Evaluating Postoperative Outcomes and Investigating the Usefulness of EU-TIRADS Scoring in Managing Pediatric Thyroid Nodules Bethesda 3 and 4.

Abstract

The study aimed to assess the postoperative outcomes of pediatric thyroid nodules with Atypia of Undetermined Significance (AUS/FLUS) or Suspicious for a Follicular Neoplasm (SFN) and their EU-TIRADS scoring. The study retrospectively reviewed 44 patients at a single center with thyroid nodules classified as Atypia of Undetermined Significance or Suspicious for a Follicular Neoplasm from August 2019 to December 2022. Data on demographics, thyroid function, nodule size, and ultrasonographic features were collected. Postoperative pathologies were categorized into benign, low-risk, and malignant neoplasms according to WHO 2022 criteria, with EU-TIRADS used for radiologic scoring. Among 21 pediatric patients, 72% had Bethesda 3 and 28% had Bethesda 4 thyroid nodules. Pathological outcomes post-surgery classified 43% as benign, 19% as low-risk, and 38% as malignant. Notably, EU-TIRADS 3 and 5 scores were present in 44% and 56% of benign cases, respectively. Malignant cases showed a prevalence of higher EU-TIRADS scores, with 64% rated as EU-TIRADS 5. Bethesda category 4 nodules had a 66% malignancy rate, significantly higher than the 27% in category 3. The investigation revealed that EU-TIRADS scoring showed a substantial proportion of benign cases were classified as EU-TIRADS 5, suggesting that EU-TIRADS may lead to unnecessary biopsies in benign cases. Malignant cases were more likely to have a higher EU-TIRADS score, indicating a positive correlation with malignancy risk, particularly in Bethesda 4 cases. However, the EU-TIRADS system's predictive value for malignancy in Bethesda 3 cases was less definitive.