Is thyroid imaging reporting and data system useful as an adult ultrasonographic malignancy risk stratification method in pediatric thyroid nodules?

Abstract

Background:Data on thyroid imaging reporting and data system (TI-RADS) generally belong to studies performed in adults. Therefore, we aimed to evaluate the performance and utility of TI-RADS in the pediatric group.Materials and Methods:From January 2015 to 2018, 108 nodules were evaluated in 1028 thyroid ultrasound examinations. Images were retrospectively evaluated by two radiologists with 3 and 7 years of pediatric radiology experience, according to TI-RADS classification. Morphological findings of the detected nodules and their histopathological results were recorded. Histopathological findings and at least 12 months of follow-up imaging were taken as reference.Results:Seventy-one patients were female (67%). The mean age was 11.4 ± 4.7, and the mean nodule size was 7.4 ± 8.3 mm. According to the histopathological assessment and at least 12 months’ follow-up with clinical and sonographic stability 100 (95.2%) of the nodules were benign and 5 (4.8%) were malignant. Two nodules, nondiagnostic cytology and 1 nodule were found to be suspicious for malignancy. All malignant nodules were in the TI-RADS 5 category. The majority of benign nodules (79%) were found in low TI-RADS categories. About 80% of the malignant nodules were very hypoechoic and taller than wide in shape, also all malignant nodules had microcalcifications (P = 0.000). The sensitivity of TI-RADS was 100%, specificity was 78.8%, positive predictive value (PPV) was 19.2%, and negative predictive value (NPV) was 100%.Conclusion:According to our study, TI-RADS system can be used to evaluate thyroid nodules in pediatric patients similar to adults.

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

“…However, the DTC prevalence and the time from irradiation to DTC onset are in agreement with those estimates by the ATA guidelines [2]. Second, the sample size and the number of DTCs were limited; however, this is the first study evaluating the role of US-RSSs in paediatric patients with a well-known history of irradiation exposure, and overall, the number of patients included in this study is in line with others evaluating non-irradiated patients [23,27,30]. Finally, only for 19 out of 52 patients was a histopathological confirmation available.…”

“…This discrepancy could be related to the higher prevalence of malignancy in the irradiated population and to the histopathology which is exclusively papillary thyroid cancer (PTC). Indeed, a large part of the studies considered in this meta-analysis [ 22 , 23 , 27 ] excluded patients with a history of radiation exposure and included patients with thyroid cancer other than PTC (10%) for which the US-RSSs are often not reliable enough [ 17 , 28 ].…”

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

“…Polat et al analyzed the TI-RADS classification, and the results indicated its use is safe in children. However, the authors noted the small sample size and indicated that more research is needed on a larger group of children [ 39 ]. Regrettably, some other reports contradicted this conclusion and showed that the use of these guidelines in children carries a risk of missing cancer in up to 22% of pediatric patients [ 38 , 40 , 41 ].…”

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.…”