Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: Experience of a Tertiary Care Referral Center

Heider, Amer; Arnold, Stacy; Jing, Xin

doi:10.5858/arpa.2018-0596-oa

Cited by 21 publications

(13 citation statements)

References 17 publications

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“…In the pediatric population, there is a wide range of reported malignancy rates for each Bethesda category I-IV respectively, and are listed as follows: 0-30%, 0-7%, 8-54%, 10-100%, 76-100%, 100%. 4,[12][13][14][15] Our results are comparable to the range of rates of malignancy from the previous series. However, when compared with the recent meta-analysis presented by Vuong et al, 5 our numbers in the benign (II) and AUS/FLUS (III) categories fell below the confidence interval that they established (Figure 2).…”

Section: Discussionsupporting

confidence: 88%

Malignancy Rates by Bethesda Subcategory in the Pediatric Population

et al. 2022

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Introduction While the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the most widely used method for categorizing thyroid nodules, its applicability to children is often debated. We describe our institution’s experience utilizing the TBSRTC and examine the rates of malignancy in our population. Methods We conducted a retrospective chart review of eligible patients undergoing primary thyroidectomy at a high-volume tertiary care pediatric hospital. All patients had pre-operative fine needle aspiration Results Of the 112 patients in our cohort, 85 (76%) were female. The median age was 15.1 years. The patients were divided into groups based on the Bethesda categorization of the fine needle aspirations of their nodules. The percentages of patients whose resection specimens showed evidence of malignancy on the surgical pathology reports were recorded as follows: category I (n = 5): 20%, category II (n = 11): 0%, category III (n = 30): 17%, category IV (n = 13): 31%, category V (n = 17): 94% and category VI (n = 36): 100%. Conclusion Our findings indicate that the malignancy rates at our institution are comparable to those reported by other high-volume studies. When compared with the 2017 TBSRTC data, we found that our results were similar in many categories, with the exception of categories I and V.

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Section: Discussionsupporting

confidence: 88%

Malignancy Rates by Bethesda Subcategory in the Pediatric Population

et al. 2022

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“…FNAB results are reported according to the Bethesda classification, and the ATA guidelines recommend the use of the same system for describing pediatric thyroid cytology as that used for adults [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

Thyroid Cancer Risk Factors in Children with Thyroid Nodules: A One-Center Study

Beń‐Skowronek

Sieniawska

Pach

et al. 2021

JCM

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Thyroid nodules are common in the adult population (13%), but in childhood, they are relatively rarely diagnosed (0.2–5%). The risk factors and diagnostic and therapeutic algorithms are well-known and effectively used in adults, but no clear procedures supported by scientific research are available in the pediatric population. Our aim in this study was to identify predictive factors for thyroid cancer in a pediatric population. We retrospectively analyzed 112 children (80 girls and 32 boys, aged 0.6–18 years, with an average group age of 13.4 ± 4.5 years) with thyroid nodules who presented or were referred between 2010 and 2021. A total of 37 children qualified for partial or total thyroidectomy. After histopathological nodule examination, the most common cases were benign lesions in 23 patients (57.5%) and malignant lesions in 14 children (32.5%). Solitary benign thyroid nodules were found in 16 children (40%). Malignancy risk was higher in children with increased nodule diameter (greater than 7 mm; p = 0.018) or hypoechogenic lesions in ultrasound (p = 0.010), with no correlation between increased blood flow in the vessels and tumor diagnosis. The relative risk of developing thyroid cancer for class III was found to be higher in comparison to adults and 11.1 times higher than for classes I and II combined.

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“…Based on the predicted risk of malignancy per TBSRTC, there are then suggested management guidelines which include further clinical monitoring, repeat FNA, or surgical resection [3]. Although TBSRTC was based primarily on data from adult populations, the utility of TBSRTC in the pediatric population has been demonstrated in a few studies [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Improving Malignancy Prediction in AUS/FLUS Pediatric Thyroid Nodules with the Aid of Ultrasound

Arora¹,

Trout²,

Chuang³

2020

Horm Res Paediatr

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Introduction: The standard workup of thyroid nodules concerning for malignancy includes fine-needle aspiration (FNA). In 2015, the American Thyroid Association (ATA) guidelines for the management of pediatric thyroid nodules recommended that all nodules with a Bethesda III cytology undergo surgical resection. Objectives: To correlate a Bethesda III cytology with histologic and clinical outcomes to determine the relevance of the ATA recommendations, and to evaluate whether Thyroid Imaging Reporting and Data System (TI-RADS) scoring could identify Bethesda III nodules at a lower risk of malignancy. Methods: A retrospective chart review of patients who had undergone thyroid nodule FNA from 2008 to 2018 was performed. Malignancy rates were determined for each Bethesda category. The reference standard was histopathology or 2-year follow-up of imaging outcomes for nonoperative cases. Ultrasound exams of Bethesda III nodules were reviewed and TI-RADS scores assigned. Results: A total of 143 FNA samples from 128 patients were identified. The mean age was 14.9 years (range 7–22). Twenty-two (15%) of the FNA samples were Bethesda III; the malignancy rate was 38%. A TI-RADS score was assigned in 20 of the 22 Bethesda III nodules. ROC analysis found an optimal cut-off for malignancy prediction of ≥7 points (risk category TR5). The negative predictive value was 85.7% (95% CI 35.9–99.6) and the positive predictive value was 83.3% (95% CI 57.2–98.2). Conclusion: Although, at baseline, thyroid nodules with a Bethesda III classification carry a moderate risk of malignancy in the pediatric population, TI-RADS scoring can identify nodules with a lower risk within this group. If validated by larger studies, this can inform decision making and reduce unneeded surgery.

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Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: Experience of a Tertiary Care Referral Center

Cited by 21 publications

References 17 publications

Malignancy Rates by Bethesda Subcategory in the Pediatric Population

Malignancy Rates by Bethesda Subcategory in the Pediatric Population

Thyroid Cancer Risk Factors in Children with Thyroid Nodules: A One-Center Study

Improving Malignancy Prediction in AUS/FLUS Pediatric Thyroid Nodules with the Aid of Ultrasound

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