Histologic and clinical follow‐up of thyroid fine‐needle aspirates in pediatric patients

• Published in: Cancer cytopathology Vol. 124; no. 7; pp. 467 - 471
• Main Authors: Partyka, Kristen L., Huang, Eric C., Cramer, Harvey M., Chen, Shaoxiong, Wu, Howard H.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2016
• Subjects: Adenocarcinoma, Follicular - pathology; Adenocarcinoma, Follicular - surgery; Adolescent; Adult; Bethesda system; Biopsy; Biopsy, Fine-Needle; Child; Child, Preschool; cytology; Female; fine‐needle aspiration (FNA); Humans; Infant; Male; pediatric; Pediatrics; Prognosis; Retrospective Studies; thyroid; Thyroid gland; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroid Nodule - pathology; Thyroid Nodule - surgery; Tumors; fine-needle aspiration (FNA); Bethesda system; cytology; thyroid; pediatric
• ISSN: 1934-662X; 1934-6638
• DOI: 10.1002/cncy.21713

BACKGROUND
Although fine‐needle aspiration (FNA) has an important role in evaluating thyroid nodules in adults, there is little published information regarding its utility in the pediatric population.
METHODS
A retrospective analysis of thyroid FNAs for patients who were 18 years old or younger at 2 institutions was conducted. Aspirates were retrospectively categorized with the Bethesda System for Reporting Thyroid Cytopathology. These diagnoses were then correlated with either final histopathology or clinical follow‐up.
RESULTS
A total of 186 thyroid FNA samples from 154 patients (122 females and 32 males), who ranged in age from 9 months to 18 years (median, 16 years; mean, 14 years), were identified. FNA was performed to evaluate 1 to 3 nodules for each patient. Aspirates were classified as follows: nondiagnostic (n = 27), benign (n = 114), atypia of undetermined significance (AUS; n = 21), follicular neoplasm (FN; n = 8), suspicious for malignancy (n = 3), and malignant (n = 13). Sixty‐one samples had a histologic correlation, 68 were followed clinically for ≥2 years, and 57 either had no follow‐up or were followed for <2 years. For statistical purposes, FNA diagnoses of suspicious and malignant were considered positive, and benign lesions were considered negative. The accuracy was 99%, and the sensitivity and specificity were 94% and 100%, respectively. The risk of malignancy, not including papillary microcarcinoma, was 2% for benign aspirates, 21% for AUS, 57% for FN, and 100% for suspicious or malignant aspirates.
CONCLUSIONS
This analysis demonstrates that FNA is a sensitive and highly specific modality for evaluating thyroid nodules in pediatric patients. Each diagnostic category can facilitate communication and guide appropriate management. Cancer Cytopathol 2016;124:467–71. © 2016 American Cancer Society.
With thyroid fine‐needle aspiration, the risk of malignancy, not including papillary microcarcinoma, for the pediatric population (≤18 years old) is 2% for benign aspirates, 21% for atypia of undetermined significance, 57% for follicular neoplasm, and 100% for suspicious or malignant aspirates.