Two Decades of Thyroid Nodule Cytology in Children: Malignancy Risk Assessment at a Tertiary Care Center.

IF 2.6 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM
Consuelo Pino, José Miguel Dominguez, Antonieta Solar, Pablo Zoroquiain, Francisco Cruz, Cristian García, Florencia De Barbieri, Lorena Mosso, Nicole Lustig, Hernán Gonzalez, Augusto León, Ignacio Goñi, Andy Contreras, Francisca Grob
{"title":"Two Decades of Thyroid Nodule Cytology in Children: Malignancy Risk Assessment at a Tertiary Care Center.","authors":"Consuelo Pino, José Miguel Dominguez, Antonieta Solar, Pablo Zoroquiain, Francisco Cruz, Cristian García, Florencia De Barbieri, Lorena Mosso, Nicole Lustig, Hernán Gonzalez, Augusto León, Ignacio Goñi, Andy Contreras, Francisca Grob","doi":"10.1159/000541134","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric thyroid nodules exhibit higher malignancy rates compared to adults and are associated with increased incidences of metastases and recurrences. The American Thyroid Association recommends surgery for indeterminate thyroid biopsies in children based on these higher malignancy risks, though this approach may lead to overtreatment. However, there remains a lack of comprehensive pediatric data to inform clinical decisions. This study examines the risk of malignancy (ROM) in pediatric thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and assesses the diagnostic accuracy of fine-needle aspiration (FNA) biopsy compared to histological outcomes.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis was performed on patients under 19 years with thyroid nodules who underwent FNA and thyroidectomy at a tertiary care center. The sensitivity, specificity, positive predictive value, negative predictive value, and ROM of cytological biopsies were evaluated using TBSRTC criteria, with histology serving as the gold standard. Two analyses were conducted to assess diagnostic accuracy: (a) TBSRTC II as negative and TBSRTC VI as positive and (b) TBSRTC II as negative with TBSRTC V and VI as positive. For neoplasia detection, TBSRTC II was deemed negative, while TBSRTC IV, V, and VI were considered positive. TBSRTC categories III and I were excluded from the performance analysis and evaluated separately. Follicular neoplasm or lesions suspicious for follicular neoplasm (FN/SFN) were treated as positive outcomes, correlated with the presence of adenoma or carcinoma in the surgical specimen.</p><p><strong>Results: </strong>Of 75 nodules from 73 patients, 28 (37.3%) were benign and 47 (62.6%) malignant. No significant differences in gender or age were noted between groups. The ROM in each TBSRTC was Bethesda I 0/2, 0%; II 0/13, 0%; III 2/7, 29%: IV 6/14, 43%; V 10/10, 100%, and VI 29/29, 100%. A sensitivity of 78.38% and specificity of 100% for FNA in detecting malignancy was found, with an even higher sensitivity (100%) for detecting neoplasia in TBSRTC IV.</p><p><strong>Conclusions: </strong>This study reveals that indeterminate thyroid nodules in pediatric patients exhibit a higher rate of malignancy compared to adults, yet align with rates previously reported in the pediatric population. These findings highlight the critical need for guidelines tailored specifically to the management of thyroid nodules and thyroid cancer in children.</p>","PeriodicalId":13025,"journal":{"name":"Hormone Research in Paediatrics","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hormone Research in Paediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000541134","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: Pediatric thyroid nodules exhibit higher malignancy rates compared to adults and are associated with increased incidences of metastases and recurrences. The American Thyroid Association recommends surgery for indeterminate thyroid biopsies in children based on these higher malignancy risks, though this approach may lead to overtreatment. However, there remains a lack of comprehensive pediatric data to inform clinical decisions. This study examines the risk of malignancy (ROM) in pediatric thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and assesses the diagnostic accuracy of fine-needle aspiration (FNA) biopsy compared to histological outcomes.

Methods: A retrospective cross-sectional analysis was performed on patients under 19 years with thyroid nodules who underwent FNA and thyroidectomy at a tertiary care center. The sensitivity, specificity, positive predictive value, negative predictive value, and ROM of cytological biopsies were evaluated using TBSRTC criteria, with histology serving as the gold standard. Two analyses were conducted to assess diagnostic accuracy: (a) TBSRTC II as negative and TBSRTC VI as positive and (b) TBSRTC II as negative with TBSRTC V and VI as positive. For neoplasia detection, TBSRTC II was deemed negative, while TBSRTC IV, V, and VI were considered positive. TBSRTC categories III and I were excluded from the performance analysis and evaluated separately. Follicular neoplasm or lesions suspicious for follicular neoplasm (FN/SFN) were treated as positive outcomes, correlated with the presence of adenoma or carcinoma in the surgical specimen.

Results: Of 75 nodules from 73 patients, 28 (37.3%) were benign and 47 (62.6%) malignant. No significant differences in gender or age were noted between groups. The ROM in each TBSRTC was Bethesda I 0/2, 0%; II 0/13, 0%; III 2/7, 29%: IV 6/14, 43%; V 10/10, 100%, and VI 29/29, 100%. A sensitivity of 78.38% and specificity of 100% for FNA in detecting malignancy was found, with an even higher sensitivity (100%) for detecting neoplasia in TBSRTC IV.

Conclusions: This study reveals that indeterminate thyroid nodules in pediatric patients exhibit a higher rate of malignancy compared to adults, yet align with rates previously reported in the pediatric population. These findings highlight the critical need for guidelines tailored specifically to the management of thyroid nodules and thyroid cancer in children.

儿童甲状腺结节细胞学二十年:一家三级医疗中心的恶性肿瘤风险评估
导言:与成人相比,小儿甲状腺结节的恶性率更高,而且转移和复发的发生率也更高。基于较高的恶性风险,美国甲状腺协会建议对儿童的不确定甲状腺活检进行手术治疗,尽管这种方法可能会导致过度治疗。然而,目前仍缺乏全面的儿科数据来为临床决策提供依据。本研究采用贝塞斯达甲状腺细胞病理学报告系统(TBSRTC)研究了小儿甲状腺结节的恶性风险(ROM),并评估了细针穿刺活检(FNA)与组织学结果相比的诊断准确性:在一家三级医疗中心对19岁以下接受FNA和甲状腺切除术的甲状腺结节患者进行了回顾性横断面分析。采用 TBSRTC 标准评估了细胞学活检的敏感性、特异性、阳性预测值 (PPV)、阴性预测值 (NPV) 和 ROM,并将组织学作为金标准。为评估诊断准确性进行了两项分析:(a) TBSRTC II 为阴性,TBSRTC VI 为阳性;(b) TBSRTC II 为阴性,TBSRTC V 和 VI 为阳性。在肿瘤检测中,TBSRTC II 被视为阴性,而 TBSRTC IV、V 和 VI 被视为阳性。TBSRTC III 和 I 类被排除在性能分析之外,单独进行评估。滤泡性肿瘤或滤泡性肿瘤可疑病变(FN/SFN)被视为阳性结果,与手术标本中出现腺瘤或癌相关:在 73 名患者的 75 个结节中,28 个(37.3%)为良性,47 个(62.6%)为恶性。两组患者在性别和年龄上无明显差异。IV 6/14,43%;V 10/10,100%;VI 29/29,100%。FNA检测恶性肿瘤的敏感性为78.38%,特异性为100%,在TBSRTC IV中检测肿瘤的敏感性更高(100%):本研究显示,与成人相比,儿科患者中不确定甲状腺结节的恶性率更高,但与之前报道的儿科人群恶性率一致。这些发现凸显了制定专门针对儿童甲状腺结节和甲状腺癌管理指南的迫切需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Hormone Research in Paediatrics
Hormone Research in Paediatrics ENDOCRINOLOGY & METABOLISM-PEDIATRICS
CiteScore
4.90
自引率
6.20%
发文量
88
审稿时长
4-8 weeks
期刊介绍: The mission of ''Hormone Research in Paediatrics'' is to improve the care of children with endocrine disorders by promoting basic and clinical knowledge. The journal facilitates the dissemination of information through original papers, mini reviews, clinical guidelines and papers on novel insights from clinical practice. Periodic editorials from outstanding paediatric endocrinologists address the main published novelties by critically reviewing the major strengths and weaknesses of the studies.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信