Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
APSA 2024 Abstract Book
Abstract
Abstract: Purpose: Thyroid nodules are uncommon in children and adolescents but carry an increased risk of malignancy when present. The Thyroid Imaging Reporting and Data System (TI-RADS) is an adult-validated ultrasound-based risk assessment providing a prediction of malignant potential for thyroid nodules, thereby guiding recommendations for fine needle aspiration biopsy (FNAB). Minimal data exist regarding the applicability of TI-RADS to predict malignancy in pediatric thyroid nodules. This study aims to analyze the performance of TI-RADS for children and adolescents with thyroid nodules, hypothesizing that applying TI-RADS criteria would improve accuracy and reduce the number of recommended FNAB compared to American Thyroid Association (ATA) size criteria alone. Methods: A multi-institutional retrospective analysis was conducted including patients < 21 years with a thyroid nodule by sonographic thyroid imaging between 2015-2020. TI-RADS scores were assigned at each institution by a pediatric radiologist trained in thyroid imaging and TI-RADS criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of TIRADS scoring was compared to existing ATA size-based recommendation for performing a FNAB. Accounting for relative size differences between adults and children, a novel PED TI-RADS category was developed and tested, recommending FNAB for thyroid nodules with a TI-RADS 3 and >1.5cm, TI-RADS 4 and >1.0cm, and TI-RADS 5 any feasible size. Results: 292 nodules from 261 patients (median age 15.0 years, 78.8% female) were assessed using TIRADS. Applying adult TI-RADS criteria resulted in recommendation of FNAB for 34.9% of nodules, in contrast to 76.7% recommended by ATA guidelines (p< .0001) (Table). Utilizing the adult TI-RADS score ≥ 3 as an FNAB indicator resulted in 100% sensitivity and 28.5% specificity, with 0 cases of missed malignant nodules on pathology. When novel PED TI-RADS criteria were applied, 88 patients would have been spared an unnecessary FNAB with improved sensitivity and accuracy over ATA criteria. Conclusions: The application of adult and PED TI-RADS scoring to thyroid nodules in pediatric patients enhances the accuracy of malignancy prediction compared to current American Thyroid Association size criteria alone. The utilization of PED TI-RADS scoring eliminated unnecessary biopsies in many children while not missing a single thyroid malignancy.
First Page
43
Last Page
44
Recommended Citation
Srivatsa S, AL-Hadidi A, Stanek JR, Horvath K, Parsons LN, Martinez-Rios C, et al. [Nagar S, Masters SE, Al-Katib S, Tucker RB]. Assessing the diagnostic accuracy of TI-RADS in pediatric thyroid nodules: a multi-institutional review. In: American Pediatric Surgical Association Annual Meeting Abstract Book 2024 [Internet]. APSA 2024: 2024 May 15-19; Phoenix, AZ. East Dundee, IL: American Pediatric Surgical Association; 2024. p.43-44. Available from: https://apsapedsurg.org/wp-content/uploads/2024/05/APSA-Abstracts-Book.pdf
Comments
American Pediatric Surgical Association Annual Meeting, May 15-19, 2024, Phoenix, AZ