Evaluating Postoperative Outcomes and Investigating the Usefulness of EU-TIRADS Scoring in Managing Pediatric Thyroid Nodules Bethesda 3 and 4
Aylin Kılınç Uğurlu1, Abdurrahman Bitkay1, Fatih Gürbüz2, Esra Karakuş3, Gülşah Bayram Ilıkan4, Çağrı Damar4, Seda Şahin5, Merve Meryem Kıran3, Nedim Gülaldi6, Müjdem Nur Azılı7, Emrah Şenel7, İnci Ergürhan İlhan5, Mehmet Boyraz21Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey2Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
3Ankara Bilkent City Hospital, Department of Medical Pathology Clinic, Ankara- Türkiye
4Ankara Bilkent City Hospital, Clinic of Pediatric Radiology, Ankara, Turkey
5Ankara Bilkent City Hospital, Clinic of Pediatric Hematology and Oncology, Ankara, Turkey
6Ankara Bilkent City Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
7Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Clinic of Pediatric Surgery, Ankara, Turkey
INTRODUCTION: The aim was to assess postoperative outcomes in pediatric thyroid nodules with atypia of undetermined significance (AUS/FLUS) or suspicious for a follicular neoplasm (SFN) and their respective the European-Thyroid Imaging Reporting and Data System (EU-TIRADS) scores.
METHODS: Forty-four pediatric patients at a single center with thyroid nodules classified as AUS/FLUS or SFN from August 2019 to December 2022 were retrospectively reviewed. Data on demographics, thyroid function, nodule size, and ultrasonographic features were collected. Postoperative pathologies were categorized into benign, low-risk, and malignant neoplasms according to the World Health Organization 2022 criteria, and EU-TIRADS was used for retrospective radiological scoring.
RESULTS: Among 21 (47.7%) of patients who had surgical intervention, 72% had Bethesda 3 and 28% had Bethesda 4 thyroid nodules. Post-surgical histopathological classifications were 43% benign, 19% low-risk, and 38% malignant. Of note, EU-TIRADS 3 and 5 scores were present in 44% and 56% of the benign cases, respectively. Malignant cases tended to produce higher EU-TIRADS scores, with 64% rated as EU-TIRADS 5. Bethesda category 4 nodules had a 66% malignancy rate, significantly higher than the 27% in category 3.
DISCUSSION AND CONCLUSION: A substantial proportion of histologically benign cases were classified as EU-TIRADS 5, suggesting that EU-TIRADS may lead to unnecessary biopsies in benign cases. Malignant cases were more likely to have a higher EU-TIRADS score, indicating a positive correlation with malignancy risk, particularly in Bethesda 4 cases. However, the EU-TIRADS system’s predictive value for malignancy in Bethesda 3 cases was poorer.
Manuscript Language: English
