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Tirkaso BH, Mulugeta GA, Belete TD, Melak MM. Papillary thyroid carcinoma in an 8-year-old Ethiopian child: A case report with literature review. SAGE Open Med Case Rep 2024; 12:2050313X241248392. [PMID: 38680599 PMCID: PMC11047237 DOI: 10.1177/2050313x241248392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Thyroid nodular disease can present in different forms, such as a solitary nodule, multinodular goiter, nodular goiter caused by autoimmune goiter, and nonpalpable thyroid nodules. Among children, thyroid cancer is the most common type of endocrine cancer. Pediatric thyroid cancer is usually detected as a neck mass without any symptoms, leading to variable stages of progression when diagnosed. Papillary thyroid carcinoma is the most common type of thyroid cancer in children with thyroid nodules. We are presenting a case of an 8-year-old male child who was referred to Jimma Medical Center after he developed swelling on the right side of his neck. On examination, multiple, matted 8 × 6 cm, firm to hard, non-tender right lateral neck masses were found, which moved with swallowing. Thyroid function tests were normal. An ultrasound diagnosis of thyroid carcinoma and a cytologic diagnosis of suspicion for papillary thyroid carcinoma (Bethesda V) was made, and an excisional biopsy was advised. A total thyroidectomy was done. A histopathology diagnosis of Papillary thyroid carcinoma (Classic variant) was made. This is an unusual case of Papillary thyroid carcinoma in an Ethiopian child, with plenty of examples previously recorded in the literature but no such report of its occurrence in our setup to our knowledge. When children under 10 have cervical masses, thyroid cancer should be considered. The evaluation of a palpable thyroid mass typically begins with a blood test to check thyroid function, along with ultrasound and fine-needle aspiration biopsy. Currently, fine-needle aspiration biopsy is the most reliable way to diagnose malignancy and determine the appropriate surgical approach. In most cases, treatment will involve a total thyroidectomy. Lymph node dissection is necessary only if lymph node disease is detected during preoperative evaluation.
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Song C, Luo JY, Pang YY, He RQ, Li XJ, Chen G, Zhao CY, Qu N, Chen YM, Yang L, Li BQ, Shi L. Historical context, process, and development trends of pediatric thyroid cancer research: a bibliometric analysis. Front Oncol 2024; 14:1340872. [PMID: 38463235 PMCID: PMC10921230 DOI: 10.3389/fonc.2024.1340872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Objective At present, the structure of knowledge in the field of childhood thyroid cancer is not clear enough, and scholars lack a sufficient understanding of the developing trends in this field, which has led to a shortage of forward-looking outputs. The purpose of this research is to help scholars construct a complete knowledge framework and identify current challenges, opportunities, and development trends. Methods We searched the literature in the Web of Science Core Collection database on August 7, 2023 and extracted key information from the top 100 most cited articles, such as the countries, institutions, authors, themes, and keywords. We used bibliometric tools such as bibliometrix, VOSviewer, and CiteSpace for a visualization analysis and Excel for statistical descriptions. Results The top 100 most cited articles fluctuated over time, and the research was concentrated in European countries, the United States, and Japan, among which scientific research institutions and scholars from the United States made outstanding contributions. Keyword analysis revealed that research has shifted from simple treatment methods for pediatric thyroid cancer (total thyroidectomy) and inducing factors (the Chernobyl power station accident) to the clinical applications of genetic mutations (such as the BRAF and RET genes) and larger-scale genetic changes (mutation studies of the DICER1 gene). The thematic strategy analysis showed an increasing trend towards the popularity of fusion oncogenes, while the popularity of research on traditional treatments and diagnostics has gradually declined. Conclusion Extensive research has been conducted on the basic problems of pediatric thyroid cancer, and there has been significant outputs in the follow-up and cohort analysis of conventional diagnostic and treatment methods. However, these methods still have certain limitations. Therefore, scholars should focus on exploring fusion genes, the clinical applications of molecular targets, and novel treatment methods. This study provides a strong reference for scholars in this field.
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Affiliation(s)
- Chang Song
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jia-Yuan Luo
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Yan Pang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rong-Quan He
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Jiao Li
- Department of Nuclear Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chun-Yan Zhao
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ning Qu
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Mei Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Yang
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bi-Qi Li
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Shi
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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McConnell RJ, Kamysh O, O’Kane PL, Greenebaum E, Rozhko AV, Yauseyenka VV, Minenko VF, Drozdovitch V, Yarets Y, Kukhta T, Mabuchi K, Little MP, Cahoon EK, Zablotska LB. Radiation Dose Does Not Affect the Predictive Value of Thyroid Biopsy for Diagnosing Papillary Thyroid Cancer in a Belarusian Cohort Exposed to Chernobyl Fallout. Acta Cytol 2024; 68:34-44. [PMID: 38246154 PMCID: PMC10987278 DOI: 10.1159/000536387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The Chernobyl nuclear accident exposed residents of contaminated territories to substantial quantities of radioiodines and was followed by an increase in thyroid cancer, primarily papillary thyroid cancer (PTC), among exposed children and adolescents. Although thyroid biopsy is an essential component of screening programs following accidental exposure to radioiodines, it is unknown whether the predictive value of biopsy is affected by different levels of environmental exposure. METHODS A cohort of 11,732 Belarusians aged ≤18 years at the time of the Chernobyl accident with individual thyroid radiation dose estimates was screened at least once 11-22 years later. Paired cytologic conclusions and histopathologic diagnoses were possible for 258 thyroid nodules from 238 cohort members. Cytologic conclusions were divided into five reporting categories, with all follicular lesion aspirates combined into a single indeterminate category. Standard performance indicators, risk of malignancy (ROM), and odds ratios for a correct cytologic conclusion were calculated, both overall and according to quintile of thyroid radiation dose. RESULTS The arithmetic mean thyroid dose estimate for the study group was 1.73 Gy (range: 0.00-23.64 Gy). The final histopathologic diagnosis was cancer for 136 of 258 biopsies (52.7%; 135 papillary and 1 follicular). The overall ROM was 96.7% for cytologies definite for PTC, 83.7% for suspicious for PTC, 33.0% for indeterminate, 8.1% for benign, and 31.0% for non-diagnostic. The ROM showed little change according to level of radiation exposure. Overall, there was no association between thyroid radiation dose and the odds ratio for a correct cytologic conclusion (p = 0.24). When analyzed according to dose quintile, the odds ratio for a correct conclusion increased two-fold at 0.10-0.29 Gy compared to a dose of 0.00-0.09 Gy and decreased at doses of 0.3-24 Gy (p value for linear trend = 0.99). CONCLUSIONS At radiation doses received by a cohort of young Belarusians exposed to radioiodines by the Chernobyl accident, the predictive value of thyroid biopsy for diagnosing PTC was not significantly affected by level of radiation exposure.
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Affiliation(s)
- Robert J. McConnell
- The Thyroid Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Olga Kamysh
- Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | - Patrick L. O’Kane
- Department of Radiology, Jefferson Health-Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Ellen Greenebaum
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander V. Rozhko
- Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | | | - Victor F. Minenko
- Institute for Nuclear Problems, Belarusian State University, Minsk, Belarus
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Yuliya Yarets
- Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus
| | - Tatiana Kukhta
- United Institute of Informatics Problems, Minsk, Belarus
| | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Mark P. Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth K. Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Tuli G, Munarin J, Scollo M, Quaglino F, De Sanctis L. Evaluation of the efficacy of EU-TIRADS and ACR-TIRADS in risk stratification of pediatric patients with thyroid nodules. Front Endocrinol (Lausanne) 2022; 13:1041464. [PMID: 36482990 PMCID: PMC9723319 DOI: 10.3389/fendo.2022.1041464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatric thyroid nodules have a lower prevalence but a higher rate of malignancy (ROM) than those in adults. Ultrasound features suspected of malignancy lead to fine needle aspiration biopsy (FNAB) and subsequent cytological determination, upon which management is decided. Based on the characteristics of ultrasound, to standardize clinician decisions and avoid unnecessary FNAB, the European Thyroid Association and the American Radiology College have established guidelines for Thyroid Imaging, Reporting and Data System (EU-TIRADS and ACR-TIRADS) for ROM stratification of thyroid nodules. The aim of this study is to evaluate the diagnostic performance of ACR-TIRADS and EU-TIRADS in pediatric age. MATERIALS AND METHODS Subjects younger than 18 years of age with thyroid nodules greater than 0.5 cm observed in the 2000-2020 period were included. RESULTS Data from 200 subjects were collected. The overall ROM was 13%, rising to 26% if nodules with a diameter >1 cm were considered. Patients with a malignant nodule were more likely to have a higher EU-TIRADS score (p=0.03). Missed cancer diagnoses were 26.9%. Using the EU-TIRADS system, 40% of FNABs could have been avoided, while this scoring system would have resulted in FNAB being performed in 12% of cases where the assessment of ultrasound features would not recommend FNAB. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.1%, 57.1%, 73.1%, and 50%, respectively. Even considering the ACR-TIRADS, a higher score correlated with a higher ROM (p<0.001). This system missed 6 diagnoses of cancer (23.1%). Using the ACR-TIRADS system, 45.3% of FNABs could have been avoided, while FNAB should have been performed in 12% of cases where it was not recommended by ultrasound characteristics. Sensitivity, specificity, PPV and NPV were 76.9%, 50%, 76.9%, and 42.9%, respectively. CONCLUSION The present study confirms the correspondence of the EU-TIRADS and ACR-TIRADS categories with respect to malignancy but indicates not entirely satisfactory performance compared to FNAB alone. However, the use of the two TIRADS systems should be encouraged in multicentre studies to increase their performance and establish paediatric-specific points in the scoring criteria.
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Affiliation(s)
- Gerdi Tuli
- Department of Health and Pediatric Sciences, University of Turin, Turin, Italy
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- *Correspondence: Gerdi Tuli,
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Mariapia Scollo
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Francesco Quaglino
- Department of General Surgery, "Maria Vittoria" Hospital Azienda Sanitaria Locale (ASL) Città di Torino, Turin, Italy
| | - Luisa De Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Tuli G, Munarin J, Agosto E, Matarazzo P, Quaglino F, Mormile A, de Sanctis L. Predictive factors of malignancy in pediatric patients with thyroid nodules and performance of the Italian classification (SIAPEC 2014) in the outcome of the cytological FNA categories. Endocrine 2021; 74:365-374. [PMID: 34128176 PMCID: PMC8497296 DOI: 10.1007/s12020-021-02784-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age. METHODS Retrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000-2020. RESULTS The distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4-TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively. CONCLUSIONS The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.
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Affiliation(s)
- Gerdi Tuli
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy.
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Jessica Munarin
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Erica Agosto
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Patrizia Matarazzo
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Francesco Quaglino
- Department of General Surgery, "Maria Vittoria" Hospital ASL Città di Torino, Turin, Italy
| | - Alberto Mormile
- Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin, Italy
| | - Luisa de Sanctis
- Department of Pediatric Endocrinology, Regina Margherita Children's Hospital, Turin, Italy
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Cimbek EA, Polat R, Sönmez B, Beyhun NE, Dinç H, Saruhan H, Karagüzel G. Clinical, sonographical, and pathological findings of pediatric thyroid nodules. Eur J Pediatr 2021; 180:2823-2829. [PMID: 33772338 DOI: 10.1007/s00431-021-04032-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022]
Abstract
Thyroid nodules are less frequent in children than in adults. A higher rate of malignancy is highlighted in this group. We aimed to analyze the clinical, laboratory, and ultrasound (US) findings of children and adolescents with benign and malignant thyroid nodules. This was a retrospective review of children and adolescents evaluated at a tertiary pediatric institution between 2007 and 2019. Patients with autonomously functioning nodules, autoimmune thyroid diseases, and a history of oncohematological disorders were excluded. A total of 102 patients with 131 nodules were identified. The study population included 57 females (55.9%); the average age was 10.6 ±4 years. Thirty-five nodules (26.7%) ranging 4.5-36 mm had a fine-needle aspiration (FNA) done: 45.7% (n = 16) were benign, 11.4% (n = 4) were classified as atypia, and 8.5% (n = 3) were consistent with papillary carcinoma. Fourteen patients (13.7%) underwent surgery. Five (4.9%) were finally diagnosed with papillary thyroid cancer. Of the 6 patients with benign FNAs, all except one, which was initially reported as atypia by an earlier FNA but was later diagnosed with papillary carcinoma, had a colloid nodular goiter. Of the 3 patients with atypia FNAs, one was found to be papillary carcinoma. One hundred twenty-five benign nodules (21 based on cytology and/or histology, 104 on clinical and imaging follow-up) were diagnosed. Nodule size, microcalcifications, solid parenchyma, and pathologic lymph node alterations were associated with malignancy, but nodule growth was not.Conclusion: Diagnostic approach and management of children with thyroid nodules should be based on a stepwise evaluation including clinical, laboratory, and US findings. Of the 102 patients identified, 4.9% had thyroid carcinoma below the range described in previous literature. What is Known: • Thyroid nodules are less frequent in children than in adults but more frequently malignant. Research on factors associated with malignancy have mostly been conducted in adults; further studies in pediatric thyroid nodules are warranted. What is New: • Microcalcifications, pathologic lymph node alterations, solid parenchyma, and larger nodule size are associated with malignant nodules, but nodule growth is not always suggestive of thyroid malignancy. The incidence of thyroid malignancy in this population was below the reported worldwide incidence in children with thyroid nodules.
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Affiliation(s)
- Emine Ayça Cimbek
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Recep Polat
- Pediatric Endocrinology Clinic, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Bircan Sönmez
- Department of Nuclear Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nazım Ercüment Beyhun
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hasan Dinç
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Haluk Saruhan
- Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gülay Karagüzel
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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Arora S, Khoury J, Trout AT, Chuang J. Improving Malignancy Prediction in AUS/FLUS Pediatric Thyroid Nodules with the Aid of Ultrasound. Horm Res Paediatr 2021; 93:239-244. [PMID: 32894855 DOI: 10.1159/000509118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The standard workup of thyroid nodules concerning for malignancy includes fine-needle aspiration (FNA). In 2015, the American Thyroid Association (ATA) guidelines for the management of pediatric thyroid nodules recommended that all nodules with a Bethesda III cytology undergo surgical resection. OBJECTIVES To correlate a Bethesda III cytology with histologic and clinical outcomes to determine the relevance of the ATA recommendations, and to evaluate whether Thyroid Imaging Reporting and Data System (TI-RADS) scoring could identify Bethesda III nodules at a lower risk of malignancy. METHODS A retrospective chart review of patients who had undergone thyroid nodule FNA from 2008 to 2018 was performed. Malignancy rates were determined for each Bethesda category. The reference standard was histopathology or 2-year follow-up of imaging outcomes for nonoperative cases. Ultrasound exams of Bethesda III nodules were reviewed and TI-RADS scores assigned. RESULTS A total of 143 FNA samples from 128 patients were identified. The mean age was 14.9 years (range 7-22). Twenty-two (15%) of the FNA samples were Bethesda III; the malignancy rate was 38%. A TI-RADS score was assigned in 20 of the 22 Bethesda III nodules. ROC analysis found an optimal cut-off for malignancy prediction of ≥7 points (risk category TR5). The negative predictive value was 85.7% (95% CI 35.9-99.6) and the positive predictive value was 83.3% (95% CI 57.2-98.2). CONCLUSION Although, at baseline, thyroid nodules with a Bethesda III classification carry a moderate risk of malignancy in the pediatric population, TI-RADS scoring can identify nodules with a lower risk within this group. If validated by larger studies, this can inform decision making and reduce unneeded surgery.
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Affiliation(s)
- Shruthi Arora
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,
| | - Jane Khoury
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew T Trout
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Janet Chuang
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Polat YD, Öztürk VS, Ersoz N, Anık A, Karaman CZ. Is Thyroid Imaging Reporting and Data System Useful as an Adult Ultrasonographic Malignancy Risk Stratification Method ın Pediatric Thyroid Nodules? J Med Ultrasound 2019; 27:141-145. [PMID: 31867177 PMCID: PMC6905278 DOI: 10.4103/jmu.jmu_35_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023] Open
Abstract
Background Data on thyroid imaging reporting and data system (TI-RADS) generally belong to studies performed in adults. Therefore, we aimed to evaluate the performance and utility of TI-RADS in the pediatric group. Materials and Methods From January 2015 to 2018, 108 nodules were evaluated in 1028 thyroid ultrasound examinations. Images were retrospectively evaluated by two radiologists with 3 and 7 years of pediatric radiology experience, according to TI-RADS classification. Morphological findings of the detected nodules and their histopathological results were recorded. Histopathological findings and at least 12 months of follow-up imaging were taken as reference. Results Seventy-one patients were female (67%). The mean age was 11.4 ± 4.7, and the mean nodule size was 7.4 ± 8.3 mm. According to the histopathological assessment and at least 12 months' follow-up with clinical and sonographic stability 100 (95.2%) of the nodules were benign and 5 (4.8%) were malignant. Two nodules, nondiagnostic cytology and 1 nodule were found to be suspicious for malignancy. All malignant nodules were in the TI-RADS 5 category. The majority of benign nodules (79%) were found in low TI-RADS categories. About 80% of the malignant nodules were very hypoechoic and taller than wide in shape, also all malignant nodules had microcalcifications (P = 0.000). The sensitivity of TI-RADS was 100%, specificity was 78.8%, positive predictive value (PPV) was 19.2%, and negative predictive value (NPV) was 100%. Conclusion According to our study, TI-RADS system can be used to evaluate thyroid nodules in pediatric patients similar to adults.
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Affiliation(s)
- Yasemin Durum Polat
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Veli Süha Öztürk
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Nimet Ersoz
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Ahmet Anık
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Can Zafer Karaman
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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Creo A, Alahdab F, Al Nofal A, Thomas K, Kolbe A, Pittock ST. Ultrasonography and the American Thyroid Association Ultrasound-Based Risk Stratification Tool: Utility in Pediatric and Adolescent Thyroid Nodules. Horm Res Paediatr 2019; 90:93-101. [PMID: 30021204 DOI: 10.1159/000490468] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/28/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pediatric thyroid nodules are more likely to be malignant compared to those in adults and may have different concerning ultrasound (US) features. Recent adult guidelines stratify malignancy risk by US features. Our aim is to (1) describe and confirm US features that predict pediatric malignancy, and (2) apply the Adult American Thyroid Association (ATA) Risk Stratification Guidelines to a large pediatric cohort. METHODS We identified 112 children with 145 thyroid nodules from 1996 to 2015. Two blinded pediatric radiologists independently read all US images, described multiple features, and reported their overall impression: benign, indeterminate, or malignant. Each nodule was assigned an ATA risk stratification category. Radiologists' impressions and ATA risk stratification were compared to histology and cytology results. RESULTS Multiple US features including a solid composition, presence of microcalcifications, irregular margins, increased blood flow, and hypoechogenicity were associated with increased odds of malignancy. ATA risk stratification correlated with the radiologists' overall impression (p < 0.001). The sensitivity for detecting malignancy was comparable between both ATA stratification (91%) and the radiologists' overall impression (90%). The specificity of the radiologists' malignant overall impression (80%) was better compared to the ATA high risk stratification (54%). CONCLUSIONS At our institution, pediatric radiologists' overall impressions had similar sensitivity but better specificity for detecting malignancy than the ATA risk stratification tool by our convention. However, neither US-based methods perfectly discriminated benign from malignant nodules, supporting the continued need for fine needle aspiration for suspicious nodules. Further work is needed to develop an US-based scoring system specific to pediatric patients.
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Affiliation(s)
- Ana Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| | - Fares Alahdab
- Division of Preventative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Sanford Health, Sioux Falls, South Dakota, USA
| | - Kristen Thomas
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy Kolbe
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
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Creo A, Alahdab F, Al Nofal A, Thomas K, Kolbe A, Pittock S. Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients. Clin Endocrinol (Oxf) 2019; 90:200-207. [PMID: 30326152 DOI: 10.1111/cen.13878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/11/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Thyroid cancer is the most common paediatric endocrine cancer; accurate diagnosis and prompt management of paediatric thyroid nodules is critical. The McGill Thyroid Nodule Score (MTNS), based upon clinical, ultrasound (US) and cytology criteria, has recently been modified and studied in a pilot paediatric group with good results. We aim to describe the diagnostic accuracy of the paediatric modified MTNS (PMTNS) in a large paediatric cohort. METHODS We utilized an established retrospective cohort between 1996 and 2015 of 99 patients ≤21 years old with 131 thyroid nodules. Two experienced paediatric radiologists, blinded to pathology and radiology reports, reviewed US features. We abstracted cytology, histology and laboratory results, assigning each nodule a PMTNS. PMTNS performance was compared to FNA and histology. RESULTS Approximately 33% of nodules were malignant. The cohort was predominantly adolescent (mean age 15.4 ± 3.8 years). The average PMTNS for malignant and benign nodules, based on final histology, was 12.7 ± 4.3 and 1.7 ± 2.9, respectively. A PMTNS ≥8 resulted in a 93.2% sensitivity and 93.1% specificity for detecting malignancy, while a PMTNS ≥9 resulted in a 90.9% sensitivity and 96.6% specificity. However, Bethesda cytology category ≥4 independently had a 97.7% sensitivity and 94.0% specificity for detecting malignancy. The PMTNS had diminishing diagnostic accuracy in younger children compared with older children. CONCLUSION Paediatric modified McGill Thyroid Nodule Score predicts malignancy, perhaps due to the score's emphasis on cytology results; however, the score is less accurate in younger patients. While cytology results remain reliable, further work is needed to develop a non-invasive scoring system to predict malignancy in children.
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Affiliation(s)
- Ana Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Fares Alahdab
- Division of Preventative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Sioux Falls, South Dakota
| | - Kristen Thomas
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Amy Kolbe
- Division of Pediatric Radiology, Mayo Clinic, Rochester, Minnesota
| | - Siobhan Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
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Alkhars A, Abouzayd M, Rouf CE, Lardy H, Bakhos D, Pondaven-Letourmy S, Moriniere S, Lescanne E. Pediatric thyroid surgery: experience in 75 consecutive thyroidectomies. Eur Arch Otorhinolaryngol 2018; 276:217-222. [PMID: 30382398 DOI: 10.1007/s00405-018-5188-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The main objective of this study is to report our experience in a university hospital in the surgical management of thyroid disease in pediatric patients. We also aim to analyze the results and evaluate the efficacy of fine-needle aspiration biopsy (FNAB) and frozen section analysis. METHODS A retrospective review of thyroid surgeries from January 1997 to December 2017 was conducted. Patients aged under 18 who underwent total or partial thyroidectomy were included. The indication of the surgery, the investigation results, the surgical technique used and the final diagnosis were reviewed and analyzed. RESULTS A total of 75 patients were included. 80% (n = 60) were females and 20% (n = 15) were males. The average age was 13.3 years ± 3.76 and age range was 3-18 years. The indication for thyroidectomy was thyroid nodule in 80% (n = 60), Grave's disease in 13.3% (n = 10), multiple endocrine neoplasm type II (MEN II) in 6.7% (n. 5). FNAB was done in 42.7% (n = 32/75) with sensitivity and specificity of 62.50% and 94.4%, respectively, the positive predictive value was 83.3% and the negative predictive value was 85%. Frozen section, which is a quick intraoperative micro and/or macroscopic examination, was done in 66.7% (n = 50/75). It was malignant in 12% (n = 6/50) and was benign in 88% (n = 44/50). Among benign results, nine (n = 9/44) patients had malignant disease in final pathological diagnosis. Its sensitivity and specificity were 40% and 100%, respectively, the positive predictive value and the negative predictive value were 100% and 79.6%, respectively. Total thyroidectomy was done in 54.7% (n = 41/75) and partial thyroidectomy was done in 45.3% (n = 34/75). Of the 75 patients, 29.3% (n = 22) had thyroid carcinoma on final pathological analysis. CONCLUSION Thyroid diseases that require surgical intervention are rare in pediatric populations. However, when surgery is indicated, there is higher risk of malignancy compared to adults. Our study showed that FNAB has a lower specificity and sensitivity compared to adults, and that surgical decision should be made considering all investigations. We also showed that frozen section is considered primarily for papillary thyroid carcinoma but is not reliable for follicular carcinoma or Bethesda IV. Finally, thyroid surgery in children and adolescents must be part of global multidisciplinary management.
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Affiliation(s)
- Ali Alkhars
- Services d'ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France.
| | - Moumainn Abouzayd
- Services d'ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France
| | - Charles-Edouard Rouf
- Services d'ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France
| | - Hubert Lardy
- Service de Chirurgie Pédiatrique Viscérale et Plastique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France
| | - David Bakhos
- Services d'ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France
| | - Soizick Pondaven-Letourmy
- Services d'ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France
| | - Sylvain Moriniere
- Services d'ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France
| | - Emmanuel Lescanne
- Services d'ORL et Chirurgie Cervico Faciale & ORL pédiatrique, CHRU de TOURS, Université de TOURS, 37044, Tours cedex 9, France
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12
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Ogle S, Merz A, Parina R, Alsayed M, Milas M. Ultrasound and the Evaluation of Pediatric Thyroid Malignancy: Current Recommendations for Diagnosis and Follow-up. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2311-2324. [PMID: 29575028 DOI: 10.1002/jum.14593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 06/08/2023]
Abstract
Ultrasound (US) plays a critical role in the evaluation, treatment, screening, and surveillance of thyroid malignancy in pediatric patients. This review aims to summarize recent advances in this topic. Improvements in imaging technology have amplified the advantage of US and US-guided fine-needle aspiration biopsy for thyroid nodule evaluation, cancer diagnosis, and surgical planning. Ultrasound has a definitive screening role for early cancer detection in high-risk patients, including those with a history of radiation exposure from childhood treatments, environmental radiation disasters, or hereditary/familial cancer syndromes. Finally, US is a key component of lifelong surveillance for recurrence among pediatric thyroid cancer survivors.
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Affiliation(s)
- Sarah Ogle
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Alexa Merz
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Ralitza Parina
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Mahmoud Alsayed
- Department of Endocrinology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Mira Milas
- Endocrine Surgery Center, Diabetes and Endocrinology Institute, Department of Surgery, University of Arizona, Phoenix School of Medicine, Banner University Medical Center, Phoenix, Arizona, USA
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Massimino M, Evans DB, Podda M, Spinelli C, Collini P, Pizzi N, Bleyer A. Thyroid cancer in adolescents and young adults. Pediatr Blood Cancer 2018. [PMID: 29528191 DOI: 10.1002/pbc.27025] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In adolescents and young adults, thyroid cancer accounts for 13% of all invasive neoplasms, being three times more frequent in females, but overdiagnosis and overtreatment are common. There are two therapeutic approaches, one radical and no longer preferred in all instances, and the other conservative. Permanent complications of surgery and metabolic irradiation can affect quality of life and carry an economic burden. The overall survival rate approaches 100% for patients with differentiated thyroid cancer regardless of the extent of treatment. Medullary thyroid carcinoma is a very different entity, occurring most frequently in the context of hereditary tumor susceptibility syndromes.
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Affiliation(s)
- Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marta Podda
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Natalia Pizzi
- Department of Otorhinology and Maxillo-Facial Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Archie Bleyer
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
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Malheiros DC, Canberk S, Poller DN, Schmitt F. Thyroid FNAC: Causes of false-positive results. Cytopathology 2018; 29:407-417. [PMID: 29768677 DOI: 10.1111/cyt.12575] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 12/17/2022]
Abstract
In this paper, we aim to focus on false positive results in the evaluation of thyroid aspirations, covering cystic, inflammatory, follicular and oncocytic lesions, papillary carcinoma, and medullary carcinoma of thyroid. The recently described entity noninvasive follicular thyroid neoplasm with papillary-like nuclear features is also discussed detailing the impact of its introduction on the sensitivity and specificity of thyroid FNA, as well as the use of molecular tests for diagnostics. Medicolegal issues in relation to current practice in English law are also described.
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Affiliation(s)
- D C Malheiros
- Faculdade de Ciências, Médicas da Santa Casa de São Paulo, São Paulo, Brasil.,IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal
| | - S Canberk
- IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Pathology subdivision of Cytopathology, Acibadem University, Atasehir-Istanbul, Turkey
| | - D N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
| | - F Schmitt
- IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Medical Faculty of Porto University, Porto, Portugal
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15
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Kochummen E, Tong S, Umpaichitra V, Chin VL. A Unique Case of Bilateral Hürthle Cell Adenoma in an Adolescent. Horm Res Paediatr 2017; 87:136-142. [PMID: 27467101 DOI: 10.1159/000448216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hürthle cell (HC) neoplasms are rare among pediatric thyroid cancers. HC adenomas (HCA) are typically benign and localized unilaterally without recurrence, and they are thus treated by hemithyroidectomy. HC carcinomas (HCC) can be bilateral and are more aggressive, necessitating total thyroidectomy. Diagnosis relies upon surgical histopathology demonstrating invasion for classification as HCC or lack of invasion in HCA, since fine needle aspiration fails to differentiate between the two. METHODS We report a case of a 14-year-old adolescent female with bilateral HCA. She had an initial left hemithyroidectomy for a large nodule measuring 2 × 1.5 × 1.2 cm3 in the left lobe, while smaller subcentimeter nodules remained under surveillance in the right. One year later, a nodule in the right lobe doubled in size, necessitating a right hemithyroidectomy which also revealed HCA. CONCLUSION To our knowledge, this is the first reported case of bilateral HCA in pediatrics. It highlights the importance of close surveillance of persistent small nodules, even in patients with previously documented benign lesions such as HCA, which are typically thought to be unilateral and localized. Both HCA and HCC remain unpredictable in behavior, and treatment of HCA should be individualized.
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Affiliation(s)
- Elna Kochummen
- Division of Pediatric Endocrinology, Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, N.Y., USA
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16
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Rossi ED, Martini M, Cenci T, Capodimonti S, Larocca LM. The role of thyroid FNA cytology in pediatric malignant lesions: An overview of the literature. Cancer Cytopathol 2017; 125:594-603. [DOI: 10.1002/cncy.21884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart; Rome Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart; Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology; Agostino Gemelli School of Medicine, Catholic University of the Sacred Heart; Rome Italy
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17
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Şişik A, Başak F, Köse E. Tiroid nodüllerine güncel yaklaşım: “2015 ATA” ve “2016 AACE/ACE/AME” kılavuzları derlemesi. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2017. [DOI: 10.25000/acem.303852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Lim-Dunham JE, Erdem Toslak I, Alsabban K, Aziz A, Martin B, Okur G, Longo KC. Ultrasound risk stratification for malignancy using the 2015 American Thyroid Association Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Pediatr Radiol 2017; 47:429-436. [PMID: 28127634 DOI: 10.1007/s00247-017-3780-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/07/2016] [Accepted: 01/04/2017] [Indexed: 01/24/2023]
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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Affiliation(s)
- Jennifer E Lim-Dunham
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA.
| | - Iclal Erdem Toslak
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Khalid Alsabban
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Amany Aziz
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Brendan Martin
- Clinical Research Office, Loyola University Chicago Health Sciences Division, Loyola University Medical Center, Maywood, IL, USA
| | - Gokcan Okur
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
| | - Katherine C Longo
- Department of Radiology, Loyola University Chicago Stritch School of Medicine, 2160 S. First Ave., Maywood, IL, 60546, USA
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Parisi MT, Eslamy H, Mankoff D. Management of Differentiated Thyroid Cancer in Children: Focus on the American Thyroid Association Pediatric Guidelines. Semin Nucl Med 2016; 46:147-64. [PMID: 26897719 DOI: 10.1053/j.semnuclmed.2015.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
First introduced in 1946, radioactive iodine (I-131) produces short-range beta radiation with a half-life of 8 days. The physical properties of I-131 combined with the high degree of uptake in the differentiated thyroid cancers (DTCs) led to the use of I-131 as a therapeutic agent for DTC in adults. There are two indications for the potential use of I-131 therapy in pediatric thyroid disorders: nonsurgical treatment of hyperthyroidism owing to Graves' disease and the treatment of children with intermediate- and high-risk DTC. However, children are not just miniature adults. Not only are children and the pediatric thyroid gland more sensitive to radiation than adults but also the biologic behavior of DTC differs between children and adults as well. As opposed to adults, children with DTC typically present with advanced disease at diagnosis; yet, they respond rapidly to therapy and have an excellent prognosis that is significantly better than that in adult counterparts with advanced disease. Unfortunately, there are also higher rates of local and distant disease recurrence in children with DTC compared with adults, mandating lifelong surveillance. Further, children have a longer life expectancy during which the adverse effects of I-131 therapy may become manifest. Recognizing the differences between adults and children with DTC, the American Thyroid Association commissioned a task force of experts who developed and recently published a guideline to address the unique issues related to the management of thyroid nodules and DTC in children. This article reviews the epidemiology, diagnosis, staging, treatment, therapy-related effects, and suggestions for surveillance in children with DTC, focusing not only on the differences between adults and children with this disease but also on the latest recommendations from the inaugural pediatric management guidelines of the American Thyroid Association.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
| | - Hedieh Eslamy
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David Mankoff
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA
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Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract 2016; 22:622-39. [PMID: 27167915 DOI: 10.4158/ep161208.gl] [Citation(s) in RCA: 702] [Impact Index Per Article: 87.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
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Amirazodi E, Propst EJ, Chung CT, Parra DA, Wasserman JD. Pediatric thyroid FNA biopsy: Outcomes and impact on management over 24 years at a tertiary care center. Cancer Cytopathol 2016; 124:801-810. [DOI: 10.1002/cncy.21750] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Elmira Amirazodi
- Division of Endocrinology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Evan J. Propst
- Department of Otolaryngology, Head and Neck Surgery; The Hospital for Sick Children and University of Toronto; Toronto Ontario Canada
| | - Catherine T. Chung
- Division of Pathology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Dimitri A. Parra
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto Ontario Canada
| | - Jonathan D. Wasserman
- Division of Endocrinology; The Hospital for Sick Children; Toronto Ontario Canada
- Department of Pediatrics; University of Toronto; Toronto Ontario Canada
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Abstract
Well differentiated thyroid cancer (DTC) in children is characterized by a high rate of response to treatment and low disease-specific mortality. Treatment of children with DTC has evolved toward a greater reliance on evaluation and monitoring with serial serum thyroglobulin measurements and ultrasound examinations. Radioiodine therapy is recommended for thyroid remnant ablation in high-risk patients, treatment of demonstrated radioiodine-avid local-regional disease not amenable to surgical resection, or distant radioiodine-avid metastatic disease. Sufficient time should be given for benefits of radioiodine therapy to be realized, with follow-up monitoring. Re-treatment with radioiodine can be deferred until progression of significant disease manifests.
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Affiliation(s)
- Josef Machac
- Nuclear Medicine, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, Box 1141, 1 Gustave Levy Place, New York, NY 10029, USA.
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Moudgil P, Vellody R, Heider A, Smith EA, Grove JJ, Jarboe MD, Bruch SW, Dillman JR. Ultrasound-guided fine-needle aspiration biopsy of pediatric thyroid nodules. Pediatr Radiol 2016; 46:365-71. [PMID: 26554855 DOI: 10.1007/s00247-015-3478-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/24/2015] [Accepted: 10/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of US-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules is not well-established in children. OBJECTIVE To retrospectively assess the utility of US-FNAB of pediatric thyroid nodules. MATERIALS AND METHODS We reviewed Department of Radiology records to identify children who underwent US-FNAB of the thyroid between 2005 and 2013. Two board-certified pediatric radiologists reviewed pre-procedural thyroid US exams and documented findings by consensus. We recorded cytopathology findings and compared them to surgical pathology diagnoses if the nodule was resected. We also recorded demographic information, use of sedation or general anesthesia, and presence of on-site cytopathological feedback. The Student's t-test was used to compare continuous data; the Fisher exact test was used to compare proportions. RESULTS US-FNAB was conducted on a total of 86 thyroid nodules in 70 children; 56 were girls (80%). Seventy-eight of the 86 (90.7%) US-FNAB procedures were diagnostic; 69/78 (88.5%) diagnostic specimens were benign (including six indeterminate follicular lesions that were proved at surgery to be benign) and 9/78 (11.5%) were malignant/suspicious for malignancy (all proved to be papillary carcinomas). There was no difference in size of benign vs. malignant lesions (P = 0.82) or diagnostic vs. non-diagnostic lesions (P = 0.87). Gender (P = 0.19), use of sedation/general anesthesia (P = 0.99), and presence of onsite cytopathological feedback (P = 0.99) did not affect diagnostic adequacy. Microcalcifications (P < 0.0001; odds ratio [OR] = 113.7) and coarse calcifications (P = 0.03; OR = 19.4) were associated with malignancy. Diagnoses at cytopathology and surgical pathology were concordant in 27/29 (93.1%) nodules; no US-FNAB procedure yielded false-positive or false-negative results for malignancy. CONCLUSION US-FNAB of pediatric thyroid nodules is feasible, allows diagnostic cytopathological evaluation, and correlates with surgical pathology results in resected nodules.
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Affiliation(s)
- Pranav Moudgil
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ranjith Vellody
- Department of Radiology, Division of Interventional Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Amer Heider
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ethan A Smith
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Jason J Grove
- Department of Radiology, Division of Interventional Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Marcus D Jarboe
- Department of Radiology, Division of Interventional Radiology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Health System, Section of Pediatric Surgery, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Steven W Bruch
- Department of Surgery, University of Michigan Health System, Section of Pediatric Surgery, C. S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Jonathan R Dillman
- Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children's Hospital, Ann Arbor, MI, USA. .,Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
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Al Nofal A, Gionfriddo MR, Javed A, Haydour Q, Brito JP, Prokop LJ, Pittock ST, Murad MH. Accuracy of thyroid nodule sonography for the detection of thyroid cancer in children: systematic review and meta-analysis. Clin Endocrinol (Oxf) 2016; 84:423-30. [PMID: 25845503 DOI: 10.1111/cen.12786] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Thyroid ultrasound (US) is a widely used tool for evaluating thyroid nodules. Various US features have been suggested as predictors of thyroid cancer in children. OBJECTIVE To conduct a systematic review and meta-analysis to assess the diagnostic accuracy of different thyroid US features in detecting thyroid cancer in children. METHODS We searched multiple online databases for cohort studies that enrolled paediatric patients with thyroid nodules (age <21 years) and evaluated the accuracy of 12 relevant ultrasound features. Diagnostic measures were pooled across studies using a random effects model. RESULTS The search strategy yielded 1199 citations, of which 12 studies met the predefined inclusion criteria (750 nodules). The prevalence of thyroid cancer was 27·2% (40·8% in patients with a history of radiation exposure and 23·2% in patients without a history of exposure to radiation). The most common cancer was papillary thyroid cancer (86·7%). The presence of internal calcifications and enlarged cervical lymph nodes were the US features with the highest likelihood ratio [4·46 (95% CI: 1·87-10·64) and 4·96 (95% CI: 2·01-12·24), respectively] for thyroid cancer. A cystic nodule was the feature with highest likelihood ratio for benign nodules [1·96 (95% CI: 0·87-4·43)]. CONCLUSION Thyroid US features are not highly accurate predictors of benign or malignant aetiology of thyroid nodules in children. Internal calcification may predict malignancy, and cystic appearance may suggest benign aetiology.
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Affiliation(s)
- Alaa Al Nofal
- Division of Paediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Rochester, MN, USA
| | - Asma Javed
- Division of Paediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Qusay Haydour
- Internal Medicine Program, Georgia Regents University, Augusta, GA, USA
| | - Juan P Brito
- Division of Diabetes, Endocrinology, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Larry J Prokop
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Paediatric Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Mohammad Hassan Murad
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN, USA
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
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Mussa A, De Andrea M, Motta M, Mormile A, Palestini N, Corrias A. Predictors of Malignancy in Children with Thyroid Nodules. J Pediatr 2015; 167:886-892.e1. [PMID: 26164379 DOI: 10.1016/j.jpeds.2015.06.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 05/06/2015] [Accepted: 06/08/2015] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Alessandro Mussa
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.
| | - Maurilio De Andrea
- Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - Manuela Motta
- Anatomical Pathology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Alberto Mormile
- Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - Nicola Palestini
- General Surgery, Department of Medical and Surgical Sciences, University of Torino, Ospedale Molinette, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Corrias
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
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Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2015; 25:716-59. [PMID: 25900731 PMCID: PMC4854274 DOI: 10.1089/thy.2014.0460] [Citation(s) in RCA: 699] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. METHODS A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. RESULTS These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. CONCLUSIONS In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
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Affiliation(s)
- Gary L. Francis
- Division of Pediatric Endocrinology, Virginia Commonwealth University, Children's Hospital of Richmond, Richmond, Virginia
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics-Patient Care, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania, The Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Salvatore Benvenga
- University of Messina, Interdepartmental Program on Clinical & Molecular Endocrinology, and Women's Endocrine Health, A.O.U. Policlinico Universitario G. Martino, Messina, Italy
| | - Janete M. Cerutti
- Department of Morphology and Genetics. Division of Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Catherine A. Dinauer
- Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Jill Hamilton
- Division of Endocrinology, University of Toronto, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian D. Hay
- Division of Endocrinology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Markus Luster
- University of Marburg, Marburg, Germany
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Department of Radiology, Seattle, Washington
| | - Marianna Rachmiel
- Pediatric Division, Assaf Haroffeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geoffrey B. Thompson
- Department of Surgery, Division of Subspecialty GS (General Surgery), Mayo Clinic, Rochester, Minnesota
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Papendieck P, Gruñeiro-Papendieck L, Venara M, Acha O, Cozzani H, Mateos F, Maglio S, Calcagno ML, Bergada I, Chiesa A. Differentiated Thyroid Cancer in Children: Prevalence and Predictors in a Large Cohort with Thyroid Nodules Followed Prospectively. J Pediatr 2015; 167:199-201. [PMID: 26117640 DOI: 10.1016/j.jpeds.2015.04.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 04/01/2015] [Accepted: 04/14/2015] [Indexed: 11/18/2022]
Abstract
We retrospectively analyzed the findings of a prospective cohort of 75 children referred for thyroid nodules between 2008 and 2013. Prevalence of papillary differentiated thyroid carcinoma was 18.7%. Thyrotropin >2.5 mIU/L, multinodular goiter, solid nodules, irregular margins, and pathologic lymphadenopathies were identified as independent predictors of malignancy.
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Affiliation(s)
- Patricia Papendieck
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá, Consejo Nacional de Investigaciones Científicas y Técnicas, Division of Endocrinology, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina.
| | - Laura Gruñeiro-Papendieck
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá, Consejo Nacional de Investigaciones Científicas y Técnicas, Division of Endocrinology, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Marcela Venara
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá, Consejo Nacional de Investigaciones Científicas y Técnicas, Division of Endocrinology, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Oscar Acha
- Surgery Department, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Hugo Cozzani
- Radiology Department, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Fernanda Mateos
- Radiology Department, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Silvana Maglio
- Pathological Anatomy Department, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Maria Lujan Calcagno
- School of Pharmacy and Biochemistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Bergada
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá, Consejo Nacional de Investigaciones Científicas y Técnicas, Division of Endocrinology, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Ana Chiesa
- Centro de Investigaciones Endocrinológicas Dr. César Bergadá, Consejo Nacional de Investigaciones Científicas y Técnicas, Division of Endocrinology, Dr. Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
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Abstract
Thyroid nodules are commonly diagnosed in adults. Although rare in children, the risk for thyroid cancer is much higher in the pediatric population compared with adults. Presenting as either a solitary nodule or a multinodular goiter, thyroid nodular disease in children requires a thorough workup that includes a detailed clinical examination comprised of prior history of thyroid disease in the patient or in their family, history of radiation exposure, careful palpation of the thyroid and lymph nodes, blood tests, ultrasonography, and cytological assessment. Thyroid surgery is the gold-standard treatment for pediatric thyroid nodules; nonetheless, the extent of surgery remains controversial. Because surgery is not without risk, the decision matrix necessitates focus on the benefits of surgery for the child contingent upon all the preoperative exams. New diagnostic technology such as molecular testing with fine needle aspiration biopsy may help distinguish between benign and malignant lesions while potentially decreasing surgery for benign disease. The objective of this review is to summarize new concepts in clinical disease management of nodular thyroid disease in the pediatric population, including patient history, medical examination, and diagnosis workup.
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Affiliation(s)
- Jeremy T Guille
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Adwoa Opoku-Boateng
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Herbert Chen
- Division of Otolaryngology-Head and Neck Surgery, Division of General Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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Thyroid nodules in childhood: indications for biopsy and surgery. Ital J Pediatr 2014; 40:48. [PMID: 24887308 PMCID: PMC4046031 DOI: 10.1186/1824-7288-40-48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
Aims of this commentary is to report the most recent views about epidemiology, diagnostic procedures, malignancy risk factors and clinical management of thyroid nodules in children. On the basis of our personal experiences and recent literature evidences, we conclude that: a) if nodule is accompanied by lymphadenopathy and/or other alert findings, fine-needle aspiration biopsy (FNAB) should be recommended; b) if no lymphadenopathy and no other clinical and ultrasonographic alert signs are observed, work-up can progress to FNAB only if nodule persists or grows over time, even under levo-thyroxine therapy.
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Abstract
Although surgical conditions of the thyroid gland are uncommon in children, the increased incidence of thyroid cancer, combined with the fact that children's hospitals are increasingly treating older adolescents, means that it is important that all pediatric surgeons have a knowledge of these conditions. Abnormalities of the thyroid can be associated with abnormalities of thyroid function (hyperthyroidism or hypothyroidism) and/or can be associated with symmetrical or asymmetrical enlargement of the gland.
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Affiliation(s)
- Daniel J Ledbetter
- Department of Surgery, University of Washington, Seattle, Washington; Seattle Children׳s Hospital, Sand Point Way, Seattle, Washington 98105.
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31
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Vasudev V, A L H, B R, S G. Efficacy and Pitfalls of FNAC of Thyroid Lesions in Children and Adolescents. J Clin Diagn Res 2014; 8:35-8. [PMID: 24596718 DOI: 10.7860/jcdr/2014/6718.3913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 09/19/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Fine-needle aspiration has proven safe and efficacious in the evaluation of nodular diseases in the adults. It has been used extensively to select patients for surgical exploration with a high degree of reliability. The purpose of this study was to assess the extent of its applicability in thyroid lesions in children and adolescents, as well as to determine distribution of thyroid lesions in pediatric and adolescent patients in whom the prevalence of thyroid nodules and probability of malignancy are different. METHODOLOGY This is a four-year study undertaken between January 2009 and December 2012, during which, 284 fine-needle aspiration cytology were performed for palpable thyroid lesions in children and adolescents and analysed. Out of these 11, 52, 82 and 116 aspirates belonged to the age group between 7-<12 years, 12 -<16 years, 16 -<19 years, 19-21 years respectively. There were 261 (91.9%) satisfactory aspirates and 23 unsatisfactory aspirates (8.1%). These 261 satisfactory aspirates with adequate cellular material were taken up for interpretation and analysed. Thirty one patients underwent thyroidectomy. There were 4 true positives, 24 true negatives, 2 false positives and one false negative case in this study. Sensitivity, Specificity, Accuracy, Positive predictive value and Negative predictive value were calculated. RESULTS Benign cytology was reported in 89 cases (34.2%) where 11 cases (4.2%) were males. Thyroiditis was observed in 154 cases (59%) and 8 cases (3.1%) were males. Suspicious cytology was reported in 12 cases and comprised of 2 cases with a suspicion of Papillary Carcinoma and 10 cases (3.8%), with a suspicion of a Follicular lesion. Papillary Carcinoma was detected on 6 cases where all were females. The Sensitivity was 96%, Specificity was 66% and the Accuracy was 90%, Positive predictive value was 66%, Negative predictive value was 96%. CONCLUSION Fine-needle aspiration cytology of palpable thyroid lesions in children and adolescents is a good screening test because of its high sensitivity. Majority of the nodules in this age-group are benign and fine-needle aspiration cytology helps prevent unnecessary surgery.
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Affiliation(s)
- Vidya Vasudev
- Assistant Professor, Department of Pathology, Mysore Medical College and Research Institute , Mysore, Karnataka, India
| | - Hemalatha A L
- Professor and HOD, Department of Pathology, Mysore Medical College and Research Institute , Mysore, Karnataka, India
| | - Rakhi B
- Post Graduate, Department of Pathology, Mysore Medical College and Research Institute , Mysore, Karnataka, India
| | - Githanjali S
- Post Graduate, Department of Pathology, Mysore Medical College and Research Institute , Mysore, Karnataka, India
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Abstract
According to the literature, thyroid nodules (TNs) are quite rare in the first two decades of life and are predominantly non-cancerous, although cancerous TNs are more common in the first two decades of life than in adults. Therefore, it is important for clinicians to distinguish benign from malignant lesions preoperatively because the latter require a total thyroidectomy with or without neck lymph node dissection. A careful work-up and a fine-needle aspiration biopsy (FNAB) are mandatory to improve the preoperative diagnosis. High-resolution thyroid ultrasound and real-time elastosonography are adjuvant presurgical tools in selecting patients for surgery, particularly those with indeterminate or non-diagnostic cytology. Elevated thyroid-stimulating hormone (TSH) level in a patient with a thyroid nodule is a new laboratory predictor of thyroid cancer risk. The majority of thyroid carcinomas derive from the follicular cell, whereas medullary thyroid carcinoma (MTC) derives from calcitonin-producing cells. Patients with MTC are screened for germ-line RET mutations to detect carriers and identify family members for prophylactic or therapeutic thyroidectomy.
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Affiliation(s)
- Marek Niedziela
- Department of Paediatric Endocrinology and Rheumatology, 2nd Chair of Paediatrics, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572 Poznan, Poland.
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Kanagal-Shamanna R, Portier BP, Singh RR, Routbort MJ, Aldape KD, Handal BA, Rahimi H, Reddy NG, Barkoh BA, Mishra BM, Paladugu AV, Manekia JH, Kalhor N, Chowdhuri SR, Staerkel GA, Medeiros LJ, Luthra R, Patel KP. Next-generation sequencing-based multi-gene mutation profiling of solid tumors using fine needle aspiration samples: promises and challenges for routine clinical diagnostics. Mod Pathol 2014; 27:314-27. [PMID: 23907151 DOI: 10.1038/modpathol.2013.122] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 05/09/2013] [Accepted: 05/11/2013] [Indexed: 12/29/2022]
Abstract
Increasing use of fine needle aspiration for oncological diagnosis, while minimally invasive, poses a challenge for molecular testing by traditional sequencing platforms due to high sample requirements. The advent of affordable benchtop next-generation sequencing platforms such as the semiconductor-based Ion Personal Genome Machine (PGM) Sequencer has facilitated multi-gene mutational profiling using only nanograms of DNA. We describe successful next-generation sequencing-based testing of fine needle aspiration cytological specimens in a clinical laboratory setting. We selected 61 tumor specimens, obtained by fine needle aspiration, with known mutational status for clinically relevant genes; of these, 31 specimens yielded sufficient DNA for next-generation sequencing testing. Ten nanograms of DNA from each sample was tested for mutations in the hotspot regions of 46 cancer-related genes using a 318-chip on Ion PGM Sequencer. All tested samples underwent successful targeted sequencing of 46 genes. We showed 100% concordance of results between next-generation sequencing and conventional test platforms for all previously known point mutations that included BRAF, EGFR, KRAS, MET, NRAS, PIK3CA, RET and TP53, deletions of EGFR and wild-type calls. Furthermore, next-generation sequencing detected variants in 19 of the 31 (61%) patient samples that were not detected by traditional platforms, thus increasing the utility of mutation analysis; these variants involved the APC, ATM, CDKN2A, CTNNB1, FGFR2, FLT3, KDR, KIT, KRAS, MLH1, NRAS, PIK3CA, SMAD4, STK11 and TP53 genes. The results of this study show that next-generation sequencing-based mutational profiling can be performed on fine needle aspiration cytological smears and cell blocks. Next-generation sequencing can be performed with only nanograms of DNA and has better sensitivity than traditional sequencing platforms. Use of next-generation sequencing also enhances the power of fine needle aspiration by providing gene mutation results that can direct personalized cancer therapy.
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Affiliation(s)
- Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Bryce P Portier
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Rajesh R Singh
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mark J Routbort
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kenneth D Aldape
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Brian A Handal
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Hamed Rahimi
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Neelima G Reddy
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Bedia A Barkoh
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Bal M Mishra
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Abhaya V Paladugu
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jawad H Manekia
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Neda Kalhor
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sinchita Roy Chowdhuri
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Gregg A Staerkel
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Rossi ED, Straccia P, Martini M, Revelli L, Lombardi CP, Pontecorvi A, Fadda G. The role of thyroid fine‐needle aspiration cytology in the pediatric population: An institutional experience. Cancer Cytopathol 2014; 122:359-67. [DOI: 10.1002/cncy.21400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and HistologyCatholic University of the Sacred Heart, Agostino Gemelli School of MedicineRome Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and HistologyCatholic University of the Sacred Heart, Agostino Gemelli School of MedicineRome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and HistologyCatholic University of the Sacred Heart, Agostino Gemelli School of MedicineRome Italy
| | - Luca Revelli
- Division of Endocrine SurgeryCatholic University of the Sacred Heart, Agostino Gemelli School of MedicineRome Italy
| | - Celestino Pio Lombardi
- Division of Endocrine SurgeryCatholic University of the Sacred Heart, Agostino Gemelli School of MedicineRome Italy
| | - Alfredo Pontecorvi
- Division of EndocrinologyCatholic University of the Sacred Heart, Agostino Gemelli School of MedicineRome Italy
| | - Guido Fadda
- Division of Anatomic Pathology and HistologyCatholic University of the Sacred Heart, Agostino Gemelli School of MedicineRome Italy
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Abstract
BACKGROUND AND AIMS Paediatric thyroid cancer is a rare disease, making diagnosis and treatment particularly challenging. Here we present the Scottish experience of thyroid cancer in the paediatric population and give an overview of how a child or adolescent that presents with a thyroid nodule should be investigated and managed. METHODS AND RESULTS Data has been obtained from ISD Scotland, giving population-based information on paediatric thyroid cancer. A literature review has been performed on the management and treatment of thyroid cancer in the younger population. Paediatric thyroid cancer in Scotland is a rare disease, although the incidence is increasing each year. In general, differentiated paediatric thyroid cancer carries a good prognosis, while the results are more mixed in the rarer pathologies such as medullary cancer. CONCLUSION Due to the small numbers of patients diagnosed each year in Scotland, it is imperative that these patients are discussed at a multidisciplinary thyroid MDT and managed in a tertiary referral centre by consultants and medical/nursing support staff who have experience in treating these patients.
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Affiliation(s)
- C M Douglas
- Department of Paediatric ENT, Royal Hospital for Sick Children, UK
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Mussa A, Salerno MC, Bona G, Wasniewska M, Segni M, Cassio A, Vigone MC, Gastaldi R, Iughetti L, Santanera A, Capalbo D, Matarazzo P, De Luca F, Weber G, Corrias A. Serum thyrotropin concentration in children with isolated thyroid nodules. J Pediatr 2013; 163:1465-70. [PMID: 23972643 DOI: 10.1016/j.jpeds.2013.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/17/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the correlation between serum thyroid-stimulating hormone (TSH) concentration and nodule nature in pediatric patients with thyroid nodules, with the aim of identifying a marker able to differentiate benign and malignant nodules. STUDY DESIGN This was a retrospective analysis of serum TSH concentrations in a multicentric case series of 125 pediatric patients with benign and malignant thyroid nodules. RESULTS Of the 125 patients, 99 had benign thyroid nodules and 26 had differentiated thyroid cancer (24 papillary and 2 follicular). Final diagnosis was based on surgery in 57 cases and on a benign cytology plus clinical follow-up in 68 cases. Serum TSH concentration was significantly higher in patients with thyroid cancer compared with those with benign nodules (3.23 ± 1.59 mU/L vs 1.64 ± 0.99 mU/L; P < .001). Binary logistic regression analysis revealed that serum TSH was the sole predictor of malignancy (P < .001). Dividing the patient cohort into 5 groups based on serum TSH quintiles (TSH cutoffs 0.40, 1.00, 1.50, 1.80, and 2.80 mU/L), we observed that cancer prevalence increased in parallel with serum TSH (P < .001), with respective rates of 0%, 4%, 16%, 32%, and 52% in the 5 quintile groups. CONCLUSION Because cases with malignant nodules are most likely seen in the upper normal serum TSH range (ie, >2.8 mU/L), serum TSH concentration can serve as a predictor of thyroid cancer in pediatric patients with thyroid nodules and can inform the decision of when to submit patients to further investigation by cytology.
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Affiliation(s)
- Alessandro Mussa
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Torino, Torino, Italy.
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Needle core biopsy in the diagnosis of pediatric thyroid neoplasms: a single institution retrospective review. Pediatr Surg Int 2013; 29:437-43. [PMID: 23411614 DOI: 10.1007/s00383-013-3278-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Our institution routinely utilizes needle core biopsy (NCB), instead of fine needle aspiration, in the evaluation of pediatric thyroid nodules. This practice initially arose from limited cytopathology services in our hospital. Given the lack of information regarding the utility of NCB in diagnosing pediatric thyroid neoplasms, we set out to review our institution's experience with this technique. METHODS We performed a single institution retrospective chart review of all children who underwent thyroidectomy for primary thyroid pathology. RESULTS Seventy-four patients, with a mean age of 12.9 ± 4.5 (SD) years, underwent partial or total thyroidectomy between 2002 and 2010. Seven of these patients had medically refractive hyperthyroidism. The remaining 67 patients had one or more thyroid nodules as identified by ultrasound. 24 (36 %) of these cases were malignant on final pathology. 14 (58 %) of the malignant cases were papillary thyroid carcinoma. 46 of the thyroid nodule cases underwent pre-operative NCB. Biopsy results for these patients were non-diagnostic in 6 (13 %), benign in 11 (24 %), atypical in 17 (37 %), and malignant in 12 (26 %). There were no complications arising from NCB. Sensitivity of NCB for diagnosing papillary carcinoma (PC) and follicular neoplasm was calculated at 0.88 (0.47-1.0, 95 % CI) and 0.84 (0.60-0.97, 95 % CI), respectively. Of the 28 patients not undergoing preoperative NCB, 12 underwent hemithyroidectomy, with one patient (8 %) requiring completion thyroidectomy for PC. Overall, the sensitivity of NCB in diagnosing PC and follicular thyroid neoplasms was 0.85 (0.55-0.99, 95 % CI), while the specificity was 0.63 (0.42-0.82, 95 % CI). CONCLUSIONS Needle core biopsy appears to have a low rate of associated complications, and its sensitivity for diagnosing PC and follicular neoplasm is comparable to what has been reported for fine needle aspiration biopsy in a similar patient population.
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Corrias A, Mussa A. Thyroid nodules in pediatrics: which ones can be left alone, which ones must be investigated, when and how. J Clin Res Pediatr Endocrinol 2013; 5 Suppl 1:57-69. [PMID: 23165002 PMCID: PMC3608010 DOI: 10.4274/jcrpe.853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Thyroid nodules are less frequent in childhood than in adulthood, but are more often malignant. Recent estimates suggest that up to 25% of thyroid nodules in children are malignant, therefore, a more aggressive approach is recommended. In this review, we suggest an approach based on a first-step clinical, laboratory, and sonographic evaluation. A history of irradiation of the neck, cranium or upper thorax, previous thyroid diseases or thyroid neoplasms in the family should alert clinicians as being associated with a greater likelihood of malignant nodules. Signs or symptoms of hyperthyroidism and dysmorphic features should be carefully considered during the physical examination. Palpable firm lymph nodes, found in some 70% of cases, are the most significant clinical finding in children with malignant nodules. Although the routine determination of calcitonin levels is not uniformly practiced, it can help recognize sporadic or familial medullary thyroid neoplasms. Blood thyroid stimulating hormone, free thyroxine, and free triiodothyronine determinations (the latter in case of symptoms of hyperthyroidism) are aimed at identifying the few hyperthyroid patients, for whom the next step should be scintiscan. Hyperthyroid patients usually disclose an increased uptake, and a diagnosis of toxic adenoma is commonly made. Cases with normal thyroid function or hypothyroidism (which is usually subclinical) should be evaluated by fine-needle aspiration biopsy (FNAB). In eu/hypo-thyroid patients, scintiscan provides poor diagnostic information and should not be routinely employed. Thyroid ultrasonography is used to select cases for FNAB. Although ultrasound cannot reliably discriminate between benign and malignant lesions, it does provide an index of suspicion. Sonographic features that increase the likelihood of malignancy are microcalcifications, lymph node alterations, nodule growth under levothyroxine treatment, and increased intranodular vascularization demonstrated by color Doppler. There is growing evidence that elastography may provide further information on nodule characteristics. FNAB is indicated in all cases with a likelihood of malignancy. FNAB has a diagnostic accuracy of approximately 90% and is used in selection of patients which require surgery. Recently, histological markers and elastography have been introduced to increase the specificity of FNAB and ultrasound, respectively. The pitfall in FNAB cytology is the follicular cytology, in which it is not possible to distinguish between adenoma and carcinoma and therefore thyroidectomy is advised.
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Affiliation(s)
- Andrea Corrias
- Department of Pediatric Endocrinology and Diabetology, University of Torino, Regina Margherita Children's Hospital, Torino, Italy.
| | - Alessandro Mussa
- University of Torino, Regina Margherita Children’s Hospital, Department of Pediatric Endocrinology and Diabetology, Torino, Italy
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Abstract
BACKGROUND Thyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules. However, it has limitations among which is the incidence of non-diagnostic results (Thy1). Management of cases with repeatedly non-diagnostic FNAC ranges from simple observation to surgical intervention. We aim to evaluate the incidence of malignancy in non-diagnostic FNAC, and the success rate of repeated FNAC. We also aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC. MATERIALS AND METHODS Retrospective analyses of consecutive cases with thyroid non diagnostic FNAC results were included. RESULTS Out of total 1657 thyroid FNAC done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt. On repeating those, the rate of a non-diagnostic result on second FNAC was 61.8% and on third FNAC was 47.2%. The overall malignancy rate in Thy1 FNAC was 4.5% (42% papillary, 42% follicular and 8% anaplastic), and the yield of malignancy decreased considerably with successive non-diagnostic FNAC. Ultrasound guidance by an experienced head neck radiologist produced the lowest non-diagnostic rate (38%) on repetition compared to US guidance by a generalist radiologist (65%) and by non US guidance (90%). CONCLUSIONS There is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule. The yield of malignancy decreased considerably with successive non-diagnostic FNAC.
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Singh S, Singh A, Khanna AK. Thyroid incidentaloma. Indian J Surg Oncol 2012; 3:173-81. [PMID: 23997505 PMCID: PMC3444577 DOI: 10.1007/s13193-011-0098-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 10/24/2011] [Indexed: 11/28/2022] Open
Abstract
Because of emerging investigation modalities many of the thyroid lesions are picked up and that poses a big dilemma about management of such lesions. Majority of these lesions especially in iodine-deficient regions, are not significant and may be only followed up without any active treatment but, sometimes the small lesions may be microcarcinoma. This article discusses about the reliability of clinical examination of neck for detection of such lesions, the controversy of such lesion being benign or malignant, and how to evaluate these lesions and the recommendation as per American Thyroid Association guidelines.
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Affiliation(s)
- Seema Singh
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Anutosh Singh
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - A. K. Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
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Roy R, Kouniavsky G, Schneider E, Allendorf JD, Chabot JA, Logerfo P, Dackiw APB, Colombani P, Zeiger MA, Lee JA. Predictive factors of malignancy in pediatric thyroid nodules. Surgery 2012; 150:1228-33. [PMID: 22136845 DOI: 10.1016/j.surg.2011.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 09/15/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Studies suggest that while most pediatric thyroid nodules are benign, there is a higher rate of malignancy than in adults. We investigate clinical factors that may predict malignancy in pediatric thyroid nodules. METHODS A retrospective review of 207 pediatric thyroidectomies was conducted over 15 years at 2 tertiary hospitals. Analyses examined predictive values of 16 clinicopathologic factors associated with cancer. Positive predictive values (PPVs) of fine-needle aspiration biopsy specimens (FNABs) were analyzed independently. RESULTS Malignancy occurred in 41% of patients. After excluding missing data, malignancy was more likely with family history of thyroid cancer (34.2% vs 17.7%; P = .111), palpable lymphadenopathy (34.2% vs 2.9%; P = .001), and hypoechoic nodules (52.2% vs 19.2%; P = .016). Palpable lymphadenopathy indicated greater than 2-fold increased risk for malignancy (relative risk, 2.18; 95% confidence interval, 1.56-3.05). PPVs of FNAB results were 0.94 for malignancy, 0.63 for suspicious for malignancy, and 0.55 for indeterminate lesions. PPV for benign FNAB to be benign on final pathology was 0.71. CONCLUSION While malignancy is associated with family history of thyroid cancer and hypoechoic lesions, palpable lymphadenopathy had the greatest risk. When compared to adults, a benign FNAB in children is not as accurate and the likelihood that an indeterminate nodule is cancer is greater.
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Affiliation(s)
- Rashmi Roy
- Endocrine Surgery Section, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Rivkees SA, Mazzaferri EL, Verburg FA, Reiners C, Luster M, Breuer CK, Dinauer CA, Udelsman R. The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy. Endocr Rev 2011; 32:798-826. [PMID: 21880704 PMCID: PMC3591676 DOI: 10.1210/er.2011-0011] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pediatric thyroid cancer is a rare disease with an excellent prognosis. Compared with adults, epithelial-derived differentiated thyroid cancer (DTC), which includes papillary and follicular thyroid cancer, presents at more advanced stages in children and is associated with higher rates of recurrence. Because of its uncommon occurrence, randomized trials have not been applied to test best-care options in children. Even in adults that have a 10-fold or higher incidence of thyroid cancer than children, few prospective trials have been executed to compare treatment approaches. We recognize that treatment recommendations have changed over the past few decades and will continue to do so. Respecting the aggressiveness of pediatric thyroid cancer, high recurrence rates, and the problems associated with decades of long-term follow-up, a premium should be placed on treatments that minimize risk of recurrence and the adverse effects of treatments and facilitate follow-up. We recommend that total thyroidectomy and central compartment lymph node dissection is the surgical procedure of choice for children with DTC if it can be performed by a high-volume thyroid surgeon. We recommend radioactive iodine therapy for remnant ablation or residual disease for most children with DTC. We recommend long-term follow-up because disease can recur decades after initial diagnosis and therapy. Considering the complexity of DTC management and the potential complications associated with therapy, it is essential that pediatric DTC be managed by physicians with expertise in this area.
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Affiliation(s)
- Scott A Rivkees
- Department of Pediatrics, Yale Child Health Research Center, Yale University School of Medicine, 464 Congress Avenue, Room 237, New Haven, Connecticut 06520, USA.
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Thyroid Nodules in Children: A Single Institution's Experience. JOURNAL OF ONCOLOGY 2011; 2011:974125. [PMID: 22007213 PMCID: PMC3189595 DOI: 10.1155/2011/974125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/11/2011] [Accepted: 08/13/2011] [Indexed: 11/21/2022]
Abstract
Thyroid nodules in children are uncommon but often present an increased risk of malignancy in comparison to their adult counterpart. Multiple diagnostic modalities are frequently employed to characterize these nodules including ultrasound, radionuclide scans, fine needle aspiration (FNA), thyroid function tests, and evaluation of patient demographics. We chose to evaluate if any of these modalities influence treatment or signify a tendency for a nodule to represent a malignant lesion. A retrospective review of patients <21 years of age who underwent partial or total thyroidectomy from 2004 to 2009 was performed (IRB no. 4695). Other than an FNA indicating a malignancy, there does not appear to be any value to extensive preoperative imaging, nor can patient risk be stratified based upon age. We conclude that there is minimal utility in an extensive preoperative workup in a child with a thyroid nodule.
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Wémeau JL, Sadoul JL, d'Herbomez M, Monpeyssen H, Tramalloni J, Leteurtre E, Borson-Chazot F, Caron P, Carnaille B, Léger J, Do C, Klein M, Raingeard I, Desailloud R, Leenhardt L. Guidelines of the French society of endocrinology for the management of thyroid nodules. ANNALES D'ENDOCRINOLOGIE 2011; 72:251-281. [PMID: 21782154 DOI: 10.1016/j.ando.2011.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 01/21/2023]
Abstract
The present document is a follow-up of the clinical practice guidelines of the French Society of Endocrinology, which were established for the use of its members and made available to scientific communities and physicians. Based on a critical analysis of data from the literature, consensuses and guidelines that have already been published internationally, it constitutes an update of the report on the diagnostic management of thyroid nodules that was proposed in France, in 1995, under the auspices of the French National Agency for Medical Evaluation (l'Agence nationale d'évaluation médicale). The current guidelines were deliberated beforehand by a number of physicians that are recognised for their expertise on the subject, coming from the specialities of endocrinology (the French Thyroid Research Group) and surgery (the French Association for Endocrine Surgery), as well as representatives from the fields of biology, ultrasonography, cytology and nuclear medicine. The guidelines were presented and submitted for the opinion of the members of the Society at its annual conference, which was held in Nice from 7-10 October 2009. The amended document was posted on the website of the Society and benefited from additional remarks of its members. The final version that is presented here was not subjected to methodological validation. It does not claim to be universal in its scope and will need to be revised in concert with progress made in technical and developmental concepts. It constitutes a document that the Society deems useful for distribution concerning the management of thyroid nodules, which is current, efficient and cost effective.
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Affiliation(s)
- J-L Wémeau
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France.
| | - J-L Sadoul
- Endocrinologie, hôpital de l'Archet, CHU 06202 Nice cedex, France
| | - M d'Herbomez
- Département de médecine nucléaire, centre de biologie pathologie, centre hospitalier régional, 59037 Lille cedex, France
| | - H Monpeyssen
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - J Tramalloni
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - E Leteurtre
- Inserm U560, service d'anatomie pathologique, CHRU de Lille, Lille, France
| | - F Borson-Chazot
- Hôpital Louis-Pradel, CHU des hospices civils de Lyon, 28, avenue Doyen-Lépine, 69500 Bron, France
| | - P Caron
- CHU Larrey, avenue du Jean-Poulhès, 31400 Toulouse, France
| | - B Carnaille
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - J Léger
- Service d'endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - C Do
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - M Klein
- Service d'endocrinologie, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - I Raingeard
- Service des maladies métaboliques et endrocriennes, hôpital Lapeyronie, 34295 Montpellier cedex 5, France
| | - R Desailloud
- Service d'endocrinologie, diabétologie et nutrition, hôpital Sud, CHU d'Amiens, avenue René-Laënnec, 80054 Amiens, France
| | - L Leenhardt
- Service de médecine nucléaire, hôpital Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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45
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Nodules thyroïdiens chez l’enfant. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and EuropeanThyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 2010; 16 Suppl 1:1-43. [PMID: 20497938 DOI: 10.4158/10024.gl] [Citation(s) in RCA: 362] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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47
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Bargren AE, Meyer-Rochow GY, Sywak MS, Delbridge LW, Chen H, Sidhu SB. Diagnostic utility of fine-needle aspiration cytology in pediatric differentiated thyroid cancer. World J Surg 2010; 34:1254-60. [PMID: 20091309 DOI: 10.1007/s00268-010-0391-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pediatric patients present with thyroid nodules less often than adults, but the rate of malignancy is much higher. This study was designed to determine the ability of fine-needle aspiration cytology (FNA) to diagnose accurately and facilitate management of thyroid neoplasms in pediatric patients. METHODS A retrospective study revealed 110 patients <19 years old who had undergone thyroid surgery and FNA biopsy at two academic institutions over the last 28 years. FNA sensitivity for diagnosing papillary thyroid cancer (PC) and follicular neoplasm (FN) was investigated. RESULTS Of 110 patients who presented for surgery, 27 had PC and 33 had a FN: 4 follicular carcinomas (FCs) and 29 follicular adenomas (FAs). Among the PCs patients, the FNA results were as follows: 1 (4%) nondiagnostic, 6 (22%) atypical, 2 (7%) benign, and 18 (67%) malignant lesions. The sensitivity of a malignant FNA was 90% for diagnosing a PC. Sensitivity of an atypical FNA was 75% for FCs and 69% for FAs, giving an overall FN sensitivity of 70%. Of the atypical FNA readings, 60% had confirmed histological atypical features, and 19% were malignant. In 95% of the malignant FNA reports, final histology confirmed PC, resulting in a positive predictive value of 95%. CONCLUSIONS FNA biopsy can reliably diagnose malignancy in pediatric thyroid patients and should be used as a standard technique to indicate surgical treatment. Atypical or suspicious FNA results do not predict cancer effectively, confirming the current accepted practice for adults that diagnostic excision is required to exclude malignancy in pediatric patients.
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Affiliation(s)
- Anna E Bargren
- Section of Endocrine Surgery, Department of Surgery, H4/722 Clinical Science Center, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA.
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Altıncık A, Demir K, Abacı A, Böber E, Büyükgebiz A. Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood. J Clin Res Pediatr Endocrinol 2010; 2:78-80. [PMID: 21274343 PMCID: PMC3005668 DOI: 10.4274/jcrpe.v2i2.78] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 05/10/2010] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To assess the role of fine-needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules. METHODS Results of 30 FNABs performed in our clinic were retrospectively reviewed. Clinical and surgical follow-up data were obtained from the patient files, and clinical correlation and accuracy of FNAB were evaluated. RESULTS The results of 30 FNABs were reported as benign in 24 (80%), insufficient in 4 (13.3%) patients, malignant in 1 (3.3%), and suspicious in 1 (3.3%) patient. One patient with a FNAB result of malignancy underwent surgery and the histological diagnosis was papillary carcinoma. FNAB was repeated in two of the insufficient biopsies, and reported as benign; in one of these patients, the thyroid nodule disappeared and in one, remained stable at clinical follow-up. Four of the patients with benign FNAB results underwent surgery at clinical follow-up because of an increase in the size of the nodules and one patient was found to have papillary carcinoma. The remaining patients were clinically followed. In this study, the malignancy prevalence was 6.6% in patients with thyroid nodules. There was only one false-negative case. CONCLUSION FNAB is a reliable diagnostic tool in the management of pediatric thyroid nodules.
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Affiliation(s)
- Ayça Altıncık
- Dokuz Eylül University Faculty of Medicine, Pediatric Endocrinology, İzmir, Turkey.
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Pediatric Endocrinology, İzmir, Turkey
| | - Ayhan Abacı
- Keçiören Training and Research Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Pediatric Endocrinology, İzmir, Turkey
| | - Atilla Büyükgebiz
- Bilim University Faculty of Medicine, Pediatric Endocrinology, İstanbul, Turkey
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Snyder EM, Nicol KK, Buchan A, Coley BD. Synchronous presentation of Hashimoto thyroiditis and papillary thyroid carcinoma in a 7-year-old girl. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1007-1010. [PMID: 20498477 DOI: 10.7863/jum.2010.29.6.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Emma M Snyder
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH 43205, USA
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50
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Camargo R, Corigliano S, Friguglietti C, Gauna A, Harach R, Munizaga F, Niepomniszcze H, Pitoia F, Pretell E, Vaisman M, Ward LS, Wohllk N, Tomimori E. Latin American Thyroid Society recommendations for the management of thyroid nodules. ACTA ACUST UNITED AC 2009; 53:1167-75. [DOI: 10.1590/s0004-27302009000900014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 10/10/2009] [Indexed: 01/08/2023]
Abstract
Several guidelines on diagnosis and treatment of thyroid nodules and cancer have recently been published. However, recommended practices are not always appropriate to different settings or countries. The aim of this consensus was to develop Clinical Guidelines for evaluation and management of patients with thyroid nodules applicable to Latin American countries. The panel was composed by 13 members of the Latin American Thyroid Society involved with research and management of thyroid nodules and cancer from different medical centers in Latin America. The consensus was produced based on the expert opinion of the panel with use of principles of evidence-based medicine. Following a group meeting, a first draft based on the expert opinion of the panel was elaborated and later circulated among panel members for further revision. After revision, this document was submitted to all LATS members for commentaries and considerations and finally revised and refined by the authors. The final recommendations represent state of the art on management of thyroid nodules applied to all Latin American countries.
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