Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children's Hospital and a Comprehensive Review of the Pediatric Literature.
Simple Summary: Children are not little adults, when it comes to many things, especially in medicine. Sometimes, a new radiology or pathology test is developed for use in adults, and only later are pediatric applications considered—perhaps the disease being tested for is more common in adults. In th...
| Published in: | Cancers Vol. 15; no. 15; pp. 3975 - 4008 |
|---|---|
| Main Authors: | , , , , , |
| Format: | diagnostic images pictorial research tables/charts Journal Article |
| Published: |
MDPI
Aug2023
|
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=169928390&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 169928390 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20726694 B74B jtl: Cancers issn: 20726694 maglogo: N pubinfo: dt: Aug2023 vid: 15 iid: 15 pid: 97109 pub: MDPI artinfo: ui: 169928390 169928390 169928390 10.3390/cancers15153975 169928390 ppf: 3975 ppct: 33 formats: tig: atl: Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children's Hospital and a Comprehensive Review of the Pediatric Literature. aug: au: Hess, Jennifer R. Van Tassel, Dane C. Runyan, Charles E. Morrison, Zachary Walsh, Alexandra M. Schafernak, Kristian T. affil: Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ 85016, USA sug: subj: Hospitals, Pediatric Thyroid Gland Pathology Thyroid Neoplasms Risk Factors Risk Assessment Methods Prediction Models Evaluation Thyroid Neoplasms Classification Childhood Neoplasms Human Child Adolescence Cytodiagnosis Retrospective Design Record Review Biopsy, Needle Neoplasm Grading Descriptive Statistics Child: 6-12 years Adolescent: 13-18 years ab: Simple Summary: Children are not little adults, when it comes to many things, especially in medicine. Sometimes, a new radiology or pathology test is developed for use in adults, and only later are pediatric applications considered—perhaps the disease being tested for is more common in adults. In this study, we aim to understand differences between adults and children when it comes to how we test for thyroid cancer. Thyroid nodules are much more common in adults, but they are much more likely to be malignant in children. Ultrasound is typically the first test when a patient has a thyroid nodule, and radiologists have developed risk stratification systems to try and determine who can be safely followed clinically and with repeat ultrasound, versus those who need to proceed to a second test, fine-needle aspiration biopsy, in which cells are removed from the thyroid and examined under a microscope, sometimes with molecular testing. While thyroid nodules are less common in children than in adults, they are more frequently malignant. However, pediatric data are scarce regarding the performance characteristics of imaging and cytopathology classification systems validated to predict the risk of malignancy (ROM) in adults and select those patients who require fine-needle aspiration (FNA) and possibly surgical resection. We retrospectively reviewed the electronic medical records of all patients 18 years of age or younger who underwent thyroid FNA at our institution from 1 July 2015 to 31 May 2022. Based on surgical follow-up from 74 of the 208 FNA cases, we determined the ROM for the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) ultrasound risk stratification system and The Bethesda System for Reporting Thyroid Cytopathology and added our results to those of pediatric cohorts from other institutions already published in the literature. We found the following ROMs for 1458 cases using ACR TI-RADS (TR): TR1. Benign: 2.2%, TR2. Not Suspicious: 9.3%, TR3. Mildly Suspicious: 16.6%, TR4. Moderately Suspicious: 27.0%, and TR5. Highly Suspicious 76.5%; and for 5911 cases using the Bethesda system: Bethesda I. Unsatisfactory: 16.8%, Bethesda II. Benign: 7.2%, Bethesda III: Atypia of Undetermined Significance: 29.6%, Bethesda IV. Follicular Neoplasm: 42.3%, Bethesda V. Suspicious for Malignancy: 90.8%, and Bethesda VI. Malignant: 98.8%. We conclude that ACR TI-RADS levels imply higher ROMs for the pediatric population than the corresponding suggested ROMs for adults, and, in order to avoid missing malignancies, we should consider modifying or altogether abandoning size cutoffs for recommending FNA in children and adolescents whose thyroid glands are smaller than those of adults. The Bethesda categories also imply higher ROMs for pediatric patients compared to adults. pubtype: Academic Journal doctype: diagnostic images pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|