Koltin Dror, O'Gorman Clodagh S, Murphy Amanda, Ngan Bo, Daneman Alan, Navarro Oscar M, García Cristián, Atenafu Eshetu G, Wasserman Jonathan D, Hamilton Jill, Rachmiel Marianna
J Pediatr Endocrinol Metab. 2016 Jul 1;29(7):789-94. doi: 10.1515/jpem-2015-0242.
Pediatric thyroid nodules, while uncommon, have high malignancy risk. The objectives of the study were (1) to identify sonographic features predictive of malignancy; (2) to create a prediction model; and (3) to assess inter-observer agreement among radiologists.
All available cases of thyroid nodules, surgically removed between 2000 and 2009. Three radiologists reviewed the sonographic images; 2 pathologists reviewed the tissue specimens. Adult prediction models were applied. Interobserver variability was assessed.
Twenty-seven subjects, mean age 13.1±3.4 years, were included. Nineteen nodules were differentiated thyroid carcinomas. On multivariate analysis, size was the only significant predictor of malignancy. On recursive partitioning analysis, size >35 mm with microcalcification and ill-defined margins yielded the best prediction model. Radiologist inter-observer agreement regarding malignancy was moderate (κ=0.50).
Larger size, microcalcifications and ill-defined margins on ultrasound demonstrate the best predictive model for malignancy in the pediatric population. Experienced pediatric radiologists demonstrate moderate inter-observer agreement in prediction of malignancy.
小儿甲状腺结节虽不常见，但恶性风险高。本研究的目的是：（1）确定预测恶性肿瘤的超声特征；（2）创建一个预测模型；（3）评估放射科医生之间的观察者间一致性。
纳入2000年至2009年间手术切除的所有甲状腺结节病例。三位放射科医生回顾超声图像；两位病理科医生回顾组织标本。应用成人预测模型。评估观察者间变异性。
纳入27名受试者，平均年龄13.1±3.4岁。19个结节为分化型甲状腺癌。多因素分析显示，大小是唯一显著的恶性肿瘤预测因素。递归划分分析显示，大小>35mm且伴有微钙化和边界不清的结节产生了最佳预测模型。放射科医生之间关于恶性肿瘤的观察者间一致性为中等（κ=0.50）。
超声检查显示较大的尺寸、微钙化和边界不清是小儿人群中恶性肿瘤的最佳预测模型。经验丰富的小儿放射科医生在预测恶性肿瘤方面表现出中等程度的观察者间一致性。
