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Toward Standardized Management of Indeterminate Thyroid Nodules in Pediatric Patients: A Systematic Review and Call
Gerdi Tuli1,2, Jessica Munarin1,2, Anna Biga1
1Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy.
Insights
Pediatric thyroid nodules, though rare, have a higher cancer risk. A new pediatric-specific risk model is proposed to standardize the management of indeterminate thyroid nodules in children.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Surgical Oncology
Background:
- Thyroid nodules are uncommon in children but present a greater risk of malignancy than in adults.
- Current evaluation and management of cytologically indeterminate thyroid nodules in pediatric patients lack standardization.
- Significant institutional and international variability exists in managing these nodules.
Purpose of the Study:
- To systematically review the existing evidence on the management of indeterminate thyroid nodules in the pediatric population.
- To identify gaps in current diagnostic and therapeutic strategies.
- To inform the development of standardized management guidelines.
Main Methods:
- Systematic literature review focusing on cytological classification systems, surgical approaches, and ancillary diagnostic tools.
- Analysis of studies reporting on the management of indeterminate thyroid nodules in children.
- Assessment of risk of malignancy (ROM) data and classification system utility.
Main Results:
- Lobectomy is the most frequently recommended surgical approach (42.9%) for pediatric indeterminate thyroid nodules.
- Substantial heterogeneity in management strategies across institutions was identified, preventing meta-analysis of surgical outcomes.
- A notable absence of pediatric-specific risk of malignancy (ROM) data for established cytological classification systems (BTA, SIAPEC) was observed.
Conclusions:
- A standardized approach is needed for managing pediatric indeterminate thyroid nodules.
- Development of a pediatric-specific, multiparametric risk stratification model is proposed.
- This model should integrate clinical, biochemical, ultrasound, cytological, and molecular data to guide decisions from observation to thyroidectomy.
Abstract:
Background/Objective: Thyroid nodules are rare in the pediatric population but carry a higher malignancy risk compared to adults. Evaluation and management of cytologically indeterminate nodules vary considerably between institutions and countries. The aim was to systematically review current evidence on the management of indeterminate thyroid nodules in the pediatric population. Methods: A systematic review of the literature was conducted, focusing on cytological classification systems, surgical strategies, and the use of ancillary tools such as molecular testing. Results: Most studies (42.9%) recommend lobectomy for indeterminate thyroid nodules in children; however, considerable heterogeneity in management strategies was observed among institutions. This variability precluded the possibility of conducting a meta-analysis of surgical outcomes. Additionally, a lack of pediatric-specific risk of malignancy (ROM) data for the British Thyroid Association (BTA) and SIAPEC cytological classification systems was noted. Conclusions: We propose the development of a pediatric-specific, multiparametric risk stratification model that incorporates clinical features, biochemical markers, ultrasound characteristics, cytological classification, and molecular profiling. This comprehensive score could help standardize the management of indeterminate thyroid nodules in children and guide clinical decision-making, ranging from observation to total thyroidectomy. Prospective validation in multicenter pediatric cohorts is essential to confirm its clinical utility.
