Anita Lavarda Scheinpflug, Leonardo Barbi Walter, Laura Marmitt, Rafael Selbach Scheffel, Mariangela Gheller Friedrich, Mauricio Farenzena, Carlo Sasso Faccin, Marcia Silveira Graudenz, José Miguel Dora, Ana Luiza Maia, Andre Borsatto Zanella
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引用次数: 0
Abstract
Purpose: The American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) is a widely used ultrasonographic risk-stratification system for thyroid nodules in adults and its use has been increasingly expanding in the pediatric population in recent years. Here, we evaluated the diagnostic performance of ACR-TIRADS in patients aged ≤ 18 years with thyroid nodules.
Methods: We performed a single-center retrospective cohort study of patients aged ≤ 18 years, followed by tertiary care for thyroid nodules. The ACR-TIRADS data were extracted from the image records by two radiologists with expertise in thyroid imaging. Malignancy rates were defined based on cytological examinations, histological diagnosis, or ultrasonographic follow-up concerning nodule characteristics and size.
Results: The cohort comprised 58 patients (65 nodules). The majority were female (70.7%), with a mean age of 14.0 ± 3.4 years and 27.5% had at least one risk factor for thyroid malignancy. The malignancy rate was 20.7% (N = 12). We could not reassess the ultrasound images of 9 patients; therefore, for this analysis, 49 patients (56 nodules) were included. The TIRADS nodule classifications were as follows: 8 TR1 (14.3%), 18 TR2 (32.1%), 15 TR3 (26.8%), 7 TR4 (12.5%), and 8 TR5 (14.3%). The ACR-TIRADS interobserver agreement was high, with a free marginal kappa of 0.86 [95% confidence interval (CI): 0.75, 0.97]. All TR1, TR2, and TR3 nodules were benign, and 8 cases of thyroid malignant neoplasm in the TR4 (N = 1) and TR5 (N = 7) groups resulted in malignancy rates of 14.3 and 87.5%, respectively. Remarkably, the TR5 nodules exhibited a positive predictive value of 87.5%, negative predictive value of 97.9%, sensitivity of 87.5%, and specificity of 97.9% for predicting malignancy. We did not identify a cutoff of nodule size for predicting malignancy - area under the receiver operating characteristic curve (AUC) of 0.58 (95% CI 0.38-0.80).
Conclusion: ACR-TIRADS effectively stratifies malignancy risk in pediatric thyroid nodules, with TR5 nodules showing particularly high malignancy risk. Clinical risk factors combined with ultrasound characteristics provide better malignancy prediction than nodule size alone in this population.
期刊介绍：
Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology.
Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted.
Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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