Malignancy Rates Higher in Children With Indeterminate Thyroid Nodules
Malignancy was more common in children with thyroid nodules classified as indeterminate by BSRTC criteria compared with adults.
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Thyroid nodules with indeterminate classification were more frequently positive for malignancy among children compared with adults, according to a study presented at the 88th Annual Meeting of the American Thyroid Association in Washington, D.C.1
Although thyroid nodules are less common among children, they are more likely to be malignant compared with adults. It is unknown, however, if the commonly used Bethesda System for Reporting Thyroid Cytopathology (BSRTC) for fine-needle aspiration (FNA) confers the same risk for malignancy between children and adults. The aim of this study was to evaluate the performance of FNA cytology among a cohort of children and adults.
The study evaluated malignancy rates of 430 and 13,415 consecutive pediatric and adult patients, respectively, with thyroid nodules undergoing FNA at Boston Children's Hospital or Brigham and Women's Hospital between 1998 and 2016. All samples were analyzed by Brigham and Women's Hospital cytopathologists using the BSRTC criteria.
There was no difference in malignancy rates between children and adults for those with nondiagnostic or benign cytology.
There was a trend toward a higher malignancy rate among children (52%) compared with adults (38%) who had atypical cells of undetermined significance (AUS; P = .12). However, when adults with AUS were classified as benign by a gene expression classifier, the malignancy rate was significantly higher among children with AUS (52%) compared with adults (30%; P = .02).
The malignancy rate was also significantly higher among children with follicular thyroid carcinoma cytology at 69% compared with 36% for adults (P = .02).
There was no difference in malignancy rates for cytology suspicious for papillary thyroid carcinoma or malignancy.
The authors concluded that these results suggest that there are differences in malignancy rates between children and adults within indeterminate BSRTC categories. They noted that “this finding likely reflects true differences in nodule biology rather than variation in cytological classification.”
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- Cherella CE, Angell TE, Richman DM, Cibas ES, Alexander EK, Wassner AJ. Malignancy rates of thyroid nodules differ between children and adults within indeterminate cytopathological categories. Presented at: the 88th Annual Meeting of the American Thyroid Association; Washington, D.C.: October 3-7, 2018. Abstract clinical oral 31.