Assessment of the American College of Radiology Thyroid Imaging Reporting and Data System for Thyroid Nodule Malignancy Risk Stratification in a Pediatric Population

Recommendations on Surveillance for Differentiated Thyroid Carcinoma in Children with PTEN Hamartoma Tumor Syndrome

“…It is essential that an experienced thyroid radiologist performs the ultrasound. Reports upon the use of the ACR TIRADS classification as reporting system in children show contradictory re-Eur Thyroid J 2020;9:234-242 DOI: 10.1159/000508872 sults about its adequacy in children [32,33], and no studies exist that evaluate this classification system in children with a germline PTEN mutation. For this reason, no recommendation for using this reporting system can be made.…”

Ultrasound guidelines for pediatric thyroid nodules: proceeding with caution

“…The current paper and others show that ACR TI-RADS performs well in identifying benign and lower-suspicion nodules in children, therefore suggesting that deferment of fineneedle aspiration biopsies in appropriately selected nodules might be a reasonable management option [1,6]. Adult guidelines would dictate no further action, not even follow-up ultrasound, for ACR TI-RADS 1 and 2 (benign and not suspicious) lesions of any size [3].…”

“…Adult guidelines would dictate no further action, not even follow-up ultrasound, for ACR TI-RADS 1 and 2 (benign and not suspicious) lesions of any size [3]. Recent studies, however, acknowledge a number of false-negatives of up to 10-13% in children using ACR and ATA criteria, and therefore we believe that more stringent standards should be applied to children [1,6,9,10]. For nodules that do not warrant fine-needle aspiration biopsies, our own inclination is to perform surveillance follow-up ultrasounds.…”

“…These results corroborate other studies showing that the ACR TI-RADS, already validated in large adult populations, holds potential for use in children for identifying nodules that are at high risk for malignancy and that therefore warrant fineneedle aspiration biopsy [4,5]. A study of the ACR TI-RADS in 74 nodules in children was found to discriminate between malignant and benign, demonstrating that for every one-unit increase in TI-RADS category the likelihood of malignancy increased 2.73 times, and showing an area under the ROC curve of 0.75 [6].…”

“…These size thresholds will likely need to be lowered or eliminated for children. The ATA guideline for children states that because thyroid volume changes with age, determination of malignancy risk in children should be based solely on ultrasound appearance without regard for nodule size, a finding supported by subsequent work [6,7]. Prospective studies of larger numbers of children are needed to determine what, if any, size thresholds are appropriate for ACR TI-RADS in pediatrics.…”