Fine needle aspiration biopsy of thyroid nodules in children and adolescents

Thyroid nodules are uncommon in children and adolescents compared with adults, but the risk of malignancy is much higher. In adults, fine needle aspiration biopsy (FNAB) has been used extensively to select patients for surgical exploration with a high degree of reliability. The purpose of this study was to assess the utility of FNAB for the management of thyroid nodules in children and adolescents. We reviewed our experience with 60 FNABs of thyroid nodules in 51 children and adolescents. Of the 60 aspirates, 45 aspirates (74%) were diagnosed as "benign", 5 aspirates (8%) as "suspicious for malignancy", and 6 aspirates (10%) as "malignant", and 4 aspirates (7%) as "unsatisfactory". Thyroidectomy was performed in 17 patients, and 5 with a cytological diagnosis of "benign" revealed nodular hyperplasia in three and follicular adenoma in two; 5 with a cytological diagnosis of "suspicious" revealed nodular hyperplasia in one, follicular adenoma in two, and papillary carcinoma in two; and 6 with a cytological diagnosis of "malignant" revealed papillary carcinoma. One patient with a cytological diagnosis of "unsatisfactory" revealed papillary carcinoma. The diagnostic accuracy was 81% with 100% sensitivity and 63% specificity. The positive and negative predictive values of FNAB were 73% and 100%, respectively. We conclude that FNAB is a good screening test for thyroid nodules in children and adolescents because of its high sensitivity.