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Evaluation of children with solid thyroid nodules: a single-center experience
Ömer Günbey1, Firdevs Dilara Paksoy1, Nurdan Yıldırım Acar1
1Medical School, Department of Pediatrics, Division of Endocrinology, Fırat University, Elazig, Türkiye.
Insights
Pediatric thyroid nodules require careful evaluation. Ultrasonography and Bethesda cytology are key, but surgery may be needed even with benign results if ultrasound shows suspicious features.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Diagnostic Imaging
Background:
- Thyroid nodules are less common in children than adults but carry a higher risk of malignancy.
- Accurate diagnosis of pediatric thyroid nodules is crucial for appropriate management.
Purpose of the Study:
- To analyze cytopathological and histopathological features of solid thyroid nodules in pediatric patients.
- To assess the diagnostic utility of ultrasonography (US) findings in these nodules.
Main Methods:
- Retrospective review of 53 pediatric patients with solid thyroid nodules undergoing biopsy.
- Classification of biopsy results using the Bethesda System.
- Evaluation of ultrasonographic features suggestive of malignancy.
Main Results:
- The majority of patients were female (81.1%), with a median age of 16.1 years.
- Bethesda categories included benign (47.2%), nondiagnostic (24.5%), and suspicious/malignant (9.4%).
- Papillary thyroid carcinoma (PTC) was diagnosed in 63.2% of surgically treated patients, often with multiple suspicious US findings. PTC was also found in two patients with benign cytology.
Conclusions:
- Thyroid nodule malignancy risk is higher in children, necessitating integrated diagnostic approaches.
- Surgical decisions should combine ultrasonographic risk assessment and Bethesda cytology.
- Consider surgery for nodules with multiple suspicious US features, even with benign or indeterminate cytology.
Objectives:
This study aimed to evaluate the cytopathological and histopathological features of solid thyroid nodules detected in the pediatric population and to investigate the diagnostic value of thyroid ultrasonography (US) findings.
Methods:
A retrospective review was conducted on 53 pediatric and adolescent patients who were followed up for solid thyroid nodules and underwent thyroid biopsy at a university hospital between January 2020 and December 2025. Data on patients were collected. Biopsy results were classified according to the Bethesda System. Ultrasonographic features considered suggestive of malignancy were noted.
Results:
The median age of the patients included in the study was 16.1 years (range: 5.5-18.0), and 81.1 % were female. The most common cytopathological Bethesda Categories were: category 2 (benign) in 47.2 % of cases, Category 1 (non-diagnostic) in 24.5 %, Category 3 (atypia of undetermined significance) in 18.9 %, Category 5 (suspicious for malignancy) in 7.5 %, and Category 6 (malignant) in 1.9 %. Among 19 patients who underwent surgery, 12 (63.2 %) were diagnosed with papillary thyroid carcinoma (PTC). In most of these PTC cases, three or more ultrasonographic malignancy criteria were present. However, PTC was also detected in two patients who had been cytopathologically evaluated as benign.
Conclusions:
Given the higher risk of malignancy associated with thyroid nodules in children compared to adults, surgical decision-making should incorporate both ultrasonographic risk features and cytological classification based on the Bethesda System. When multiple suspicious ultrasound findings are present, surgical intervention should be considered even in cases with benign or indeterminate cytology.
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