Utility of thyroid nodule to thyroid lobe volume ratio to measure fine needle aspiration cytologic malignancy risk of thyroid nodules in the pediatric population.
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INTRODUCTION: Pediatric thyroid cancer incidence is rising, but ultrasound (US) surveillance and biopsy thresholds remain highly debated due to multiple practice guidelines and limited supporting evidence. OBJECTIVE: To evaluate thyroid nodule to lobe (NL) volume ratios across ultrasound-guided fine-needle aspiration (FNA) biopsy status, pathology, and TI-RADS recommendation criteria. METHODS: After IRB approval, we retrospectively reviewed patients less than 21 years old who underwent thyroid US and FNA at a single institution (Figure 1). Nodule volume was divided by lobe volume to yield the volume ratio. Two-sample Wilcoxon rank-sum (Mann-Whitney) tests evaluated the ratio by biopsy status, Bethesda classification (BC), and TI-RADS criteria recommendation (Figure 2). RESULTS: Among 122 patients, 92 (75.4%) were female and 30 (24.6%) were male; 379 nodules met the criteria for US review. The median NL ratio for the biopsy group was higher than the no biopsy group [0.14 (IQR: 0.04,0.38) vs 0.03 (IQR: 0.01,0.07); p < 0.0001]. When evaluating the BC to the NL ratio, there were 114 individuals with 323 eligible nodules. The median NL ratio was higher in the malignant group compared to the not malignant group [0.26 (IQR: 0.11,0.50) vs 0.12 (IQR: 0.04,0.34); p = 0.0032]. Additionally, the median NL ratio was greater for the TI-RADS biopsy recommended group compared to no TI-RADS biopsy recommended group [0.34 (IQR: 0.17,0.57) vs 0.05 (IQR: 0.03,0.12); p < 0.001]. CONCLUSION: We found significantly greater NL ratios in pediatric patients with malignant thyroid FNAs. Higher NL ratios were found for individuals meeting criteria for biopsy based on TI-RADS. Further investigation is warranted to assess the NL ratio as an objective adjunct for determining pediatric thyroid nodule biopsy thresholds and optimizing US-based surveillance in the pediatric population.