Thyroid Nodules in Children and Adolescents: Mini-review

Kerr, Catherine E.; Hackman, Sarah; Francis, Gary L.

doi:10.29245/2767-5157/2020/1.1110

Cited by 1 publication

(2 citation statements)

References 42 publications

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“…Thyroid nodules are more common in adults compared to the pediatric population, but a much higher proportion of pediatric thyroid nodules are malignant. More specifically, thyroid nodules are present in 20-76% of adults, with prevalence increasing with age [1], whereas they are found in 0.2-5% of children and 13% of adolescents [2]. Certain subgroups of pediatric patients, however, (those with genetic risk factors (APC-associated polyposis, Carney complex, DICER1 syndrome, PTEN hamartoma tumor syndrome and Werner syndrome) [3], radiation exposure, iodine deficiency, autoimmune thyroid disease, and goiter) are particularly likely to develop them [2].…”

Section: Introduction 1general Overviewmentioning

confidence: 99%

“…More specifically, thyroid nodules are present in 20-76% of adults, with prevalence increasing with age [1], whereas they are found in 0.2-5% of children and 13% of adolescents [2]. Certain subgroups of pediatric patients, however, (those with genetic risk factors (APC-associated polyposis, Carney complex, DICER1 syndrome, PTEN hamartoma tumor syndrome and Werner syndrome) [3], radiation exposure, iodine deficiency, autoimmune thyroid disease, and goiter) are particularly likely to develop them [2]. Compared to adults, in whom only about 5% of thyroid nodules are malignant, 22-26% of pediatric thyroid nodules are malignant [3,4].…”

Section: Introduction 1general Overviewmentioning

confidence: 99%

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Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children’s Hospital and a Comprehensive Review of the Pediatric Literature

Hess

Tassel

Runyan

et al. 2023

Cancers

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While thyroid nodules are less common in children than in adults, they are more frequently malignant. However, pediatric data are scarce regarding the performance characteristics of imaging and cytopathology classification systems validated to predict the risk of malignancy (ROM) in adults and select those patients who require fine-needle aspiration (FNA) and possibly surgical resection. We retrospectively reviewed the electronic medical records of all patients 18 years of age or younger who underwent thyroid FNA at our institution from 1 July 2015 to 31 May 2022. Based on surgical follow-up from 74 of the 208 FNA cases, we determined the ROM for the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) ultrasound risk stratification system and The Bethesda System for Reporting Thyroid Cytopathology and added our results to those of pediatric cohorts from other institutions already published in the literature. We found the following ROMs for 1458 cases using ACR TI-RADS (TR): TR1. Benign: 2.2%, TR2. Not Suspicious: 9.3%, TR3. Mildly Suspicious: 16.6%, TR4. Moderately Suspicious: 27.0%, and TR5. Highly Suspicious 76.5%; and for 5911 cases using the Bethesda system: Bethesda I. Unsatisfactory: 16.8%, Bethesda II. Benign: 7.2%, Bethesda III: Atypia of Undetermined Significance: 29.6%, Bethesda IV. Follicular Neoplasm: 42.3%, Bethesda V. Suspicious for Malignancy: 90.8%, and Bethesda VI. Malignant: 98.8%. We conclude that ACR TI-RADS levels imply higher ROMs for the pediatric population than the corresponding suggested ROMs for adults, and, in order to avoid missing malignancies, we should consider modifying or altogether abandoning size cutoffs for recommending FNA in children and adolescents whose thyroid glands are smaller than those of adults. The Bethesda categories also imply higher ROMs for pediatric patients compared to adults.

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