Pino Consuelo, Dominguez José Miguel, Solar Antonieta, Zoroquiain Pablo, Cruz Francisco, García Cristian, De Barbieri Florencia, Mosso Lorena, Lustig Nicole, Gonzalez Hernán, León Augusto, Goñi Ignacio, Contreras Andy, Grob Francisca
Division of Pediatrics, School of Medicine, Pontificia Universidad Católica, Santiago, Chile.
Department of Endocrinology, School of Medicine, Pontificia Universidad Católica, Santiago, Chile.
Horm Res Paediatr. 2024 Aug 26:1-8. doi: 10.1159/000541134.
Pediatric thyroid nodules exhibit higher malignancy rates compared to adults and are associated with increased incidences of metastases and recurrences. The American Thyroid Association recommends surgery for indeterminate thyroid biopsies in children based on these higher malignancy risks, though this approach may lead to overtreatment. However, there remains a lack of comprehensive pediatric data to inform clinical decisions. This study examines the risk of malignancy (ROM) in pediatric thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and assesses the diagnostic accuracy of fine-needle aspiration (FNA) biopsy compared to histological outcomes.
A retrospective cross-sectional analysis was performed on patients under 19 years with thyroid nodules who underwent FNA and thyroidectomy at a tertiary care center. The sensitivity, specificity, positive predictive value, negative predictive value, and ROM of cytological biopsies were evaluated using TBSRTC criteria, with histology serving as the gold standard. Two analyses were conducted to assess diagnostic accuracy: (a) TBSRTC II as negative and TBSRTC VI as positive and (b) TBSRTC II as negative with TBSRTC V and VI as positive. For neoplasia detection, TBSRTC II was deemed negative, while TBSRTC IV, V, and VI were considered positive. TBSRTC categories III and I were excluded from the performance analysis and evaluated separately. Follicular neoplasm or lesions suspicious for follicular neoplasm (FN/SFN) were treated as positive outcomes, correlated with the presence of adenoma or carcinoma in the surgical specimen.
Of 75 nodules from 73 patients, 28 (37.3%) were benign and 47 (62.6%) malignant. No significant differences in gender or age were noted between groups. The ROM in each TBSRTC was Bethesda I 0/2, 0%; II 0/13, 0%; III 2/7, 29%: IV 6/14, 43%; V 10/10, 100%, and VI 29/29, 100%. A sensitivity of 78.38% and specificity of 100% for FNA in detecting malignancy was found, with an even higher sensitivity (100%) for detecting neoplasia in TBSRTC IV.
This study reveals that indeterminate thyroid nodules in pediatric patients exhibit a higher rate of malignancy compared to adults, yet align with rates previously reported in the pediatric population. These findings highlight the critical need for guidelines tailored specifically to the management of thyroid nodules and thyroid cancer in children.
与成人相比，儿童甲状腺结节的恶性率更高，且与转移和复发的发生率增加有关。基于这些更高的恶性风险，美国甲状腺协会建议对儿童甲状腺活检结果不确定的患者进行手术，尽管这种方法可能导致过度治疗。然而，目前仍缺乏全面的儿科数据来为临床决策提供依据。本研究使用甲状腺细胞病理学报告贝塞斯达系统（TBSRTC）检查儿童甲状腺结节的恶性风险（ROM），并评估细针穿刺（FNA）活检与组织学结果相比的诊断准确性。
对在三级医疗中心接受FNA和甲状腺切除术的19岁以下甲状腺结节患者进行回顾性横断面分析。使用TBSRTC标准评估细胞学活检的敏感性、特异性、阳性预测值、阴性预测值和ROM，以组织学作为金标准。进行了两项分析以评估诊断准确性：（a）将TBSRTC II视为阴性，TBSRTC VI视为阳性；（b）将TBSRTC II视为阴性，TBSRTC V和VI视为阳性。对于肿瘤检测，TBSRTC II被视为阴性，而TBSRTC IV、V和VI被视为阳性。TBSRTC III和I类别被排除在性能分析之外并单独评估。滤泡性肿瘤或疑似滤泡性肿瘤（FN/SFN）的病变被视为阳性结果，与手术标本中腺瘤或癌的存在相关。
在73例患者的75个结节中，28个（37.3%）为良性，47个（62.6%）为恶性。两组之间在性别或年龄上未发现显著差异。每个TBSRTC中的ROM分别为：贝塞斯达I类2个结节，0/2，0%；II类13个结节，0/13，0%；III类7个结节，2/7，29%；IV类14个结节，6/14，43%；V类10个结节，10/10，100%；VI类29个结节，29/29，100%。FNA检测恶性肿瘤的敏感性为78.38%，特异性为100%，在TBSRTC IV中检测肿瘤的敏感性更高（100%）。
本研究表明，与成人相比，儿科患者中不确定的甲状腺结节恶性率更高，但与先前报道的儿科人群发生率一致。这些发现凸显了迫切需要专门针对儿童甲状腺结节和甲状腺癌管理的指南。
