Utility of adult-based ultrasound malignancy risk stratifications in pediatric thyroid nodules

Martínez-Ríos, Claudia; Daneman, Alan; Bajno, Lydia; Kaay, Daniëlle C M van der; Moineddin, Rahim; Wasserman, Jonathan D.

doi:10.1007/s00247-017-3974-y

Cited by 67 publications

(48 citation statements)

References 15 publications

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“…The overall thyroid nodule malignancy rate in our cohort (33%) is very similar to previous reports. 9,16,19 Our malignancy rate is likely It is possible, given the PMTNS includes ultrasound components known to best predict malignancy risk in adults that the PMTNS performs better in older adolescents rather than in young children.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

“…,16,19 Our malignancy rate is likely inflated due to the study design, requiring at least one year of follow-up, therefore excluding patients more likely to have benign nodules. In this cohort of patients with a high malignancy rate, The Pediatric McGill Thyroid Nodule Score (PMTNS) predicted malignancy well (sensitivity 93.2% and specificity 93.1%) in patients ≤21 years.…”

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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%

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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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confidence: 99%

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confidence: 99%

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confidence: 99%

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Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients

Creo

Alahdab

Nofal

et al. 2018

Clinical Endocrinology

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“…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. Likewise, Canfarotta et al [3] described good diagnostic accuracy of the Adult McGill Criteria (a scoring system based upon clinical, US, and cytology results) in a pilot study of children [14].…”

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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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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Validity of the American College of Radiology Thyroid Imaging Reporting and Data System in Children

et al. 2022

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ObjectiveTo assess the validity of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI‐RADS) for evaluating thyroid nodules in children.MethodsPatients aged <19 years with thyroid nodule(s) evaluated by ultrasound (US) from 2007–2018 at a tertiary children's hospital were included. Two radiologists scored de‐identified thyroid US images using ACR TI‐RADS (from 1, “benign” to 5, “highly suspicious”). The radiologists recorded size and rated vascularity for each nodule. Ultrasound findings were compared to pathology results (operative cases, n = 91) and clinical follow‐up without disease progression (non‐operative cases, n = 15).ResultsThyroid images from 115 patients were reviewed. Nine patients were excluded due to the absence of an evaluable nodule. Forty‐seven benign and 59 malignant nodules were included. Median age at ultrasound was 15 years (range 0.9–18 years). Twenty (18.9%) patients were male. There was moderate agreement between TI‐RADS levels assigned by the two raters (kappa = 0.57, p < 0.001). When the raters' levels were averaged, >3 as the threshold for malignancy correctly categorized the greatest percentage of nodules (68.9%). Eleven (18.6%) malignant nodules received a TI‐RADS level of 2 (n = 3) or 3 (n = 8). Sensitivity, specificity, and positive and negative predictive values were 81.4%, 53.2%, 68.6%, and 69.4%, respectively. Although not part of TI‐RADS, vascularity was similar between benign and malignant nodules (p = 0.56).ConclusionIn a pediatric population, TI‐RADS can help distinguish between benign and malignant nodules with comparable sensitivity and specificity to adults. However, the positive and negative predictive values suggest TI‐RADS alone cannot eliminate the need for FNA.Level of Evidence3 Laryngoscope, 133:2394–2401, 2023

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Utility of adult-based ultrasound malignancy risk stratifications in pediatric thyroid nodules

Abstract: We validated the use of ATA and TI-RADS methods in children and showed that they have test characteristics similar to those in adults, although neither is independently sufficient to discriminate nodules' likelihood of malignancy.

Cited by 67 publications

References 15 publications

Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients

Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients

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

Validity of the American College of Radiology Thyroid Imaging Reporting and Data System in Children

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