University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Surgery, Ankara, Turkey
J Clin Res Pediatr Endocrinol. 2021 Aug 23;13(3):276-284. doi: 10.4274/jcrpe.galenos.2020.2020.0213. Epub 2020 Dec 30.
We aimed to evaluate the clinical, radiological and pathological findings of children and adolescents with thyroid nodules.
Data of 121 children and adolescent with thyroid nodules and had fine needle aspiration (FNA) were examined retrospectively. Concomitant thyroid disease, ultrasonography (US) features of the nodule, FNA and histopathological results were recorded. FNA results were assessed according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).
Median (range) age of the cases was 14 (3-18) years and 81% were female. FNA results of patients were: insufficient in 1 (0.8%); benign in 68 (56.2%); indeterminate in 44 (36.4%); and malignant in 8 (6.6%) patients. Among 39 patients who underwent surgery, 10 (25.6%) had differentiated thyroid cancer (DTC) and the overall malignancy rate was 10.0% (10/100). Follow-up FNA results showed progress based on TBSRTC in 18.7% of benign results and 4/75 patients had DTC on surgical excision. Two of 22 patients with atypia of undetermined significance (AUS) who continued follow-up was diagnosed with DTC. Male gender, presence of Hashimoto thyroiditis and US findings of uninodularity, hypoechogenicity, increased blood flow, irregular margins, solid structure, microcalcification and presence of abnormal cervical lymph nodes were associated with malignancy.
In this study 10% of thyroid nodules were malignant in children and adolescents. Patients with AUS have a 9% potential for malignancy. Patients with initially benign FNA result may have changes on repeat FNA when assessed with TBSTRC indicating a 5.3% false negative rate.
评估儿童和青少年甲状腺结节的临床、影像学和病理学表现。
回顾性分析 121 例经细针抽吸活检（FNA）的儿童和青少年甲状腺结节患者的资料。记录并存的甲状腺疾病、结节的超声（US）特征、FNA 和组织病理学结果。根据甲状腺细胞病理学报告的 Bethesda 系统（TBSRTC）评估 FNA 结果。
病例的中位（范围）年龄为 14（3-18）岁，81%为女性。患者的 FNA 结果为：不足 1 例（0.8%）；良性 68 例（56.2%）；不确定 44 例（36.4%）；恶性 8 例（6.6%）。39 例接受手术的患者中，10 例（25.6%）患有分化型甲状腺癌（DTC），总恶性率为 10.0%（10/100）。根据 TBSRTC，良性结果中有 18.7%进展，75 例患者中有 4 例在手术切除时患有 DTC。22 例不典型意义不确定（AUS）患者中，有 2 例继续随访，被诊断为 DTC。男性、桥本甲状腺炎、US 表现为单结节、低回声、血流增加、不规则边缘、实性结构、微钙化和异常颈部淋巴结与恶性有关。
在这项研究中，儿童和青少年甲状腺结节的恶性率为 10%。AUS 患者有 9%的恶性潜能。根据 TBSRTC 评估，最初良性 FNA 结果的患者可能在重复 FNA 时有变化，提示假阴性率为 5.3%。
