Singh Anurag, Prasad Pallavi, Singh Alka
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Discoveries (Craiova). 2023 Mar 31;11(1):e164. doi: 10.15190/d.2023.3. eCollection 2023 Jan-Mar.
Thyroid lesions in childhood and adolescence are uncommon, and the risk of malignancy widely varies. They require careful evaluation and more aggressive diagnostic approach. The present study aimed to evaluate the frequency of various pediatric thyroid lesions in pediatric cases with thyroid nodules and ascertain the utility of clinical, laboratory, ultrasonography, and fine-needle aspiration cytology (FNAC) findings to discriminate between benign and malignant lesions.
A retrospective study where 95 consecutive cases of pediatric patients with thyroid nodules received over six years (January 2016-December 2021) were retrieved from the hospital information system. The differences in clinical, laboratory, ultrasonography, and cytological findings between benign and malignant lesions were analysed. Statistical analysis was performed using SPSS software (version 21.0).
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was used to categorise the cases into: unsatisfactory (n=3), benign (n=66), intermediate (n=8) and suspicious/malignant (n=18). The specificity of cytopathology in diagnosing benign lesions (TBSRTC-II) was 90%, whereas sensitivity in diagnosing malignant lesions (TBSRTC-VI) was 100%. Colloid nodule (n=57) and papillary thyroid carcinoma (n=15) were the most common benign and malignant lesions encountered respectively. Malignant lesions more frequently showed the presence of palpable lymph nodes (p-value <0.001), microcalcifications (p-value 0.011) and intranodular vascularization (p-value <0.001).
The diagnosis of pediatric thyroid lesions should be based on a multistep evaluation that includes clinical, laboratory, and radiographic modalities. Thyroid function tests and ultrasonography can help identify clinically unapparent thyroid nodules and provide detailed nodule characterization for suspected malignant lesions. FNAC is a simple, less-invasive, and cost-effective technique that can differentiate between benign and malignant thyroid lesions.
儿童和青少年甲状腺病变并不常见，恶性风险差异很大。它们需要仔细评估和更积极的诊断方法。本研究旨在评估小儿甲状腺结节病例中各种小儿甲状腺病变的发生率，并确定临床、实验室、超声和细针穿刺细胞学检查（FNAC）结果在鉴别良性和恶性病变方面的效用。
一项回顾性研究，从医院信息系统中检索了连续六年（2016年1月至2021年12月）收治的95例小儿甲状腺结节患者。分析了良性和恶性病变在临床、实验室、超声和细胞学检查结果上的差异。使用SPSS软件（版本21.0）进行统计分析。
采用甲状腺细胞病理学报告贝塞斯达系统（TBSRTC）将病例分为：不满意（n = 3）、良性（n = 66）、中间型（n = 8）和可疑/恶性（n = 18）。细胞病理学诊断良性病变（TBSRTC-II）的特异性为90%，而诊断恶性病变（TBSRTC-VI）的敏感性为100%。胶体结节（n = 57）和甲状腺乳头状癌（n = 15）分别是最常见的良性和恶性病变。恶性病变更常表现为可触及的淋巴结（p值<0.001）、微钙化（p值0.011）和结节内血管形成（p值<0.001）。
小儿甲状腺病变的诊断应基于包括临床、实验室和影像学方法在内的多步骤评估。甲状腺功能检查和超声有助于识别临床上不明显的甲状腺结节，并为疑似恶性病变提供详细的结节特征。FNAC是一种简单、侵入性小且具有成本效益的技术，可区分良性和恶性甲状腺病变。
