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Updated: Sep 30, 2025
A Swin Transformer-Based Model for Thyroid Nodule Detection in Ultrasound Images
Published on: April 21, 2023
Pediatric Thyroid Nodules: Ultrasound Characteristics as Indicators of Malignancy
Brandon Fornwalt1, Manasa Melachuri2, Matthew Kubina2
1Department of Otolaryngology, Mercy Bon Secours, Youngstown, Ohio, USA.
Insights
Pediatric thyroid nodules are uncommon, but ultrasound findings like microcalcifications, abnormal lymph nodes, and large size (>3.5 cm) can predict malignancy. These indicators can help guide clinical decisions for children with thyroid nodules.
Area of Science:
- Pediatric Endocrinology
- Diagnostic Imaging
- Oncology
Background:
- Pediatric thyroid nodules are rare but have a significant 25% risk of malignancy.
- Established ultrasound criteria for malignancy in adults are not well-defined for pediatric patients.
- Accurate risk stratification is crucial for appropriate management of pediatric thyroid nodules.
Purpose of the Study:
- To identify ultrasound characteristics predictive of malignancy in pediatric thyroid nodules.
- To evaluate the association between specific ultrasound features and thyroid cancer in children.
- To provide data that can inform clinical decision-making for pediatric thyroid nodules.
Main Methods:
- Retrospective case series including 112 pediatric thyroid nodules with ultrasounds from 2006 to 2016.
- Data collected from two pediatric tertiary care centers.
- Analysis of nodule characteristics including microcalcifications, lymph node status, margins, and size in relation to malignancy.
Main Results:
- Seventeen percent (20/112) of pediatric thyroid nodules were malignant.
- Malignant nodules were associated with microcalcifications (OR 19.1), abnormal lymph nodes (OR 9.0), and size >3.5 cm (OR 5.8).
- Irregular margins were not a statistically significant predictor of malignancy in this cohort.
Conclusions:
- Abnormal lymph nodes, microcalcifications, and nodule size greater than 3.5 cm are potential predictors of malignancy in pediatric thyroid nodules.
- These ultrasound findings may aid in clinical decision-making for the evaluation of pediatric thyroid nodules.
- Further research can refine ultrasound-based risk stratification for pediatric thyroid cancer.
Objective:
Pediatric thyroid nodules are uncommon but carry a 25% malignancy risk. Adult patients have well-established ultrasound characteristics that are predictive of malignancy, but these are not clearly defined in pediatric patients. We reviewed a case series of pediatric thyroid nodules.
Study Design:
Retrospective chart review.
Setting:
Tertiary children's hospital.
Method:
Institutional review board approval was obtained. This case series with chart review includes all pediatric thyroid nodules with ultrasounds from 2006 to 2016 at 2 pediatric tertiary care centers.
Results:
An overall 112 pediatric thyroid nodules were analyzed. The mean patient age was 14.3 years; there was a female:male ratio of 4:1; and 94% were Caucasian. Seventeen percent (20/112) of nodules were malignant. In patients with malignant nodules, the average presenting age was 15.5 years, with a female:male ratio of 5.6:1. Seventy percent of malignant nodules had accompanying microcalcifications, 55% had abnormal lymph nodes, and 45% had irregular margins. In the benign nodules, 11% had microcalcifications, 12% had abnormal lymph nodes, and 26% had irregular margins. The presence of microcalcifications (odds ratio, 19.1 [95% CI, 6.0-61.0]; P < .0001), abnormal lymph nodes (odds ratio, 9.0 [95% CI, 3.0-26.6]; P = .0001), and size >3.5 cm (odds ratio, 5.8 [95% CI, 1.5-22.5]; P = .01) was associated with thyroid cancer. Irregular margins were not statistically significant (odds ratio, 2.3 [95% CI, 0.86-6.3]; P = .9).
Conclusions:
Our data suggest that abnormal lymph nodes, microcalcifications, and size >3.5 cm could be predictors of malignancy in the pediatric population and influence clinical decision making.
