Sonographic Evaluation of Pediatric Thyroid Nodules

Abstract

A thyroid nodule detected clinically or incidentally at medical imaging is a common indication for ultrasonography (US) in the adult population. This scenario is less frequently the case in pediatric patients, and the approach to evaluation of thyroid nodules deserves modification in these patients because of the increased probability of malignancy in children, compared with adults. Evaluating a thyroid nodule with US in a systematic way requires familiarity with a number of features that can be assessed and the terms that the radiologist uses in each category. The probability of malignancy is influenced by certain features, and several models have emerged to integrate these details into an overall risk assessment to guide management and biopsy of thyroid nodules. Clinical features of thyroid cancer differ between pediatric and adult patients, and risk factors and certain genetic syndromes portend earlier manifestation of thyroid malignancy. This article provides a review of (a) US features of thyroid nodules with an emphasis on the predictive capacity for malignancy, focused on the pediatric age group when the data exist, (b) clinical information, including risk factors and genetic syndromes pertinent to the pediatric population, and (c) the state of the current literature and controversies in diagnosing and managing pediatric thyroid cancer. RSNA, 2017.

Imaging and Imaging-Based Management of Pediatric Thyroid Nodules

“…In general, the US features most concerning for malignancy are hypoechogenicity, irregular margins, and increased intranodular blood flow, as well as the presence of microcalcifications and abnormal cervical lymph nodes. On the other hand, entirely cystic nodules are regarded as almost always benign [3,25,26].…”

“…Several studies have investigated the sonographic features of malignant pediatric thyroid nodules [8,[25][26][27][28][29]. In the largest and most detailed series, including 404 nodules in 314 children, Richman et al showed that most of the sonographic characteristics of a nodule associated with increased risk of cancer in adults also convey a higher risk of malignancy in children.…”

Recent Trends in the Clinicopathological Features of Thyroid Nodules in Pediatric Patients: A Single Tertiary Center Experience over 25 Years

“…e early detection of thyroid nodules in adult patients has contributed to the increased diagnosis of thyroid cancer and has improved the clinical outcomes in these patients [9,[11][12][13]. In pediatric thyroid nodule patients, the American yroid Association recommends ultrasonography (US) and fine needle aspiration (FNA) for the evaluation of thyroid nodules [14][15][16]. More accurate diagnoses of the nodules have, therefore, been made possible, although the number of unnecessary examinations of benign nodules has also increased [17][18][19].…”

Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients

“…4,5 Finally, no well-validated paediatric scoring scheme helping predict malignancy risk, akin to the ATA Adult US Risk Stratification Scheme or the Adult McGill Thyroid Nodule Score, exists. 4,5 Finally, no well-validated paediatric scoring scheme helping predict malignancy risk, akin to the ATA Adult US Risk Stratification Scheme or the Adult McGill Thyroid Nodule Score, exists.…”

“…Secondly, though US features suspicious for malignancy are well known to be similar between children and adults, few large studies explore which subtle, paediatric-specific US findings most predict malignancy. 4,5 Finally, no well-validated paediatric scoring scheme helping predict malignancy risk, akin to the ATA Adult US Risk Stratification Scheme or the Adult McGill Thyroid Nodule Score, exists. 13,14 Having an adjunctive scoring tool to be used with FNA results may help providers improve both the diagnosis and management of paediatric thyroid nodules.…”