Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

Tuli, Gerdi; Munarin, Jessica; Agosto, Erica; Matarazzo, Patrizia; Quaglino, Francesco; Mormile, Alberto; Sanctis, Luisa De

doi:10.1007/s12020-021-02784-0

Cited by 9 publications

(11 citation statements)

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“…Other features include intranodal calcification or vascularization, lymph node involvement, marked hypoechoic pattern, bilateral or right lobe localization of the nodule, poorly defined nodule margins and some clinical risk factors, particularly radiation exposure for cancer treatment, increased TSH values, young age and male gender. In our cohort, TSH levels were correlated to malignancy, as previously reported ( 6 , 26 ). Considering the child’s body size and the presence of microcarcinomas, in presence of multiple risk factors FNAB should be performed even if the nodule size is smaller than 1 cm ( 1 – 7 ).…”

Section: Discussionsupporting

confidence: 68%

“…The cytological category assignment leads to different clinical management that includes clinical-radiological follow-up or surgery, with some differences between these classifications. Despite the differences, all agree on a higher ROM in paediatric age for all categories, especially for indeterminate nodules ( 6 , 33 , 34 ).…”

Section: Introductionmentioning

confidence: 78%

“…Nodular thyroid disease in paediatric age has a lower prevalence (0.2-5.1%) than in adulthood (1-10%) ( 1 – 3 ), but the main difference between paediatric and adult age lies in the rate of malignancy (ROM) (16-26% vs 5-10%) ( 4 – 6 ). The most important risk factors for the development of thyroid cancer include underlying thyroid disease, radiation exposure, previous malignancy, family history, young age, male gender, and genetic predisposition ( 1 – 21 ).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

et al. 2022

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BackgroundPediatric thyroid nodules have a lower prevalence but a higher rate of malignancy (ROM) than those in adults. Ultrasound features suspected of malignancy lead to fine needle aspiration biopsy (FNAB) and subsequent cytological determination, upon which management is decided. Based on the characteristics of ultrasound, to standardize clinician decisions and avoid unnecessary FNAB, the European Thyroid Association and the American Radiology College have established guidelines for Thyroid Imaging, Reporting and Data System (EU-TIRADS and ACR-TIRADS) for ROM stratification of thyroid nodules. The aim of this study is to evaluate the diagnostic performance of ACR-TIRADS and EU-TIRADS in pediatric age.Materials and methodsSubjects younger than 18 years of age with thyroid nodules greater than 0.5 cm observed in the 2000-2020 period were included.ResultsData from 200 subjects were collected. The overall ROM was 13%, rising to 26% if nodules with a diameter >1 cm were considered. Patients with a malignant nodule were more likely to have a higher EU-TIRADS score (p=0.03). Missed cancer diagnoses were 26.9%. Using the EU-TIRADS system, 40% of FNABs could have been avoided, while this scoring system would have resulted in FNAB being performed in 12% of cases where the assessment of ultrasound features would not recommend FNAB. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.1%, 57.1%, 73.1%, and 50%, respectively. Even considering the ACR-TIRADS, a higher score correlated with a higher ROM (p<0.001). This system missed 6 diagnoses of cancer (23.1%). Using the ACR-TIRADS system, 45.3% of FNABs could have been avoided, while FNAB should have been performed in 12% of cases where it was not recommended by ultrasound characteristics. Sensitivity, specificity, PPV and NPV were 76.9%, 50%, 76.9%, and 42.9%, respectively.ConclusionThe present study confirms the correspondence of the EU-TIRADS and ACR-TIRADS categories with respect to malignancy but indicates not entirely satisfactory performance compared to FNAB alone. However, the use of the two TIRADS systems should be encouraged in multicentre studies to increase their performance and establish paediatric-specific points in the scoring criteria.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

et al. 2022

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“…Pediatric thyroid diseases of surgical interest are rare: however, data provided by literature report constantly increasing incidence rates (14, 15). Children and adolescents show diseases with a worse prognosis and higher malignancy rates (12.5-50%), much higher than the adult population by 5-10% (16).…”

Section: Discussionmentioning

confidence: 99%

Pediatric thyroid surgery: Retrospective analysis on the first 25 pediatric thyroidectomies performed in a reference center for adult thyroid diseases

et al. 2023

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IntroductionPediatric thyroid carcinoma represents about 4-5% of all pediatric carcinoma with an incidence of 0.5 cases/100,000, compared to 2-10/100000 cases in the adult population. The aim of this study is to present the experience of a reference adult endocrine surgery unit in charge of the treatment of pediatric thyroid diseases.Materials and methodsFrom January 2019 to September 2022, 25 patients, aged 5-17, underwent thyroid surgery. We analysed indications for surgery, use of intraoperative nerve monitoring (IONM), definitive histological examination, postoperative outcomes and risk factors related.ResultsSurgical indication was performed for Graves’ disease (27%) and for nodular pathology (73%): of these, four were malignant lesions (TIR4/TIR5), eight with indeterminate characteristics (TIR3A/TIR3B) and four characterized as benign (TIR1/TIR2). Total thyroidectomy (TT) was performed in 76% of cases, three of which were prophylactic for the activation of the RET gene mutation in MEN 2A. IONM was used in eight cases (32%), all patients aged 11 years or less. FNA’s accuracy was 100% for lesions typified as benign and malignant (TIR1/TIR2 and TIR4/TIR5). The overall malignancy rate achieved was 40% and in the final histological examination 75% of the TIR 3B lesions were malignant. Six patients (24%) developed hypoparathyroidism in the first postoperative day, with normalization of calcium values within thirty days in 5 patients.ConclusionsPediatric thyroid nodules are rare and distinguished from adult thyroid disease by a worse prognosis and higher malignancy rates. Our work reports a much higher malignancy rate among indeterminate TIR 3B lesions than observed in the adult population and the three patients who underwent prophylactic total thyroidectomy for activating RET gene mutation had all a definitive histological diagnosis of medullary carcinoma. Post-surgical hypoparathyroidism is a common finding in these patients: in most cases the condition is transient and it benefits from supportive therapy. Intraoperative finding of a thinner recurrent laryngeal nerve in younger patients makes nerve isolation more difficult than in adult surgery: IONM is recommended in patients under 12. Pediatric thyroid surgery is challenging, we sustain it requires referral thyroid Centers for thyroid disease with highly skilled general endocrine surgeons.

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“…Another pediatric study cited a 50% benignity rate of AUS/FLUS lesions, calling into question the 2015 ATA recommendations for surgical resection for all these lesions [39]. A 200-patient pediatric Italian study which used its own, more nuanced, FNA reporting system, reported a total FNAB accuracy of 95% with a sensitivity and specificity of 92.3% and 92.6%, respectively [57]. A recent study examined the use of machine learning to better determine which pediatric thyroid nodules warrant FNA and surgical intervention, with the intent to avoid surgery for benign lesions [58].…”

Section: Fine Needle Aspirationmentioning

confidence: 99%

Differences in the management of thyroid nodules in children and adolescents as compared to adults

Goldfarb

Dinauer

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewTo describe recent advances in the diagnosis and management of thyroid nodules in both children and adults, highlighting differences between the two groups. Recent findingsThyroid nodules are less common in children than adults but the risk of malignancy is higher. Screening recommendations for patients with certain genetic syndromes or specific risk factors for thyroid nodules and cancer continue to evolve ultrasound is the most appropriate imaging modality for evaluating thyroid nodules in all patients, but radiographic risk stratification systems validated in adults have not been extensively studied in children. Criteria for proceeding to fine needle aspiration (FNA) biopsy differ some between children and adults, with nodule size being less of a consideration in young patients. Molecular testing continues to improve the diagnostic capabilities of FNA for all age groups, but options for pediatric thyroid nodules are currently limited. In children, only oncogene panels are validated and their exact utility, along with miRNA classifiers, is an evolving area of study. For adults, data support selection of a specific molecular test based on ultrasound characteristics and pretest probability of malignancy. Multiple series have shown that fusion mutations are more common in pediatric thyroid nodules, while point mutations are seen more often in adult thyroid nodules. Molecular data help guide management recommendations regarding the need for surgery when FNA is indeterminate, but clinical use is still being refined. Radiofrequency ablation is a nonoperative approach that has gained significant traction for the treatment of symptomatic benign nodules in adults, but data are currently extremely limited in children. SummaryThere are difference in the diagnosis and treatment of thyroid nodules in adults and children, the nuances of which are important for clinical management.

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Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories

Cited by 9 publications

References 58 publications

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules

Pediatric thyroid surgery: Retrospective analysis on the first 25 pediatric thyroidectomies performed in a reference center for adult thyroid diseases

Differences in the management of thyroid nodules in children and adolescents as compared to adults

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