Diagnostic Performance of Five Adult-based US Risk Stratification Systems in Pediatric Thyroid Nodules

Abstract

Background The validation of adult-based US risk stratification systems (RSSs) in the discrimination of malignant thyroid nodules in a pediatric population remains lacking.

Purpose To estimate and compare the diagnostic performance of pediatric US RSSs based on five adult-based RSSs in the discrimination of malignant thyroid nodules in a pediatric sample.

Materials and methods Pediatric patients (age ≤18 years) with histopathologically confirmed US-detected thyroid nodules at a tertiary referral hospital between January 2000 and April 2020 were analyzed retrospectively. The diagnostic performance of US-based fine-needle aspiration biopsy (FNAB) criteria in thyroid cancer detection was estimated. The following sensitivity analyses were performed: (a) scenario 1: nodules smaller than 1 cm, with the highest category additionally biopsied; (b) scenario 2, application of American College of Radiology Thyroid Imaging Reporting and Data System nodule size cutoffs to other RSSs; (c) scenario 3, scenarios 1 and 2 together. Generalized estimating equations (GEEs) were used for estimation.

Results A total of 277 thyroid nodules in 221 pediatric patients (median age, 16 years [interquartile range {IQR}, 13–17]; 172 female; 152 of 277 patients [55%] malignant) were analyzed. The GEE-estimated sensitivity and specificity ranged from 70% to 78% (104 to 119 of 152 patients, based on each reader’s interpretation) and from 42% to 78% (49 of 124 patients to 103 of 125 patients). In scenario 1, the missed malignancy rate was reduced from 32%–38% (41 of 134 patients to 34 of 83 patients) to 15%–21% (eight of 59 patients to 28 of 127 patients). In scenario 2, the unnecessary biopsy rate was reduced from 35%–39% (60 of 176 patients to 68 of 175 patients) to 20%–34% (18 of 109 patients to 62 of 179 patients). The highest accuracy was noted in scenario 3 (range, 71%–81%; 199 of 277 patients to 216 of 262 patients).

Conclusion The diagnostic performances of the fine-needle aspiration biopsy criteria of five adult-based risk stratification systems were acceptable in the pediatric population and were improved by applying the American College of Radiology Thyroid Imaging Reporting and Data System size cutoff for nodules 1 cm or larger and allowing biopsy of the highest category nodules smaller than 1 cm.