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Published on: November 10, 2014
TI-RADS and Bethesda Classification System Correlate With Predicting Pediatric Papillary Thyroid Carcinoma
Shaunak N Amin1, Megan Branson2, J Nathaniel Perkins3,4
1Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Insights
This study found a moderate correlation between Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda classification in pediatric thyroid nodules. Both systems help predict papillary thyroid carcinoma (PTC) risk in children.
Area of Science:
- Pediatric Endocrinology
- Diagnostic Imaging
- Cytopathology
Background:
- Thyroid nodules are common in children, requiring accurate risk stratification.
- Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda classification are standard tools for evaluating thyroid nodules.
- Understanding the relationship between these systems is crucial for pediatric thyroid nodule management.
Purpose of the Study:
- To evaluate the relationship between TI-RADS and Bethesda classification in pediatric thyroid nodules.
- To compare the diagnostic performance of TI-RADS and Bethesda classification for papillary thyroid carcinoma (PTC) in children.
Main Methods:
- Retrospective case series of 157 pediatric patients undergoing thyroid ultrasound and fine needle aspiration (FNA).
- Analysis of demographics, TI-RADS scores, Bethesda classifications, and final pathology.
- Calculation of Spearman's rank correlation and relative risks for predicting PTC.
Main Results:
- A moderate correlation (Spearman's rho = 0.41, P < .001) was observed between TI-RADS and Bethesda classifications.
- High-risk TI-RADS (≥3) showed a relative risk of 7.99 for predicting PTC.
- High-risk Bethesda classification (5-6) showed a relative risk of 6.62 for predicting PTC.
Conclusions:
- A moderate correlation exists between TI-RADS and Bethesda classifications in pediatric thyroid nodules.
- Patients with TI-RADS ≥3 and Bethesda 3-4 are at intermediate risk for PTC and require careful counseling.
- These findings support the combined use of TI-RADS and Bethesda classification for improved risk assessment in pediatric thyroid nodules.
Objective:
Our study objectives were to evaluate the relationship between Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda classification and to compare both TI-RADS and Bethesda classification for the diagnosis of papillary thyroid carcinoma (PTC) within the pediatric population.
Study Design:
Retrospective case series.
Setting:
Academic pediatric hospital.
Methods:
A 13-year retrospective review was performed of all pediatric patients undergoing thyroid fine needle aspiration (FNA) and ultrasound at our institution. Demographics, TI-RADS scoring, FNA results, surgical history, and final pathology were collected. High-risk ultrasonography and cytopathology were defined as TI-RADS 3-5 and Bethesda 5-6, respectively. Spearman's rank correlation was determined for TI-RADS and Bethesda classification. Relative risks of high-risk TI-RADS and Bethesda classification for predicting PTC were calculated.
Results:
A total of 157 patients (21.7% male, median age at time of FNA 15 years, and range 2.7-21 years) underwent ultrasound and FNA during the study. The Spearman's rank correlation coefficient for TI-RADS compared with the Bethesda classification was 0.41 (P < .001). The relative risk of high-risk TI-RADS scores to predict the presence of PTC was 7.99 (95% CI 1.16-54.90). High-risk Bethesda classification demonstrated a relative risk for predicting PTC of 6.62 (95% CI 4.22-10.41).
Conclusion:
In our cohort, there was a moderate correlation between TI-RADS and Bethesda classifications. Patients with a TI-RADS score ≥3 and Bethesda classification 3 or 4 are at intermediate risk for harboring PTC and should be counseled accordingly.
