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Pediatric thyroid nodules: disease demographics and clinical management as determined by fine needle aspiration
S S Raab1, J F Silverman, T M Elsheikh
1Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City 52242-1009, USA.
Insights
Fine needle aspiration biopsy (FNAB) is a valuable tool for diagnosing pediatric thyroid nodules, showing high accuracy. This study found an 18% malignancy rate in children, confirming FNAB
Area of Science:
- Pediatric Endocrinology
- Oncology
- Diagnostic Cytopathology
Background:
- Thyroid nodularity affects 1.8% of children, with reported malignancy rates varying widely from 2% to 50%.
- Accurate classification of pediatric thyroid nodules is crucial for appropriate management.
- The utility of fine needle aspiration biopsy (FNAB) in this age group requires further evaluation.
Purpose of the Study:
- To evaluate the diagnostic utility and accuracy of fine needle aspiration biopsy (FNAB) in pediatric patients with thyroid nodules.
- To better classify thyroid diseases in patients under 18 years old.
- To determine the prevalence of malignancy in pediatric thyroid nodules.
Main Methods:
- Retrospective review of 66 FNABs from 64 thyroid nodules and 2 perithyroid lymph nodes in 57 pediatric patients (ages 1-18).
- Patients included 8 males and 49 females.
- Surgical and/or clinical follow-up was obtained for all patients; FNAB diagnoses were categorized as insufficient, benign, suspicious, or malignant.
Main Results:
- Overall, 18% of pediatric patients (10 out of 57) had malignant thyroid lesions.
- Malignancies included 8 papillary carcinomas and 2 follicular carcinomas.
- There were no false positives and one false negative (papillary carcinoma misdiagnosed as benign).
Conclusions:
- The prevalence of malignancy in pediatric thyroid nodules is 18%.
- Fine needle aspiration biopsy (FNAB) demonstrates high diagnostic accuracy and minimal invasiveness.
- FNAB is a useful tool in the management of pediatric thyroid nodules.
Objective:
The prevalence of thyroid nodularity in children has been estimated to be 1.8%. The reported prevalence of specific diseases which comprise these nodules is conflicting as evidenced by a reported range of malignancy of 2 to 50% in solitary nodules. In order to better classify pediatric (< 18 years old) thyroid disease and evaluate the utility of fine needle aspiration biopsy (FNAB) in this patient population, we retrospectively reviewed 66 FNABs from 64 thyroid nodules and 2 perithyroid lymph nodes from 57 patients.
Patients:
The study was composed of 8 males and 49 females who ranged in age from 1 to 18 years old (mean = 13.1).
Design:
Surgical and/or clinical follow-up was obtained in all patients. The 66 FNAB diagnoses were initially classified into specific diseases. However, for the purpose of this review, the cases were classified as: 3 insufficient, 51 benign, 8 suspicious, and 4 malignant.
Results:
There were no "false positives" and one "false negative" (a papillary carcinoma was misdiagnosed as a benign nodule). Overall, 10 patients (18%) had malignant thyroid lesions, including 8 papillary carcinomas and 2 follicular carcinomas. Benign diagnoses included benign nodule, cyst, lymphocytic thyroiditis, granulomatous thyroiditis, hyperplasia, and abscess.
Conclusions:
The prevalence of malignancy in pediatric patients with thyroid nodules was 18%. We conclude that, because of its high diagnostic accuracy and minimal invasiveness, FNAB is useful in the management of pediatric thyroid nodules.