Predictors of Malignancy in Children with Thyroid Nodules

Area of Science:

• Pediatric Endocrinology
• Oncology
• Radiology

Background:

• Thyroid nodules are common in children and adolescents.
• Accurate diagnosis of malignancy is crucial for appropriate management.
• Identifying reliable predictors of malignancy is essential.

Purpose of the Study:

• To evaluate the diagnostic accuracy of clinical, laboratory, and ultrasound (US) imaging characteristics of thyroid nodules in assessing the likelihood of malignancy in pediatric patients.
• To identify independent predictors of malignant thyroid nodules in children.

Main Methods:

• Retrospective analysis of data from 184 children and adolescents with thyroid nodules.
• Comparison of clinical, laboratory, and US findings with cytologic/histologic outcomes.
• Regression modeling to assess predictors of malignancy and calculate odds ratios (ORs).

Main Results:

• Twenty-nine malignant neoplasms were diagnosed among 184 nodules.
• Fine-needle aspiration biopsy demonstrated high diagnostic accuracy (91%), sensitivity (100%), and specificity (88%).
• Predictors of malignancy included male sex, compression symptoms, palpable lymphadenopathy, elevated thyroid-stimulating hormone, microcalcifications, indistinct margins, hypoechoic US pattern, abnormal lymph nodes, and increased intranodular vascularization. Nodule growth during follow-up, especially with levothyroxine therapy, was associated with malignancy.

Conclusions:

• Clinical, laboratory, and US features serve as valuable predictors of malignancy in pediatric thyroid nodules.
• These predictors, while not as accurate as fine-needle aspiration biopsy, should inform the diagnostic strategy for children with thyroid nodules.
• Multivariate analysis identified microcalcifications, hypoechoic pattern, intranodular vascularization, lymph node alterations, and thyroid-stimulating hormone concentration as independent predictors of malignant outcomes.