Pediatric thyroid nodules: ultrasonographic characteristics and inter-observer variability in prediction of malignancy
-
Dror Koltin
,
Amanda Murphy
Abstract
Background: Pediatric thyroid nodules, while uncommon, have high malignancy risk. The objectives of the study were (1) to identify sonographic features predictive of malignancy; (2) to create a prediction model; and (3) to assess inter-observer agreement among radiologists.
Methods: All available cases of thyroid nodules, surgically removed between 2000 and 2009. Three radiologists reviewed the sonographic images; 2 pathologists reviewed the tissue specimens. Adult prediction models were applied. Interobserver variability was assessed.
Results: Twenty-seven subjects, mean age 13.1±3.4 years, were included. Nineteen nodules were differentiated thyroid carcinomas. On multivariate analysis, size was the only significant predictor of malignancy. On recursive partitioning analysis, size >35 mm with microcalcification and ill-defined margins yielded the best prediction model. Radiologist inter-observer agreement regarding malignancy was moderate (κ=0.50).
Conclusions: Larger size, microcalcifications and ill-defined margins on ultrasound demonstrate the best predictive model for malignancy in the pediatric population. Experienced pediatric radiologists demonstrate moderate inter-observer agreement in prediction of malignancy.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Roy R, Kouniavsky G, Schneider E, Allendorf JD, Chabot JA, et al. Predictive factors of malignancy in pediatric thyroid nodules. Surgery 2011;150:1228–33.10.1016/j.surg.2011.09.023Search in Google Scholar PubMed
2. Hayashida N, Imaizumi M, Shimura H, Okubo N, Asari Y, et al. Thyroid ultrasound findings in children from three Japanese prefectures: aomori, yamanashi and nagasaki. PloS One 2013;8:e83220.10.1371/journal.pone.0083220Search in Google Scholar PubMed PubMed Central
3. Hogan AR, Zhuge Y, Perez EA, Koniaris LG, Lew JI, et al. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surg Res 2009;156:167–72.10.1016/j.jss.2009.03.098Search in Google Scholar PubMed
4. Hung W. Solitary thyroid nodules in 93 children and adolescents. a 35-years experience. Horm Res 1999;52:15–8.10.1159/000023426Search in Google Scholar PubMed
5. Koike E, Noguchi S, Yamashita H, Murakami T, Ohshima A, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg 2001;136:334–7.10.1001/archsurg.136.3.334Search in Google Scholar PubMed
6. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002;87:1941–6.10.1210/jcem.87.5.8504Search in Google Scholar PubMed
7. Kang HW, No JH, Chung JH, Min Y-K, Lee M-S, et al. Prevalence, clinical and ultrasonographic characteristics of thyroid incidentalomas. Thyroid 2004;14:29–33.10.1089/105072504322783812Search in Google Scholar PubMed
8. Lin J-H, Chiang F-Y, Lee K-W, Ho K-Y, Kuo W-R. The role of neck ultrasonography in thyroid cancer. Am J Otolaryngol 2009;30:324–6.10.1016/j.amjoto.2008.07.003Search in Google Scholar PubMed
9. Wienke JR, Chong WK, Fielding JR, Zou KH, Mittelstaedt CA. Sonographic features of benign thyroid nodules: interobserver reliability and overlap with malignancy. J Ultrasound Med 2003;22:1027–31.10.7863/jum.2003.22.10.1027Search in Google Scholar PubMed
10. Choi SH, Kim E-K, Kwak JY, Kim MJ, Son EJ. Interobserver and intraobserver variations in ultrasound assessment of thyroid nodules. Thyroid 2010;20:167–72.10.1089/thy.2008.0354Search in Google Scholar PubMed
11. Park CS, Kim SH, Jung SL, Kang BJ, Kim JY, et al. Observer variability in the sonographic evaluation of thyroid nodules. J Clin Ultrasound 2010;38:287–93.10.1002/jcu.20689Search in Google Scholar PubMed
12. Iannuccilli JD, Cronan JJ, Monchik JM. Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med 2004;23:1455–64.10.7863/jum.2004.23.11.1455Search in Google Scholar PubMed
13. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005;237:794–800.10.1097/01.ruq.0000226877.19937.a1Search in Google Scholar PubMed
14. Domínguez JM, Baudrand R, Cerda J, Campusano C, Fardella C, et al. An ultrasound model to discriminate the risk of thyroid carcinoma. Acad Radiol 2011;18:242–5.10.1016/j.acra.2010.09.018Search in Google Scholar PubMed
15. Corrias A, Mussa A, Baronio F, Arrigo T, Salerno M, et al. Diagnostic features of thyroid nodules in pediatrics. Arch Pediatr Adolesc Med 2010;164:714–9.10.1001/archpediatrics.2010.114Search in Google Scholar PubMed
16. Saavedra J, Deladoëy J, Saint-Vil D, Boivin Y, Alos N, et al. Is ultrasonography useful in predicting thyroid cancer in children with thyroid nodules and apparently benign cytopathologic features? Horm Res Pædiatr 2011;75:269–75.10.1159/000322877Search in Google Scholar PubMed
17. Salmaslioğlu A, Erbil Y, Dural C, Işsever H, Kapran Y, et al. Predictive value of sonographic features in preoperative evaluation of malignant thyroid nodules in a multinodular goiter. World J Surg 2008;32:1948–54.10.1007/s00268-008-9600-2Search in Google Scholar PubMed
18. Goldfarb M, Gondek SS, Sanchez Y, Lew JI. Clinic-based ultrasound can predict malignancy in pediatric thyroid nodules. Thyroid 2012;22:827–31.10.1089/thy.2011.0494Search in Google Scholar PubMed
19. Gupta A, Ly S, Castroneves LA, Frates MC, Benson CB, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab 2013;98:3238–45.10.1210/jc.2013-1796Search in Google Scholar PubMed PubMed Central
20. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Hauger BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167–214.10.1089/thy.2009.0110Search in Google Scholar PubMed
21. Moon W-J, Baek JH, Jung SL, Kim DW, Kim EK, et al. Ultrasonography and the ultrasound-based management of thyroid nodules: consensus statement and recommendations. Korean J Radiol 2011;12:1–14.10.3348/kjr.2011.12.1.1Search in Google Scholar PubMed PubMed Central
22. Kamran SC, Marqusee E, Kim MI, Frates MC, Ritner J, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab 2013;98:564–70.10.1210/jc.2012-2968Search in Google Scholar PubMed
©2016 by De Gruyter
Articles in the same Issue
- Frontmatter
- Original Articles
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- Generic and disease-specific quality of life in adolescents with type 1 diabetes: comparison to age-matched healthy peers
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- Frequency of thyroid status monitoring in the first year of life and predictors for more frequent monitoring in infants with congenital hypothyroidism
- Biochemical, radiological, and genetic characterization of congenital hypothyroidism in Abu Dhabi, United Arab Emirates
- High prevalence of DUOX2 mutations in Japanese patients with permanent congenital hypothyroidism or transient hypothyroidism
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- Case Reports
- Sertoli cell only syndrome with ambiguous genitalia
- Childhood parathyroid adenoma: a rare but important cause of nephrolithiasis
- A unique case of growth hormone and human chorionic gonadotropin treatment in a 45,X male with Y: autosome translocation and literature review
- Propionic acidemia: a Turkish case report of a successful pregnancy, labor and lactation
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Articles in the same Issue
- Frontmatter
- Original Articles
- Translation and psychometric properties of the Persian version of self-management of type 1 diabetes for adolescents
- Generic and disease-specific quality of life in adolescents with type 1 diabetes: comparison to age-matched healthy peers
- Relationship between HOMA-IR and serum vitamin D in Chinese children and adolescents
- Low 25-hydroxyvitamin D level is not an independent risk factor for hepatosteatosis in obese children
- Pediatric thyroid nodules: ultrasonographic characteristics and inter-observer variability in prediction of malignancy
- Frequency of thyroid status monitoring in the first year of life and predictors for more frequent monitoring in infants with congenital hypothyroidism
- Biochemical, radiological, and genetic characterization of congenital hypothyroidism in Abu Dhabi, United Arab Emirates
- High prevalence of DUOX2 mutations in Japanese patients with permanent congenital hypothyroidism or transient hypothyroidism
- Children with severe Osteogenesis imperfecta and short stature present on average with normal IGF-I and IGFBP-3 levels
- Association between physical activity and bone in children with Prader-Willi syndrome
- CNDP1 genotype and renal survival in pediatric nephropathies
- 17-Hydroxyprogesterone responses to human chorionic gonadotropin are not associated with serum anti-Mullerian hormone levels among adolescent girls with polycystic ovary syndrome
- Near-final height in 82 Chinese patients with congenital adrenal hyperplasia due to classic 21-hydroxylase deficiency: a single-center study from China
- Case Reports
- Sertoli cell only syndrome with ambiguous genitalia
- Childhood parathyroid adenoma: a rare but important cause of nephrolithiasis
- A unique case of growth hormone and human chorionic gonadotropin treatment in a 45,X male with Y: autosome translocation and literature review
- Propionic acidemia: a Turkish case report of a successful pregnancy, labor and lactation
- Unusual phenotype of congenital adrenal hyperplasia (CAH) with a novel mutation of the CYP21A2 gene
- Central diabetes insipidus as a very late relapse limited to the pituitary stalk in Langerhans cell histiocytosis
