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Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
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Diagnostic Accuracy of Ultrasound With Color Flow Doppler in Children With Thyroid Nodules

Anthony W Gannon1, Jill E Langer2, Richard Bellah3

  • 1Division of Pediatric Endocrinology, Nemours/Alfred I DuPont Hospital for Children, Wilmington, Delaware.

The Journal of Clinical Endocrinology and Metabolism
|March 17, 2018
PubMed

Insights

Thyroid ultrasound can identify benign nodules in children with 80.9% accuracy. However, no ultrasound features alone can rule out thyroid cancer, underscoring the need for biopsy in pediatric thyroid nodule evaluation.

Area of Science:

  • Pediatric Endocrinology
  • Radiology
  • Oncology

Background:

  • Thyroid nodules are increasingly diagnosed in children, carrying a higher risk of thyroid cancer than in adults.
  • Thyroid ultrasound is the primary imaging tool, but its accuracy in identifying low-risk nodules in pediatric patients is not well-established.

Purpose of the Study:

  • To evaluate the capability of thyroid ultrasound in accurately identifying pediatric thyroid nodules with a low risk of malignancy.
  • To determine the reliability and predictive value of specific ultrasound features for benign thyroid nodules in children.

Main Methods:

  • Retrospective cohort study of children (age ≤18 years) with thyroid nodules and adequate follow-up.
  • Independent review of ultrasound images by two blinded expert radiologists.
  • Analysis of ultrasound characteristics to identify features predictive of low malignancy risk.

Main Results:

  • Of 152 subjects with adequate follow-up, 59 (38.8%) had thyroid cancer. Ultrasound accurately identified benign thyroid nodules in 80.9% of subjects.
  • Features associated with benign nodules included small size, isoechoic echogenicity, partial cystic composition, well-defined margins, and absence of calcifications or Doppler flow.
  • Significant inter-observer variability was noted, with nodule composition being the most reliable feature for risk stratification.

Conclusions:

  • Thyroid ultrasound is valuable for evaluating pediatric thyroid nodules.
  • No combination of ultrasound features was sufficient to definitively exclude thyroid cancer, indicating biopsy remains necessary.
  • Nodule composition is the most sensitive and reliable ultrasound feature for assessing thyroid cancer risk in children.
Abstract

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