-year disease-specific survival was 100%. Pediatric and adolescent patients with low-risk PTC per ATA classification have an excellent prognosis. A major limitation of this study is the lack of recurrence data in the SEER registry. Nonetheless, favorable outcomes support minimizing therapy for low-risk patients. Prospective studies are warranted to assess radiation avoidance and subsequent outcomes in this group.
