Background and Aims

Thyroid nodules are uncommon in pediatric patients. However, a thyroid nodule in a child poses a risk of malignancy up to 25-30%. A validated radiographic classification of thyroid nodules in adults, but not yet widely used in children, is Thyroid Imaging Reporting and Data System (TI-RADS). The purpose of this study was to determine the sensitivity, specificity, and accuracy of TI-RADS in predicting thyroid malignancy for nodules in children with available cytopathology, and to compare the diagnostic accuracy to the current American Thyroid Association (ATA) guidelines.

Methods

A single-institution retrospective review was performed of patients younger than 21 years who underwent thyroid nodule FNAB, and who had ultrasound imaging available. Two radiologists were blinded to the pathology and independently classified all biopsied thyroid nodules based on TI-RADS. The reliability of radiologists’ ratings was done using Spearman correlation. We then compared TI-RADS with ATA guidelines to determine the diagnostic sensitivity and specificity of TI-RADS in this cohort. All statistical analysis was conducted using SAS 9.4.

Results

115 patients (median age 15.5years, IQR (13-16.9), 90 females) were included. In these 115 patients, 138 nodules were retrospectively scored using TI-RADS. There was moderate inter-rater agreement between radiologists (Kappa = 0.42; p<.0001). Both systems recommended FNAB in 32 (23.2%), and no FNAB in 24 (17.4%), for a congruency rate of 40.6%. Using ATA guidelines, 114/138 (82.6%) of nodules were recommended for FNAB. Using TI-RADS scoring, 32/138 (23.2%) of nodules were recommended for FNAB. The majority of nodules for which ATA recommended FNAB but TI-RADS did not were benign (84%). Sensitivity, specificity, and accuracy for TIRAD is 76.9%, 71.4%, and 73.5% respectively.

Conclusions

Using TI-RADS for diagnostic management of pediatric thyroid nodules improves accuracy in predicting malignancy, thereby avoiding unnecessary biopsies. Further efforts to validate TI-RADS for pediatric thyroid nodules is required.

Background and Aims

Pediatric thyroid surgery has gained importance in recent years due to increasing malignancy rates. We aim to characterize the clinical presentation, diagnosis and treatment outcomes of a pediatric cohort submitted to thyroid surgery.

Methods

Retrospective data collection and analysis of patients submitted to total thyroidectomy (TT), lobectomy and/or modified neck lymphadenectomy (MNL) in a pediatric surgery department between January 2014 and March 2020.

Results

31 patients (68% female), aged 15 [5-18] years-old, underwent 38 surgical interventions. Nineteen (61%) patients had relevant past medical history (second tumors in 8 cases). The most common reason for surgical consultation (74%) was a thyroid nodule; 6 patients were symptomatic (dyspnea, dysphagia and asthenia); 1 patient had MEN 2A syndrome.

Nodule dimension was 21 [8-57] mm; 2 patients (MEN 2A, Graves disease) showed no nodules. Fine needle aspiration cytology was performed in 29 patients: 14 papillary carcinoma (PaC) (all confirmed in postoperative histology); 7 follicular tumors (postoperative histology: 2 PaC, 3 well-differentiated carcinomas, 1 familiar multiple adenomas, 1 adenomatous goiter); 4 follicular lesion/atypia of undetermined significance (histology: 2 PaC, 2 follicular adenomas); 3 colloid nodules (benign histology); and 1 PaC metastasis.

Patients underwent 19 TT (3 with MNL), 11 lobectomies, 6 totalizations (1 with MNL) and 2 isolated MNL. Six patients presented self-limited postoperative complications (stridor and hypocalcemia); 2 patients (0.6%) showed permanent hypoparathyroidism.

Definitive histology revealed malignancy in 74% of cases, and PaC was the most common type (82%). Radioiodine therapy was performed in 20 patients.

After a mean follow up of 32 months, there is no mortality.

Conclusions

Papillary carcinoma is the most frequent cause of thyroid surgery in children. Thyroid nodules are the most frequent presentation and there is an important prevalence of past comorbidities. Thyroid surgery, although aggressive, presents little long-term morbidity.