Evaluation of Children and Adolescents with Thyroid Nodules: A Single Center Experience
Selin Elmaoğulları1, Şervan Özalkak1, Semra Çetinkaya1, İbrahim Karaman2, Çiğdem Üner3, Nilüfer Arda4, Şenay Savaş-Erdeve1, Zehra Aycan51University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey2University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Surgery, Ankara, Turkey
3University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Radiology, Ankara, Turkey
4University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Pathology, Ankara, Turkey
5University of Health Sciences Turkey, Ankara Dr. Sami Ulus Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey & Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
Objective: We aimed to evaluate the clinical, radiological and pathological findings of children and adolescents with thyroid nodules.
Methods: Data of 121 children and adolescent with thyroid nodules and had fine needle aspiration (FNA) were examined retrospectively. Concomitant thyroid disease, ultrasonography (US) features of the nodule, FNA and histopathological results were recorded. FNA results were assessed according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).
Results: Median (range) age of the cases was 14 (3-18) years and 81% were female. FNA results of patients were: insufficient in 1 (0.8%); benign in 68 (56.2%); indeterminate in 44 (36.4%); and malignant in 8 (6.6%) patients. Among 39 patients who underwent surgery, 10 (25.6%) had differentiated thyroid cancer (DTC) and the overall malignancy rate was 10.0% (10/100). Follow-up FNA results showed progress based on TBSRTC in 18.7% of benign results and 4/75 patients had DTC on surgical excision. Two of 22 patients with atypia of undetermined significance (AUS) who continued follow-up was diagnosed with DTC. Male gender, presence of Hashimoto thyroiditis and US findings of uninodularity, hypoechogenicity, increased blood flow, irregular margins, solid structure, microcalcification and presence of abnormal cervical lymph nodes were associated with malignancy.
Conclusion: In this study 10% of thyroid nodules were malignant in children and adolescents. Patients with AUS have a 9% potential for malignancy. Patients with initially benign FNA result may have changes on repeat FNA when assessed with TBSTRC indicating a 5.3% false negative rate.
Manuscript Language: English
