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. 2024 Mar 20:15:1350123.
doi: 10.3389/fendo.2024.1350123. eCollection 2024.

Comparison of ultrasound risk stratification systems for pediatric thyroid nodules

Jing Yu  1 , Yiyang Cui  1 , Chao Fu  1 , Xiao Ma  1 , Caifeng Si  1 , Yuanjing Huang  1 , Kefei Cui  1 , Yan Zhang  1
Affiliations

Comparison of ultrasound risk stratification systems for pediatric thyroid nodules

Jing Yu et al. Front Endocrinol (Lausanne). .

Abstract

Background: There is currently insufficient data to validate adult-based US risk stratification systems (RSSs) for the identification of malignant thyroid nodules in a pediatric population.

Methods: From October 2016 and May 2023, 173 thyroid nodules of pediatric patients (age ≤ 18 years) with definitive pathology results and ultrasound (US) examination within 1 month before surgery or fine-needle aspiration (FNA) biopsy in our institution were enrolled in this study. The clinical and US characteristics of these nodules were retrospectively reviewed and categorized according to the ACR-TIRADS, C-TIRADS, and ATA guidelines. The diagnostic performance of US-based FNA criteria (original and simulating) of the three guidelines in thyroid cancer detection was estimated.

Results: The three RSSs had similar AUC according to the categories(0.849-0.852, all P > 0.05). When combined with the original FNA criteria of the three RSSs to manage the nodules, the FNA rate of ACR-TIRADS and C-TIRADS were significantly less than ATA guidelines (53.18% vs. 64.63%, P < 0.05, and 52.60% vs. 64.63%, P < 0.05). The missed malignancy rate (MMR) and unnecessary FNA rate (UFR) of ATA guidelines (50.00%, 35.85%) was highest among the three RSSs, followed by the C-TIRADS (37.80%, 19.57%) and the ACR-TIRADS (37.04%, 19.57%). When nodules < 1 cm with the highest category in each RSS biopsied, that is when using the simulating FNA thresholds, the MMR was reduced overall (all P < 0.001), without a change in the UFR (all P > 0.05). All the three RSSs showed a substantial improvement in accuracy and malignant detection rate (all P < 0.05).

Conclusion: The ACR-TIRADS, C-TIRADS, and ATA guidelines showed high missed malignancy rates when using their original recommended FNA criteria. When nodules < 1 cm with the highest category in each RSS biopsied, the missed malignancy rate of each RSS was decreased. Decreasing the FNA thresholds for highly suspicious malignant nodules may therefore be an effective means of managing malignant thyroid nodules in pediatric patients.

Keywords: American Thyroid Association guidelines (ATA guidelines); Chinese Thyroid Imaging Reporting and Data System (C-TIRADS); Thyroid Imaging Reporting and Data System of the American College of Radiology (ACR-TIRADS); fine needle aspiration (FNA); pediatric; risk stratification system (RSS); thyroid nodule; ultrasound (US).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
ROC curves of the ACR-TIRADS, C-TIRADS, and ATA guidelines. ACR-TIRADS, Thyroid Imaging Reporting and Data System of the American College of Radiology; C-TIRADS, Chinese Thyroid Imaging Reporting and Data System; ATA, American Thyroid Association guidelines; ROC, receiver operating characteristic; AUC, area under the ROC curve.
See this image and copyright information in PMC

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