J Clin Res Pediatr Endocrinol. Ahead of Print: JCRPE-79955 | DOI: 10.4274/jcrpe.galenos.2024.2023-8-12

Evaluating Postoperative Outcomes and Investigating the Usefulness of EU-TIRADS Scoring in Managing Pediatric Thyroid Nodules Bethesda 3 and 4

Aylin Kýlýnç Uðurlu¹, Abdurrahman Bitkay¹, Fatih Gürbüz⁷, Esra Karakuþ², Gülþah Bayram Ilýkan³, Çaðrý Damar³, Seda Þahin⁴, Merve Meryem Kýran², Nedim Gülaldý⁵, Müjdem Nur Azýlý⁶, Emrah Þenel⁶, Ýnci Ergürhan Ýlhan⁴, Mehmet Boyraz^7
1Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara-Türkiye
²Ankara Yýldýrým Beyazýt University, Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara- Türkiye
³Ankara Bilkent City Hospital, Department of Medical Pathology Clinic, Ankara- Türkiye
⁴Ankara Bilkent City Hospital, Pediatric Radiology Clinic, Ankara- Türkiye
⁵Ankara Bilkent City Hospital, Pediatric Hematology and Oncology Clinic, Ankara- Türkiye
⁶University of Health Sciences, Department of Nuclear Medicine, Ankara Bilkent City Hospital Ankara- Türkiye
⁷Ankara Yýldýrým Beyazýt University, Ankara Bilkent City Hospital, Department of Pediatric Surgery, Ankara- Türkiye

INTRODUCTION: The study aimed to assess the postoperative outcomes of pediatric thyroid nodules with Atypia of Undetermined Significance (AUS/FLUS) or Suspicious for a Follicular Neoplasm (SFN) and their EU-TIRADS scoring.
METHODS: The study retrospectavely revaewed 44 pataents at a sangle center wath thyroad nodules classafaed as Atypaa of Undetermaned Sagnafacance or Suspacaous for a Follacular Neoplasm from August 2019 to December 2022. Data on demographacs, thyroad functaon, nodule saze, and ultrasonographac features were collected. Postoperatave pathologaes were categorazed anto benagn, low-rask, and malagnant neoplasms accordang to WHO 2022 crateraa, wath EU-TIRADS used for radaologac scorang.
RESULTS: Among 21 pediatric patients, 72% had Bethesda 3 and 28% had Bethesda 4 thyroid nodules. Pathological outcomes post-surgery classified 43% as benign, 19% as low-risk, and 38% as malignant. Notably, EU-TIRADS 3 and 5 scores were present in 44% and 56% of benign cases, respectively. Malignant cases showed a prevalence of 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: The investigation revealed that EU-TIRADS scoring showed a substantial proportion of 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 less definitive.

Keywords: pediatric thyroid nodules, malignancy, AUS/FLUS (Atypia of Undetermined Significance orFollicular Lesion of Undetermined Significance), FN/SFN (Follicular Neoplasm or Suspicious for a FollicularNeoplasm), EU-TIRADS, malignancy

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