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Risk of malignancy in thyroid nodules in children and adolescents, based on the result of a fine-needle aspirate

Risk of malignancy in thyroid nodules in children and adolescents, based on the result of a fine-needle aspirate
Overall average percent range of subjects with malignancy* Number of subjects Subjects with histology confirmed Nondiagnostic
(Category I)		 Benign
(Category II)		 AUS/FLUS
(Category III)		 Follicular neoplasm
(Category IV)		 Suspicious for malignancy
(Category V)		 Malignant
(Category VI)
Pediatric – – 5 to 11% 0 to 3% 30 to 45% 30 to 70% 70 to 85% 95 to 99%
Adult[1] – – 5 to 10% 0 to 3% 6 to 18% 10 to 40% 45 to 60% 95 to 96%
Individual pediatric studies:
Monaco et al[2] 179 96 0% 7% 28% 58% 100% 100%
Gupta et al[3] 136 64 8% 2% 40% 100% 40% 100%
Lale et al[4] 282 78 17% 0% 50% 47% 100% 100%
Norlen et al[5] 66 39 0% 0% 22% 100% 100% 100%
Buryk et al[6] 76 36 0% 10% 0% 50% 86% 100%
Amirazodi et al[7] 207 65 0% 16% 67% – 71% 100%
Cherella et al[8] 430 190 30% 3% 54% 71% 76% 100%
Heider et al[9] 46 41 – – 36% 20% 100% –
Vuong et al[10] 1217 300 30% 9% 67% 36% 100% 99%
AUS: atypia of undetermined significance; FLUS: follicular lesion of undetermined significance; BSRTC: Bethesda System for Reporting Thyroid Cytopathology; NIFTP: noninvasive follicular thyroid neoplasm with papillary-like nuclear features.
* Overall percent of patients in each histologic category for their fine-needle aspirate (based on categories defined by BSRTC[1]) who were ultimately diagnosed with a thyroid malignancy. Adult figures exclude patients with NIFTP, which has indolent behavior and is no longer classified as a malignancy. NIFTP appears to be rare in pediatric patients. Note that pediatric studies report malignancy rates only among nodules with histologic confirmation. This approach overestimates malignancy rate among nodules in lower cytological categories (nondiagnostic, benign, AUS/FLUS) due to detection bias, since resection is more likely to be performed in nodules judged to be malignant for other reasons.
References:
  1. Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2017; 27:1341.
  2. Monaco SE, Pantanowitz L, Khalbuss WE, et al. Cytomorphological and molecular genetic findings in pediatric thyroid fine-needle aspiration. Cancer Cytopathol 2012; 120:342.
  3. Gupta A, Ly S, Castroneves LA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab 2013; 98:3238.
  4. Lale SA, Morgenstern NN, Chiara S, Wasserman P. Fine needle aspiration of thyroid nodules in the pediatric population: a 12-year cyto-histological correlation experience at North Shore-Long Island Jewish Health System. Diagn Cytopathol 2015; 43:598.
  5. Norlen O, Charlton A, Sarkis LM, et al. Risk of malignancy for each Bethesda class in pediatric thyroid nodules. J Pediatr Surg 2015; 50:1147.
  6. Buryk MA, Simons JP, Picarsic J, et al. Can malignant thyroid nodules be distinguished from benign thyroid nodules in children and adolescents by clinical characteristics? A review of 89 pediatric patients with thyroid nodules. Thyroid 2015; 25:392.
  7. Amirazodi E, Propst EJ, Chung CT, et al. Pediatric thyroid FNA biopsy: outcomes and impact on management over 24 years at a tertiary care center. Cancer Cytopathol 2016; 124:801.
  8. Cherella CE, Angell TE, Richman DM, et al. Differences in thyroid nodule cytology and malignancy risk between children and adults. Thyroid 2019; 29:1097.
  9. Heider A, Arnold S, Lew M, et al. Malignant risk of indeterminate pediatric thyroid nodules – an institutional experience. Diagn Cytopathol 2019; 47:993.
  10. Vuong HG, Suzuki A, Na HY, et al. Application of the Bethesda System for Reporting Thyroid Cytopathology in the Pediatric Population. Am J Clin Pathol 2020; aqaa182.
From: Bauer AJ. Thyroid nodules in children and adolescents. Curr Opin Endocrinol Diabetes Obes 2019; 26:266. DOI: 10.1097/MED.0000000000000495. Copyright © 2019. Adapted with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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