Division of Pediatric Endocrinology, Nemours/Alfred I DuPont Hospital for Children, Wilmington, Delaware.
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
J Clin Endocrinol Metab. 2018 May 1;103(5):1958-1965. doi: 10.1210/jc.2017-02464.
Thyroid nodules are increasingly recognized in children and are associated with a greater risk for thyroid cancer compared with adults. Thyroid ultrasound is the favored tool for evaluation of thyroid nodules; however, there are limited data regarding the accuracy of thyroid ultrasound to confirm features associated with a low risk of thyroid cancer in children.
We examined whether thyroid ultrasound is capable of accurately identifying thyroid nodules at a low risk of malignancy in children.
Using a retrospective cohort study design, we identified children age ≤18 years with thyroid nodules and adequate follow-up. Ultrasound images were reviewed independently by two blinded expert radiologists, and ultrasound characteristics were analyzed to determine optimal predictive value and reliability.
A total of 417 subjects were found to have thyroid nodules, and 152 subjects had adequate follow-up; 59 (38.8%) of these were diagnosed with thyroid cancer. We evaluated 236 individual nodules. Features most consistent with benign nodules included small size, isoechoic echogenicity, partially cystic structure, sharp or noninfiltrative margins, absent Doppler flow, and absent calcifications. Significant variability was found between expert interpretations of ultrasound features. Thyroid nodule composition appears to be the most sensitive and reliable feature for stratifying the risk of thyroid cancer. Ultrasound accurately identified benign thyroid nodules in 80.9% of subjects (95% confidence interval, 74-86.6).
Ultrasonography is useful for the evaluation of thyroid nodules, but we found no combination of ultrasound features sufficient to exclude thyroid cancer without a biopsy.
甲状腺结节在儿童中越来越常见，与成人相比，儿童甲状腺结节发生甲状腺癌的风险更高。甲状腺超声是评估甲状腺结节的首选工具；然而，关于甲状腺超声在儿童中准确识别低风险甲状腺癌相关特征的准确性的数据有限。
我们研究了甲状腺超声是否能够准确识别儿童甲状腺癌风险低的甲状腺结节。
使用回顾性队列研究设计，我们确定了年龄≤18 岁且有足够随访的甲状腺结节儿童。两名盲法专家放射科医生独立对超声图像进行了复查，并对超声特征进行了分析，以确定最佳预测值和可靠性。
共发现 417 例甲状腺结节患者，152 例患者有足够的随访；其中 59 例（38.8%）被诊断为甲状腺癌。我们评估了 236 个单独的结节。最符合良性结节的特征包括结节体积小、等回声、部分囊性结构、边界清晰或无浸润、无多普勒血流和无钙化。专家对超声特征的解释存在显著差异。甲状腺结节的构成似乎是分层甲状腺癌风险最敏感和可靠的特征。超声准确地在 80.9%的患者（95%置信区间，74-86.6）中识别出良性甲状腺结节。
超声检查对甲状腺结节的评估有用，但我们发现没有任何一种超声特征组合足以在不进行活检的情况下排除甲状腺癌。
