Facing Thyroid Nodules in Paediatric Patients Previously Treated with Radiotherapy for Non-Thyroidal Cancers: Are Adult Ultrasound Risk Stratification Systems Reliable?

Abstract

Thyroid nodule ultrasound-based risk stratification systems (US-RSSs) have been successfully used in adults to predict the likelihood of malignancies. However, their applicability to the paediatric population is unclear, especially in children with a history of radiation exposure, who are at a higher cancer risk. We tested the efficacy of three US-RSSs in this setting by retrospectively applying three classification systems (ACR-TIRADS, ATA and EU-TIRADS) to all paediatric patients referred for thyroid nodules and with a radiation exposure history. We compared the results with a reference standard (pathology or 36-month follow-up); sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy were calculated. A total of 52 patients were included; fourteen of them (27%) had papillary thyroid cancer (PTC) at the final histology. No significant differences across the US-RSSs were detected; specificity (range 95–97%) and NPV (range 88–93%) were particularly elevated. However, ACR-TIRADS, ATA and EU-TIRADS did not indicate the need for a biopsy in six (42.8%), seven (50%) and eight (57%) cases of PTC; in five cases, this lack of indication was due to a small (<1 cm) nodule size. In conclusion, US-RSSs show a high NPV and specificity in paediatric patients, whereas the cytology indication could be improved by reconsidering the dimensional criterion.

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

“…Many efforts have been made to evaluate the diagnostic performance of ACR-TIRADS also in paediatric age (63). Its performance has been mostly defined as suboptimal, with a higher rate of cancers missed than in adulthood, up to 25% of cases (63,64), suggesting that FNAB should be performed in all the 4 and 5 ACR-TIRADS categories (65)(66)(67)(68)(69)(70)(71). EU-TIRADS has also been considered a useful tool for physicians managing adults with thyroid nodules, although its performance should be improved and a FNAB should be performed in all nodules assessed as EU-TIRADS ≥4 (50,(72)(73)(74)(75).…”

Performance of the Bethesda System for Reporting Thyroid Cytology in Multi-Institutional Large Cohort of Pediatric Thyroid Nodules: A Detailed Analysis

“…Considering that more than half of the nodules in AUS/FLUS category were benign, direct surgery recommendation could be questionable as proposed in ATA 2015 guidelines [ 3 ]. The use of ultrasound-based risk stratification systems to manage paediatric patients was previous validated [ 15 ] but until this moment the results are quite controversial with some studies showing a suboptimal performance for indication for FNAC and consequent cancer detection [ 19 , 20 ].…”

Suspected Malignant Thyroid Nodules in Children and Adolescents According to Ultrasound Elastography and Ultrasound-Based Risk Stratification Systems—Experience from One Center

“…However, the usefulness of different classification systems has not yet been clearly assessed in the population of children and adolescents. Single data are available in the literature regarding the utility of assessing thyroid nodules in pediatric patients using scales such as the ATA, TI-RADS, ACR-TIRADS and EU-TIRADS, especially after exclusion of the dimension criterion [ 31 , 32 , 33 ]. Both analyzed classifications performed well in predicting malignancy in our study group, as none of the PTCs were assessed as U3, U2 or U1 in BTA nor intermediate, low or very low suspicion in ATA.…”