Division of Endocrinology and Diabetes, The Thyroid Center, Children's Hospital of Philadelphia, Associate Professor of Pediatrics, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Curr Opin Endocrinol Diabetes Obes. 2019 Oct;26(5):266-274. doi: 10.1097/MED.0000000000000495.
Compared with adults, there is a two-fold to three-fold increased risk of malignancy for a pediatric patient undergoing evaluation of a thyroid nodule. In 2015, the American Thyroid Association published guidelines on the evaluation and management of pediatric patients with thyroid nodules and differentiated thyroid cancer. The goal of this clinical update is to review recent additions to the literature and propose opportunities how to best incorporate these findings into clinical practice.
Recent additions to the literature include assessment of ultrasound-based scoring systems to improve selection of patients for fine needle aspiration, defining the pediatric-specific risk of malignancy within The Bethesda System for Reporting Thyroid Cytopathology, and broadening our knowledge of the oncogene landscape that supports incorporation of adjunct oncogene testing to rule-in malignancy of nodules with indeterminate cytology.
There have been significant additions to the literature on the evaluation and management of children and adolescents with thyroid nodules since publication of the 2015 American Thyroid Association guidelines. Incorporating these changes into clinical care, within the setting of multidisciplinary, pediatric-specific, regional centers, will maximize ongoing efforts to improve the care of children and adolescents with thyroid nodules.
与成人相比，儿科患者在评估甲状腺结节时发生恶性肿瘤的风险增加了两到三倍。2015 年，美国甲状腺协会发布了关于儿科患者甲状腺结节和分化型甲状腺癌评估和管理的指南。本临床更新的目的是回顾文献中的最新进展，并提出如何将这些发现最好地纳入临床实践的机会。
文献中的最新进展包括评估基于超声的评分系统，以改善对细针抽吸的患者选择，定义贝塞斯达系统报告甲状腺细胞学中的儿科特异性恶性肿瘤风险，以及拓宽我们对支持辅助肿瘤基因检测以确定细胞学不确定的结节恶性肿瘤的致癌基因景观的认识。
自 2015 年美国甲状腺协会指南发布以来，关于儿童和青少年甲状腺结节评估和管理的文献有了重大进展。在多学科、儿科特异性、区域性中心的背景下将这些变化纳入临床护理，将最大限度地提高改善儿童和青少年甲状腺结节患者护理的持续努力。
