Abstract
Background
The 2015 American Thyroid Association (ATA) Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer provides selection criteria for nodules prior to ultrasound-guided fine-needle aspiration biopsy.
Objective
To evaluate the diagnostic performance of pediatric thyroid nodule risk stratification for predicting malignancy when applying the ultrasound (US) criteria recommended.
Materials and methods
US characteristics of 39 thyroid nodules in 33 pediatric patients who underwent US fine-needle aspiration biopsy were reviewed by two radiologists. Based on the aggregated US criteria from the ATA Guidelines, each nodule was assigned a level of malignancy risk. Kappa coefficients were estimated to assess intra- and interobserver reliability. Using each patient’s largest nodule observation (n = 33), univariable exact logistic regression analyses of US parameters were then conducted to estimate the odds of a malignant pathology diagnosis. A penalized Firth correction was employed in the univariable models analyzing composition, shape and level of suspicion due to quasi-complete data separation.
Results
Twenty-seven nodules in 21 patients (median age: 16 years; 17 female) were benign and 12 nodules in 12 patients (median age: 16.5 years; 11 female) were malignant. Intraobserver agreement was substantial to almost perfect for composition, echogenicity, shape and margins. Interobserver agreement was almost perfect for composite level of suspicion. High level of suspicion was assigned to all 12 malignant nodules versus 9/21 (43%) of the benign nodules. Level of suspicion, solid/predominantly solid composition, irregular margins and echogenic foci emerged as significant predictors of malignancy with odds ratios (OR) of 8.5 (95% confidence interval [CI]: 1.7–1,130, P = 0.001), 10.5 (95% CI: 1.1–1,417, P = 0.04), 53.2 (95% CI: 5.1–2,988, P < 0.0001) and 3.5 (95% CI: 1.1–23.2, P = 0.03), respectively.
Conclusion
The composite, US-based risk stratification criteria from the 2015 ATA Guidelines may provide an appropriate and reproducible method for estimating risk of malignancy for pediatric thyroid nodules.
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References
Corrias A, Einaudi S, Chiorboli E et al (2001) Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: comparison with conventional clinical, laboratory, and imaging approaches. J Clin Endocrinol Metab 86:4644–4648
Siegel MJ (2002) Pediatric sonography. In: Siegel MJ (ed) Pediatric sonography, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 132–161
Francis GL, Waguespack SG, Bauer AJ et al (2015) Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 25:716–759
Diesen DL, Skinner MA (2016) Pediatric thyroid cancer. Semin Pediatr Surg 21:44–50
Howlader N, Noone AM, Krapcho M et al (eds). SEER Cancer Statistics Review, 1975-2010, National Cancer Institute, Bethesda, MD. http://seer.cancer.gov/csr/1975_2010/, based on November 2012 SEER data submission, posted to the SEER web site, April 2013
Vergamini LB, Frazier AL, Abrantes FL et al (2014) Increase in the incidence of differentiated thyroid carcinoma in children, adolescents, and young adults: a population-based study. J Pediatr 164:1481–1485
Haugen B, Alexander EK, Bible KC et al (2015) American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–412
Harris PA, Taylor R, Thielke R et al (2009) Research Electronic Data Capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381
Cibas ES, Ali SZ (2009) The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol 132:658–665
Grant EG, Tessler FN, Hoang JK et al (2015) Thyroid ultrasound reporting lexicon: white paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee. J Am Coll Radiol 12:1272–1279
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80:27–38
Heinze G, Schemper M (2002) A solution to the problem of separation in logistic regression. Stat Med 21:2409–2419
Young Kwak J, Hwa Han K, Jung Hyun Yoon M et al (2011) Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 260:892–899
Yoon JH, Lee HS, Kim EK et al (2016) Malignancy risk stratification of thyroid nodules: comparison between the Thyroid Imaging Reporting and Data System and the 2014 American Thyroid Association Management Guidelines. Radiology 278:917–924
Hobbs HA, Bahl M, Nelson RC et al (2014) Applying the Society of Radiologists in Ultrasound recommendations for fine-needle aspiration of thyroid nodules: effect on workup and malignancy detection. AJR Am J Roentgenol 202:602–607
Frates MC, Benson CB, Charboneau JW et al (2006) Management of thyroid nodules detected at US Society of Radiologists in Ultrasound consensus conference statement. Ultrasound Q 22:231–240
Moon W-J, Lyung Jung S, Hyun Lee J et al (2008) Benign and malignant thyroid nodules: US differentiation— multicenter retrospective study. Radiology 247:762–770
Moudgil P, Vellody R, Heider A et al (2015) Ultrasound-guided fine-needle aspiration biopsy of pediatric thyroid nodules. Pediatr Radiol 46:365–371
Khoo MLC, Asa SL, Witterick IJ et al (2002) Thyroid calcification and its association with thyroid carcinoma. Head Neck 24:651–655
Dinauer C, Francis GL (2007) Thyroid cancer in children. Endocrinol Metab Clin North Am 36:779–806
Malhi H, Beland MD, Cen SY et al (2014) Echogenic foci in thyroid nodules: significance of posterior acoustic artifacts. AJR Am J Roentgenol 203:1310–1316
Tahvildari AM, Pan L, Kong CS et al (2016) Sonographic-pathologic correlation for punctate echogenic reflectors in papillary thyroid carcinoma: what are they? J Ultrasound Med 35:1645–1652
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Lim-Dunham, J.E., Erdem Toslak, I., Alsabban, K. et al. Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Pediatr Radiol 47, 429–436 (2017). https://doi.org/10.1007/s00247-017-3780-6
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DOI: https://doi.org/10.1007/s00247-017-3780-6