Author(s)
Brandon E. Fornwalt, DO
Matthew Kubina
Manasa Melachuri
Janice McDaniel
Anita Jeyakumar, MD, MS, FACS, FAAP
Affiliation(s)
St. Elizabeth Boardman Hospital; Northeast Ohio Medical University; Mercy Bon-Secours;
Abstract:
Introduction: Pediatric thyroid nodules are uncommon but carry a 25% malignancy risk. Adult patients have well established ultrasound characteristics that are predictive of malignancy, but these are not as clearly defined in pediatric patients.
Methods: Objective: Retrospective review of pediatric thyroid nodules ultrasound characteristics and correlate the findings with pathology.
Retrospective review of all pediatric thyroid nodules with ultrasounds from 2006-2016 at a pediatric tertiary care center.
Results: We identified 116 pediatric thyroid nodules. 17% (20/116) were malignant. The mean patient age was 14.2 years old, a female to male ratio of 4:1 and 94% were Caucasian. In patients with malignant nodules average presenting age was 15.5 years old, with a female to male ratio of 5.6:1. 70% of malignant nodules had accompanying microcalcifications, 50% had abnormal lymph nodes, and 40% had irregular margins. In the benign nodules, 6% had microcalcifications, 15.6% with abnormal lymph nodes, and 9% with irregular margins.
The presence of microcalcification (odds ratio 35.00, 95% CI 9.89-123.88), irregular borders (odds ratio 6.44, CI 2.09-19.9), abnormal lymph nodes (odds ratio 5.4, CI 1.92-15.21), and size >3.5 cm (odds ratio 12, CI 3.18-48.2) were associated with thyroid cancer.
Conclusions: Our data suggest that abnormal lymph nodes, microcalcifications, irregular margins, and size greater than 3.5 cm could be better defined predictors of malignancy in the pediatric population and influence clinical decision-making.