Clinic-based ultrasound can predict malignancy in pediatric thyroid nodules

Background: Thyroid nodules in pediatric patients may carry a greater risk for malignancy than in adults. Most nodules >1 cm in patients ≤21 years of age may require thyroidectomy for definitive diagnosis and treatment. Although clinic-based ultrasound (CBUS) has been shown useful in the evaluation of thyroid nodules in adults, its utility in evaluating nodules in the pediatric population remains unclear. Methods: Prospectively collected data regarding 50 patients ≤21 years who underwent preoperative CBUS and initial thyroidectomy at a single institution were retrospectively reviewed. All CBUS were performed by endocrine surgeons certified in basic and cervical ultrasonography. Preoperative CBUS characteristics of pediatric thyroid nodules were analyzed with respect to final pathology. Results: Of the 50 patients ≤21 years of age who underwent surgical resection for a dominant thyroid nodule, there were 45 females and 5 males with an average age of 17.4 years (range: 10-21 years). On univariate analysis, microcalcifications (p<0.001), abnormal lymph nodes (p<0.001), and dimensions taller more than wide (p=0.033) were individual CBUS characteristics predictive of thyroid malignancy. All nine patients with abnormal lymph nodes on CBUS had malignant disease on final pathology. Multiple thyroid nodules, a cystic component, and echogenicity did not predict malignancy; regular borders trended toward predicting a benign nodule (p=0.066). When malignant ultrasound features were considered (i.e., hypoechoic, irregular borders, microcalcifications, abnormal lymph nodes, and shape taller more than wide), having one malignant feature predicted malignancy with an odds ratio of 2.0 while having ≥2 features held even greater significance (p=0.004, OR 4.0). All patients with ≥3 malignant ultrasound features had thyroid cancer on final pathology. Conclusion: CBUS is a useful diagnostic modality in determining malignancy status of thyroid nodules in patients ≤21 years of age. CBUS should be employed as part of an initial assessment of any pediatric patient presenting with thyroid nodules to help further guide management and treatment.