The Canadian Pediatric Thyroid Nodule Study: an evaluation of current management practices

doi:10.1016/j.jpedsurg.2007.12.019

Cited by 59 publications

(10 citation statements)

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“…In the differential diagnosis of a thyroid nodule, follicular adenoma and colloid goiter are the most frequently reported benign etiologies (8, 9, 13, 15). In various studies, papillary carcinoma was found to be the most frequent (5−47%) malignancy in pediatric cases with thyroid nodules (6, 8, 9, 11, 16, 17). The reasons for this large discrepancy in the rate are attributed to factors such as differences in diagnostic procedures, ethnic origin of the study groups and reluctance to use unnecessary neck and head radiation.…”

Section: Discussionmentioning

confidence: 99%

Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood

Altıncık

Demir²,

Abacı³

et al. 2010

jcrpe

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Objective: To assess the role of fine−needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules.Methods: Results of 30 FNABs performed in our clinic were retrospectively reviewed. Clinical and surgical follow−up data were obtained from the patient files, and clinical correlation and accuracy of FNAB were evaluated.Results: The results of 30 FNABs were reported as benign in 24 (80%), insufficient in 4 (13.3%) patients, malignant in 1 (3.3%), and suspicious in 1 (3.3%) patient. One patient with a FNAB result of malignancy underwent surgery and the histological diagnosis was papillary carcinoma. FNAB was repeated in two of the insufficient biopsies, and reported as benign; in one of these patients, the thyroid nodule disappeared and in one, remained stable at clinical follow−up. Four of the patients with benign FNAB results underwent surgery at clinical follow−up because of an increase in the size of the nodules and one patient was found to have papillary carcinoma. The remaining patients were clinically followed. In this study, the malignancy prevalence was 6.6% in patients with thyroid nodules. There was only one falsenegativecase.Conclusion: FNAB is a reliable diagnostic tool in the management of pediatric thyroid nodules.Conflict of interest:None declared.

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Section: Discussionmentioning

confidence: 99%

Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood

Altıncık

Demir²,

Abacı³

et al. 2010

jcrpe

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“…Based on a prior study from our institution, thyroid FNAs in the pediatric age group result in approximately 50% of cases in a definitive diagnosis, including 46% negative for malignant cells and 4% positive for malignant cells, and of the surgically excised nodules, 35% were malignant [13]. In general, the rate of malignancy in surgically excised pediatric thyroid nodules is higher than in adults and has been reported to be up to 49% [14,15]. Given the rate of malignancy in this age group, the goal of this study was to analyze indeterminate thyroid FNAs in a pediatric population and to correlate these findings with clinical and histological features.…”

Section: Introductionmentioning

confidence: 99%

Indeterminate Pediatric Thyroid Fine Needle Aspirations: A Study of 68 Cases

et al. 2013

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Objective: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides a reporting scheme for thyroid fine needle aspiration (FNA) and includes three indeterminate categories with different management strategies. This study analyzes indeterminate thyroid FNAs in children, and correlates these findings with the histological features. Methods: A total of 179 thyroid FNA specimens were retrieved from children. Cases were categorized by TBSRTC. Only cases diagnosed as atypia (AUS)/follicular lesion of undetermined significance (FLUS), suspicious for follicular or oncocytic neoplasm (SFON), or suspicious for malignancy (SM) were selected and correlated with the nodule size and histological follow-up. Results: Sixty-eight cases were identified, including 43 (63%) AUS/FLUS diagnoses, 19 (28%) SFON, and 6 (9%) SM. On follow-up, 48% were malignant, including 28% AUS/FLUS cases, 58% SFON, and 100% SM. The average size of the malignant lesions diagnosed preoperatively as AUS/FLUS was 1.5 cm (range 0.7-4.5), compared to 3.3 cm (range 1.2-6.6) in SFON and 2.8 cm (range 0.7-3.8) in SM. Malignancies included 92% papillary thyroid carcinoma (PTC), 77% of which were the follicular variant of PTC (FVPTC) and 8% follicular carcinomas. The AUS/FLUS cases were largely due to compromised specimens (49%) and the highest malignancy rate occurred in those with cytological atypia (50%). Conclusions: This study shows an incremental risk of malignancy within the indeterminate categories using TBSRTC in children. Malignant nodules with a preoperative AUS/FLUS diagnosis tended to be smaller than those with a SFON or SM diagnosis, and the vast majority of malignancies were PTC, with a high proportion being FVPTC.

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“…When there are cases of children who have congenital hypothyroidism due to dyshormogenesis or iodide organification defect, thyroid cancer can arise if TSH is consistently increased due to inappropriate L-thyroxine treatment1,3,4,5,6,24). Therefore, it is thought that a more aggressive approach is needed for thyroid nodules found in children with congenital hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

“…The malignant rate of thyroid nodules is assumed to be 5% in adults and 25% in children. For this reason, a more aggressive approach is required for thyroid nodules found in children1,3,4,5,6). In children with congenital hypothyroidism due to dyshormogenesis or iodide organification defect, their risk of developing thyroid nodules increases, and changes from nodules to tumors can arise if the level of thyroid-stimulating hormone (TSH) increases for a long period of time due to inappropriate L-thyroxine treatment3,7).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of thyroid nodules in infant with congenital hypothyroidism

et al. 2014

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PurposeThis study aimed to assess the characteristics of thyroid nodules among infants diagnosed with congenital hypothyroidism.MethodsA retrospective study of 660 infants (374 males, 286 females) diagnosed with congenital hypothyroidism was carried out at the Pediatric Endocrine Clinic in Soonchunhyang University Hospital, Korea, between May 2003 and February 2013. The average age at diagnosis was 1.16±1.68 months.ResultsOf the 28 patients (4.2%) with thyroid nodules, 17 (2.6%) had cystic thyroid nodules and 11 (1.6%) had solid thyroid nodules. There were no significant differences in gender or age between congenital hypothyroidism patients who hadthyroid nodules and those who did not. All nodules were asymptomatic. The average age at diagnosis of congenital hypothyroidism with nodules was 1.42±1.39 months. All detected nodules measured less than 1 cm in diameter. Twenty-two of the 28 infants (78.6%) had only one nodule, while multiple nodules were found in 6 infants (21.4%). Of the 28 infants diagnosed with nodules, 16 underwent thyroid ultrasonography during follow-up and 8 of them (50%) showed no signs of nodules at thyroid ultrasonography.ConclusionThe prevalence of thyroid nodules in infants with congenital hypothyroidism was 4.2%. Most thyroid nodules were small in size and benign, disappearing during follow-up observation. We therefore conclude that thyroid nodules in infants with congenital hypothyroidism can simply be observed and do not require direct treatment.

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The Canadian Pediatric Thyroid Nodule Study: an evaluation of current management practices

Abstract: The incidence of malignancy in pediatric thyroid nodules is high, and the risk of surgical complications significant. With variable management practices across Canada, evidence-based guidelines for diagnosis and surgical treatment may be valuable.

Cited by 59 publications

References 14 publications

Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood

Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood

Indeterminate Pediatric Thyroid Fine Needle Aspirations: A Study of 68 Cases

Characteristics of thyroid nodules in infant with congenital hypothyroidism

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