Risk Stratification of Pediatric Thyroid Nodules Using Adult Thyroid Nodule Scoring Systems:American Thyroid Association and American College of Radiology Thyroid Imaging Reporting and Data System.
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OBJECTIVE: To evaluate the performance of the American Thyroid Association (ATA) and the American College of Radiology Thyroid Imaging and Reporting Data System (ACR TIRADS) in pediatrics. METHODS: Retrospective review, patients aged ≤18 years with thyroid nodules from 2002 to 2022. Patients with no available ultrasound images or pathology results were excluded. Each neck ultrasound was independently and blindly reviewed and scored using ATA and TIRADS by 2 study radiologists; discordant scores were arbitrated by a third radiologist. Thyroid nodules that did not undergo surgical resection were considered benign if their size was stable and/or if repeat fine needle aspiration (FNA) was again benign. The performance of each system was calculated. Sensitivity analyses were performed to determine the optimal size cut-off for FNA biopsy while maintaining sensitivity equivalent to adults. RESULTS: Seventy-seven patients (median age, 15 years [range 2-18 years]; 71.4% women) with 115 thyroid nodules. Malignancy rate was 27.8%. Using adult size cut-offs for FNA, ATA, and TIRADS would have failed to recommend biopsy in 11 of 32 and 15 of 32 malignant nodules, respectively (sensitivity 66%, specificity 55%, vs 53%, 87%, respectively). In our sensitivity analysis, the optimal size cut-offs for ATA were 2 cm for very low risk, 1 cm for low risk, and 0.5 cm for intermediate and high-risk categories (sensitivity 94% and specificity 33%). For TIRADS were 3 cm for TIRADS-2, 0.8 cm for TIRADS-3 and TIRADS-4, and 0.5 cm for TIRADS-5 (sensitivity 91% and specificity 59%). CONCLUSION: ATA and TIRADS have low sensitivity in pediatrics. Lowering the size cut-offs for FNA increases sensitivity to >90%.