Incidence and malignancy rates of indeterminate pediatric thyroid nodules

We investigated the malignancy rates based on histologic follow-up in the indeterminate and ­malignant

Huiying Wang


Scholarcy highlights

  • Thyroid nodules are uncommon in children, with a reported incidence of 1% to 2%,1,2 the prevalence of pediatric thyroid cancer has significantly increased in the last decade. Most pediatric thyroid nodules are benign, but the reported risk of malignancy is as high as 22% to 26% compared with only 5% in adults. The most common thyroid cancer in children is papillary thyroid carcinoma.Compared with PTC in adults, childhood PTC is more likely to have regional lymph node involvement, higher tumor stage, and more frequent metastasis to distant sites, yet children have a better long-term prognosis. This phenotype potentially may be attributable to the characteristically higher prevalence of the rearranged in transformation/PTC gene rearrangement
  • The study cohort included 302 thyroid fineneedle aspiration obtained between May 2001 and April 2018
  • The average risk of malignancy based on histologic follow-up alone for different Bethesda System categories was calculated by combining data from 6 major pediatric series with results from the current study
  • Because thyroid cancer in children is uncommon, the data are limited for the pediatric population upon which to base this endorsement
  • The average combined percentage of AUS/FLUS and follicular neoplasm/suspicious for a follicular neoplasm among all series is only 19%, which is much lower than previously reported by the American Thyroid Association
  • Children with thyroid nodules diagnosed as AUS/FLUS or FN/SFN may benefit from molecular testing and serial FNA
  • Molecular testing on fineneedle aspiration material has been well established in adult practice, and its role in pediatric nodules appears to be promising but remains to be refined by more studies, given differences in the underlying molecular changes between pediatric and adult PTCs. With the current trend in overdiagnosis and overtreatment of indolent thyroid cancers in adults, it may be prudent to assess our diagnostic and management protocols further in the pediatric population

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