Malignancy Risk of Paediatric Thyroid Nodules Classified According to the Bethesda System

Area of Science:

• Endocrinology
• Pediatric Oncology
• Cytopathology

Background:

• Thyroid nodules are less common in children but have a higher risk of malignancy.
• The Bethesda System for Reporting Thyroid Cytopathology categorizes nodules to predict malignancy risk.
• This study evaluates the malignant potential of pediatric thyroid nodules using the Bethesda system.

Purpose of the Study:

• To estimate the malignant potential of thyroid nodules in children using the Bethesda system.
• To compare malignancy rates in pediatric thyroid nodules with adult data and existing guidelines.

Main Methods:

• Retrospective study of 121 pediatric patients (≤19 years) who underwent thyroid surgery after fine-needle aspiration (FNA).
• Nodules were categorized using the Bethesda classification system.
• Malignancy prevalence for each category was calculated and compared with final pathology results.

Main Results:

• 66 out of 121 nodules (54.5%) were malignant.
• Malignancy risks were: B2 (24%), B3 (52.6%), B4 (58.8%), and B5-B6 (100%).
• Malignancy rates were higher in pediatric patients across all Bethesda categories compared to adult data.

Conclusions:

• Pediatric thyroid nodules exhibit higher malignancy rates across all Bethesda categories than reported in adults.
• Observed malignancy rates in children exceeded those previously reported in comparable pediatric studies.
• A more intensive evaluation approach is recommended for pediatric patients with suspected thyroid nodules, especially those with concerning clinical or sonographic features.