Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

Lim-Dunham, Jennifer E.; Toslak, İclal Erdem; Alsabban, Khalid; Aziz, Amany; Martin, Brendan; Okur, Gökcan; Longo, Katherine C.

doi:10.1007/s00247-017-3780-6

Cited by 49 publications

(36 citation statements)

References 21 publications

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“…Other work supports the potential of US-based ATA risk stratification. Lim-Dunham et al [12] described an excellent diagnostic performance of ATA Adult Risk Stratification in a small cohort of 33 children (12 of whom had malignant nodules). The authors concluded that US surveillance may be appropriate for pediatric nodules stratified to less than high suspicion groups.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Lim-Dunham et al [12] applied the Adult ATA Risk Stratification to a small cohort of children with good results. Martinez-Rios et al [13] compared the performance of the ATA Risk Stratification to adult Thyroid Imaging, Reporting, and Data System (TIRADS) scoring in children, validating a similar sensitivity and specificity to adult patients.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

Creo¹,

Alahdab²,

Nofal³

et al. 2018

Horm Res Paediatr

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Background: Pediatric thyroid nodules are more likely to be malignant compared to those in adults and may have different concerning ultrasound (US) features. Recent adult guidelines stratify malignancy risk by US features. Our aim is to (1) describe and confirm US features that predict pediatric malignancy, and (2) apply the Adult American Thyroid Association (ATA) Risk Stratification Guidelines to a large pediatric cohort. Methods: We identified 112 children with 145 thyroid nodules from 1996 to 2015. Two blinded pediatric radiologists independently read all US images, described multiple features, and reported their overall impression: benign, indeterminate, or malignant. Each nodule was assigned an ATA risk stratification category. Radiologists’ impressions and ATA risk stratification were compared to histology and cytology results. Results: Multiple US features including a solid composition, presence of microcalcifications, irregular margins, increased blood flow, and hypoechogenicity were associated with increased odds of malignancy. ATA risk stratification correlated with the radiologists’ overall impression (p < 0.001). The sensitivity for detecting malignancy was comparable between both ATA stratification (91%) and the radiologists’ overall impression (90%). The specificity of the radiologists’ malignant overall impression (80%) was better compared to the ATA high risk stratification (54%). Conclusions: At our institution, pediatric radiologists’ overall impressions had similar sensitivity but better specificity for detecting malignancy than the ATA risk stratification tool by our convention. However, neither US-based methods perfectly discriminated benign from malignant nodules, supporting the continued need for fine needle aspiration for suspicious nodules. Further work is needed to develop an US-based scoring system specific to pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

Creo¹,

Alahdab²,

Nofal³

et al. 2018

Horm Res Paediatr

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“…[15][16][17] The McGill Criteria is another thyroid nodule scoring system that uses ultrasound features, clinical findings and cytology results to predict malignancy risk. In three independent paediatric cohorts, the Adult ATA Risk Stratification system (using specific ultrasound features to stratify malignancy risk) performed well, having a similar diagnostic accuracy for detecting malignancy in paediatric patients compared to adults.…”

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confidence: 99%

“…In three independent paediatric cohorts, the Adult ATA Risk Stratification system (using specific ultrasound features to stratify malignancy risk) performed well, having a similar diagnostic accuracy for detecting malignancy in paediatric patients compared to adults. [15][16][17] The McGill Criteria is another thyroid nodule scoring system that uses ultrasound features, clinical findings and cytology results to predict malignancy risk. While many components of the McGill score likely predict malignancy risk for children and adults, some features such as nodule size or shape may not predict malignancy in children.…”

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confidence: 99%

Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients

Creo

Alahdab

Nofal

et al. 2018

Clinical Endocrinology

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Introduction Thyroid cancer is the most common paediatric endocrine cancer; accurate diagnosis and prompt management of paediatric thyroid nodules is critical. The McGill Thyroid Nodule Score (MTNS), based upon clinical, ultrasound (US) and cytology criteria, has recently been modified and studied in a pilot paediatric group with good results. We aim to describe the diagnostic accuracy of the paediatric modified MTNS (PMTNS) in a large paediatric cohort. Methods We utilized an established retrospective cohort between 1996 and 2015 of 99 patients ≤21 years old with 131 thyroid nodules. Two experienced paediatric radiologists, blinded to pathology and radiology reports, reviewed US features. We abstracted cytology, histology and laboratory results, assigning each nodule a PMTNS. PMTNS performance was compared to FNA and histology. Results Approximately 33% of nodules were malignant. The cohort was predominantly adolescent (mean age 15.4 ± 3.8 years). The average PMTNS for malignant and benign nodules, based on final histology, was 12.7 ± 4.3 and 1.7 ± 2.9, respectively. A PMTNS ≥8 resulted in a 93.2% sensitivity and 93.1% specificity for detecting malignancy, while a PMTNS ≥9 resulted in a 90.9% sensitivity and 96.6% specificity. However, Bethesda cytology category ≥4 independently had a 97.7% sensitivity and 94.0% specificity for detecting malignancy. The PMTNS had diminishing diagnostic accuracy in younger children compared with older children. Conclusion Paediatric modified McGill Thyroid Nodule Score predicts malignancy, perhaps due to the score's emphasis on cytology results; however, the score is less accurate in younger patients. While cytology results remain reliable, further work is needed to develop a non‐invasive scoring system to predict malignancy in children.

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“…These are often termed "microcalcifications" and are relevant because their presence within a nodule is one of several US features known to increase the likelihood of malignancy in both the pediatric and adult popula-tions. [1][2][3][4] Microcalcifications are generally assumed to represent psammoma bodies, which are considered specific for papillary thyroid carcinoma (PTC) but may also be found in follicular or medullary thyroid carcinoma and thyrotoxicosis. 5 Nevertheless, many PTCs do not contain psammoma bodies, which are found in only 25%-37% of PTCs.…”

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confidence: 99%

Patterns of Sonographically Detectable Echogenic Foci in Pediatric Thyroid Carcinoma with Corresponding Histopathology: An Observational Study

Toslak¹,

Martin

Barkan

et al. 2017

AJNR Am J Neuroradiol

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Sonographically detectable echogenic foci in malignant pediatric thyroid nodules can be reliably classified on the basis of American College of Radiology Thyroid Imaging, Reporting and Data System, with punctate echogenic foci composing the most common subtype. These echogenic foci do not represent psammomatous calcifications most of the time; instead, more than half of the malignant thyroid nodules with echogenic foci contained stromal calcifications or sticky colloid.

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Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer

Abstract: The composite, US-based risk stratification criteria from the 2015 ATA Guidelines may provide an appropriate and reproducible method for estimating risk of malignancy for pediatric thyroid nodules.

Cited by 49 publications

References 21 publications

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules

Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients

Patterns of Sonographically Detectable Echogenic Foci in Pediatric Thyroid Carcinoma with Corresponding Histopathology: An Observational Study

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