Department of Pathology; Oklahoma City, Oklahoma, USA.
Stephenson Cancer Center; Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.
Thyroid. 2021 Aug;31(8):1203-1211. doi: 10.1089/thy.2020.0702. Epub 2021 Mar 4.
Little is known about the application of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. This meta-analysis was aimed to investigate the use of TBSRTC in the pediatric population. Relevant articles were searched in PubMed and Web of Science. Meta-analysis of proportion and its 95% confidence interval (CI) were computed utilizing the random-effect model. We used subgroup analyses and meta-regression to explore the sources of heterogeneities. Egger's regression test and funnel plot visualization were used to examine publication bias. We included 17 articles comprising of 3687 pediatric thyroid nodules for meta-analyses. TBSRTC outputs including frequency and risk of malignancy (ROM) for the majority of categories were not statistically different from recently published meta-analysis of 145,066 thyroid nodules in adult patients. The resection rate (RR) in the pediatric group was significantly higher in most of the categories compared with published adult data: benign, 23.2% [CI = 18.6-27.9] vs. 13.0% [CI = 9.5-16.5]; atypia of undetermined significance/follicular lesion of undetermined significance, 62.6% [CI = 50.3-74.9] vs. 36.2% [CI = 29.9-42.5]; follicular neoplasm/suspicious for follicular neoplasm, 84.3% [CI = 75.2-93.4] vs. 60.5% [CI = 54.5-66.5]; and suspicious for malignancy, 93.8% [CI = 90.1-97.6] vs. 69.7% [CI = 64.0-75.5]. TBSRTC is a valuable tool to make clinical decisions for pediatric patients with thyroid nodules. Pediatric patients with benign and indeterminate thyroid nodules had a higher RR than adult counterpart, but ROM of these categories in adults and children was not statistically different suggesting a potential risk of overtreatment in pediatric patients. Determining the best treatment guidelines and additional tools for risk stratification must be a top priority to precisely identify the target patient groups for surgical intervention.
关于贝塞斯达系统在儿科甲状腺结节中的应用知之甚少。本荟萃分析旨在探讨 TBSRTC 在儿科人群中的应用。在 PubMed 和 Web of Science 中搜索相关文章。使用随机效应模型计算比例及其 95%置信区间（CI）的荟萃分析。我们使用亚组分析和元回归来探索异质性的来源。使用 Egger 回归检验和漏斗图可视化来检查发表偏倚。我们纳入了 17 项包含 3687 例儿科甲状腺结节的研究进行荟萃分析。TBSRTC 的输出结果包括大多数类别的频率和恶性风险（ROM）与最近发表的 145066 例成人甲状腺结节荟萃分析结果无统计学差异。与已发表的成人数据相比，儿科组中大多数类别的切除率（RR）明显更高：良性，23.2%[CI=18.6-27.9] vs. 13.0%[CI=9.5-16.5]；不典型意义不明/滤泡性病变意义不明，62.6%[CI=50.3-74.9] vs. 36.2%[CI=29.9-42.5]；滤泡性肿瘤/滤泡性肿瘤可疑，84.3%[CI=75.2-93.4] vs. 60.5%[CI=54.5-66.5]；可疑恶性肿瘤，93.8%[CI=90.1-97.6] vs. 69.7%[CI=64.0-75.5]。TBSRTC 是儿科甲状腺结节患者做出临床决策的有价值工具。良性和不确定甲状腺结节的儿科患者 RR 高于成人，但成人和儿童这些类别的 ROM 无统计学差异，表明儿科患者存在过度治疗的潜在风险。确定最佳治疗指南和风险分层的附加工具必须是首要任务，以准确识别手术干预的目标患者群体。
