Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Thyroid. 2021 Oct;31(10):1472-1480. doi: 10.1089/thy.2020.0875. Epub 2021 May 19.
The guideline for managing pediatric thyroid nodules has not been established. We investigated the appropriateness of the Korean Society of Thyroid Radiology (KSThR) guidelines and the need to consider risk factors for managing pediatric thyroid nodules. From August 2007 to February 2020, a database of thyroid nodules in patients younger than 19 years who underwent fine-needle aspiration (FNA) was analyzed. Two radiologists retrospectively reviewed ultrasound images to characterize the nodules according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) criteria. Thyroid nodules were divided into benign and malignant nodules. Clinical risk factors were identified, including familial thyroid cancer, history of radiation therapy, and underlying thyroiditis. According to the K-TIRADS categories and the presence of risk factors, malignancy rates were calculated. We compared the diagnostic performance of the original KSThR guidelines and newly suggested criteria for FNA derived by simulation tests with variable size cutoffs in the total study population, a group with risk factors, and a group without risk factors. A total of 107 patients (mean age, 13.9 years; range, 4-18 years; 83 females; 50 patients with risk factors) with 133 nodules (71 benign and 62 malignant) were included. The malignancy rate of thyroid nodules was higher in the group with risk factors (64.0%) than in the group without risk factors (43.9%; = 0.037). Compared with the KSThR guideline (≥1.0 cm for K-TIRADS 4 and 5), the accuracy was higher (62.4% vs. 56.4%) and the unnecessary biopsy rate was lower (44.0% vs. 47.4%) when the new criteria (≥0.6 cm for K-TIRADS 4 and ≥0.5 cm for K-TIRADS 5) were used in the total study population. In particular, in the group with risk factors, the newly suggested size criteria had a much higher accuracy (73.1% vs. 59.7%) and lower unnecessary biopsy rate (30.4% vs. 35.5%) than the KSThR guideline. For the management of thyroid nodules in children, it is necessary to consider risk factors and adjust the criteria values for FNA. FNA should be considered in children with risk factors for thyroid cancer even if thyroid nodules are small.
儿童甲状腺结节管理指南尚未建立。我们调查了韩国甲状腺放射学会 (KSThR) 指南的适宜性以及考虑管理儿童甲状腺结节的危险因素的必要性。
从 2007 年 8 月至 2020 年 2 月，对接受细针穿刺抽吸术 (FNA) 的年龄小于 19 岁的甲状腺结节患者的数据库进行了分析。两位放射科医生回顾性地分析了超声图像，根据韩国甲状腺成像报告和数据系统 (K-TIRADS) 标准对结节进行特征描述。甲状腺结节分为良性和恶性结节。确定了临床危险因素，包括家族性甲状腺癌、放疗史和潜在甲状腺炎。根据 K-TIRADS 类别和危险因素的存在，计算恶性肿瘤发生率。我们比较了原始 KSThR 指南和通过模拟测试得出的新的 FNA 建议标准在总研究人群、有危险因素的人群和无危险因素的人群中的诊断性能。
共纳入 107 例患者（平均年龄 13.9 岁；范围，4-18 岁；83 例女性；50 例有危险因素），共 133 个结节（71 个良性，62 个恶性）。有危险因素的患者甲状腺结节恶性率（64.0%）高于无危险因素的患者（43.9%；=0.037）。与 KSThR 指南（K-TIRADS 4 和 5≥1.0cm）相比，在总研究人群中使用新的标准（K-TIRADS 4≥0.6cm，K-TIRADS 5≥0.5cm）时，准确性更高（62.4%比 56.4%），不必要的活检率更低（44.0%比 47.4%）。特别是在有危险因素的患者中，新建议的大小标准的准确性更高（73.1%比 59.7%），不必要的活检率更低（30.4%比 35.5%）。
对于儿童甲状腺结节的管理，有必要考虑危险因素并调整 FNA 的标准值。即使甲状腺结节较小，对于有甲状腺癌危险因素的儿童，也应考虑进行 FNA。
