Is Ultrasonography Useful in Predicting Thyroid Cancer in Children with Thyroid Nodules and Apparently Benign Cytopathologic Features?

Abstract

Background/Aims: To assess whether the presence of certain findings on thyroid ultrasonography (US) correctly diagnoses malignancy even when a fine-needle aspiration biopsy (FNAB) suggests a benign lesion. Methods: We reviewed the charts of 35 children and adolescents with a thyroid nodule who had had an US and a FNAB, and for whom final pathology was available. Results: The global accuracy of FNAB was 83%, with a sensitivity of 75% and a specificity of 94%. 14 FNABs suggested malignancy (40%), only 1 of which was a false positive (7%). By contrast, 5 of the 21 FNABs suggesting benign lesions were false negatives (24%). These 5 cases had US findings suggestive of malignancy. When FNAB suggested a benign lesion, US had a good sensitivity (80%) but a poor specificity and accuracy (50 and 57%, respectively); its negative predictive value was 90% and its positive predictive value 36%. Conclusions: US complements FNAB in the evaluation of thyroid nodules in children. A more aggressive approach is warranted in children with a thyroid nodule and a benign FNAB if US findings suggest malignancy.

What Is the Safe and Accurate Procedure for Thyroid Nodules in Childhood?

“…In the literature, FNAB showed the highest sensitivity, specificity, and accuracy [6] . On the contrary, in this study, Saavedra et al [1] report an accuracy lower than that of US, but these data are probably due to the small study group. Other researchers show a cor-I read with great interest the article by Saavedra et al [1] who evaluated whether ultrasonography (US) is useful in predicting thyroid cancer in children with thyroid nodules and apparently benign cytopathologic features.…”

“…On the contrary, in this study, Saavedra et al [1] report an accuracy lower than that of US, but these data are probably due to the small study group. Other researchers show a cor-I read with great interest the article by Saavedra et al [1] who evaluated whether ultrasonography (US) is useful in predicting thyroid cancer in children with thyroid nodules and apparently benign cytopathologic features. They reported that the global accuracy of fine-needle aspiration biopsy (FNAB) was 83%, with a sensitivity of 75% and a specificity of 94%.…”

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

“…Recent studies cite slightly lower US diagnostic accuracy with a lower sensitivity but equal specificity [30, 31]. The radiologists had a better ability to confidently predict a true malignancy compared to the ATA high risk category (80 vs. 53%).…”

Predictors of Malignancy in Children with Thyroid Nodules

“…27,28 Most of these differences have been already seen in studies on adults 18-21 and many were inconsistently observed in smaller pediatric cohorts. 12,14,15,18,29,30 To remove confounders and assess the relative weight of each predictor, we designed a regression model that confirmed that microcalcifications, hypoechoic pattern, increased intranodular vascular flow, lymph nodal sonographic alterations, and serum TSH concentration were independent predictors of malignancy. Increased intranodular vascular flow and microcalcifications were the strongest predictors of malignancy among factors studied.…”