Pediatric Thyroid Nodules: K-TIRADS/ACR TI-RADS Pediatric-Specific Biopsy Cutoff Incorporating Clinical Risk Factors

Area of Science:

• Pediatric Endocrinology
• Radiology
• Oncology

Background:

• Pediatric thyroid nodules have a higher malignancy rate than adult nodules.
• Current biopsy guidelines lack pediatric-specific cutoffs.
• Risk factors like Hashimoto thyroiditis increase malignancy suspicion.

Purpose of the Study:

• To evaluate repeat biopsy usefulness in pediatric thyroid nodules.
• To develop a pediatric-specific biopsy cutoff for K-TIRADS and ACR TI-RADS.
• To enhance diagnostic performance by incorporating risk factors.

Main Methods:

• Retrospective analysis of ultrasound images of biopsy-confirmed pediatric thyroid nodules.
• Evaluation of K-TIRADS and ACR TI-RADS diagnostic performance with risk factor incorporation.
• Statistical analysis using McNemar test and generalized score statistic.

Main Results:

• A modified pediatric-specific cutoff (0.5 cm for category 4 with risk factors and category 5) significantly improved sensitivity and reduced missed malignancy rates for both K-TIRADS and ACR TI-RADS.
• Repeat biopsy identified malignancy in 29% of initially benign nodules.
• Modified ACR TI-RADS showed improved accuracy (77% vs 67%).

Conclusions:

• A 0.5-cm biopsy cutoff is beneficial for pediatric thyroid nodules, especially category 4 with risk factors and category 5.
• Repeat biopsy is crucial for pediatric thyroid nodules with discordant findings.
• Tailored biopsy guidelines can improve pediatric thyroid nodule diagnosis.