Predictors of Malignancy in Children with Thyroid Nodules

• Published in: The Journal of pediatrics Vol. 167; no. 4; pp. 886 - 892.e1
• Main Authors: Mussa, Alessandro, MD, PhD, De Andrea, Maurilio, MD, Motta, Manuela, MD, Mormile, Alberto, MD, Palestini, Nicola, MD, Corrias, Andrea, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2015
• Subjects: Adolescent; Biopsy; Biopsy, Fine-Needle; Child; Female; Humans; Lymph Nodes - pathology; Male; Multivariate Analysis; Odds Ratio; Pediatrics; Predictive Value of Tests; Regression Analysis; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - diagnostic imaging; Thyroid Nodule - diagnosis; Thyroid Nodule - diagnostic imaging; Thyrotropin - blood; Thyroxine - therapeutic use; Ultrasonography; Levothyroxine; TSH; FNAB; Thyroid stimulating hormone; Fine-needle aspiration biopsy; LT4; Ultrasound; US
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.06.026

Objective To evaluate the diagnostic accuracy of clinical, laboratory, and ultrasound (US) imaging characteristics of thyroid nodules in assessing the likelihood of malignancy. Study design Data from 184 children and adolescents with thyroid nodules were evaluated and compared with respective cytologic/histologic outcomes. A regression model was designed to assess the predictors associated with malignancy and to calculate ORs. Results Twenty-nine malignant neoplasms (25 papillary, 1 medullary, 3 Hurtle-cell carcinomas), 8 follicular adenomas, and 147 goitrous nodules (92 based on cytology, 55 on follow-up) were diagnosed. Fine-needle aspiration biopsy diagnostic accuracy, sensitivity, and specificity were 91%, 100%, and 88%, respectively. Male sex, compression symptoms, palpable lymphopathy, thyroid stimulating hormone concentration, microcalcifications, indistinct margins, hypoechoic US pattern, pathologic lymph node alterations, and increased intranodular vascularization were associated with malignancy. Regular margins, mixed echoic pattern, and peripheral-only vascularization were associated with benignity. During follow-up, nodule growth was associated with malignant disease, especially with levothyroxine therapy. A multivariate analysis confirmed that microcalcifications, hypoechoic pattern, intranodular vascularization, lymph node alterations, and thyroid stimulating hormone concentration were independent predictors of malignant outcome. For each predictor, we provide sensitivity, specificity, and positive/negative predictive values. Conclusions Clinical, laboratory, and US features of nodules can be used as predictors of malignancy in children. Although none has diagnostic accuracy as high as that of fine-needle aspiration biopsy, these predictors should be considered in deciding the diagnostic approach of children with thyroid nodules.