Performance of the Bethesda System for Reporting Thyroid Cytology in Multi-Institutional Large Cohort of Pediatric Thyroid Nodules: A Detailed Analysis.

Sule Canberk,Helena Barroca,Paula Soares,Massimo Bongiovanni,Valdemar Máximo,Ozlem Aydın,Fernando Schmitt,Inês Girão,Ebru Tastekin,Kıvılcım Erdogan,Aysun Uguz

doi:10.3390/diagnostics12010179

Abstract

Background: To evaluate the performance of TBSRTC through multi-institutional experience in the paediatric population and questioning the management recommendation of ATA Guidelines Task Force on Paediatric Thyroid Cancer; Methods: A retrospective search was conducted in 4 institutions to identify consecutive thyroid FNAC cases in paediatric population between 2000 and 2018. Following the 2nd TBSRTC, the risk of malignancy ratios (ROMs) was given in ranges and calculated by 2 different ways. Sensitivity, specificity, PPV, NPV and DA ratios were calculated using histologic diagnosis as the gold standard; Results: Among a total of 405 specimens, the distribution of cases for each category was, 44 (11%) for ND, 204 (50%) for B category, 40 (10%) for AUS/FLUS, 36 (9%) for FN/SFN, 24 (6%) for SFM and 57 (14%) for M categories. 153 cases have a histological diagnosis. The ratio of surgery was 23% in ND, 16% in the B, 45% for AUS/FLUS, 75% for SFN/FN and 92% for SFM and 75% in M categories; Conclusions: The data underlines the high ROM values in paediatric population which might be clinically meaningful. The high rate of malignancy of the cohort of operated patients (50%) also underlines the need of better preoperative indicators for stratification. Considering that more than half of the nodules in AUS/FLUS category were benign, direct surgery recommendation could be questionable as proposed in ATA 2015 guidelines.

Highlights

Thyroid nodules are uncommon in paediatric population and most of them are expected to be benign
Due to the multi-layered unique profile of paediatric thyroid cancer, the first ATA guidelines were released targeting the paediatric population with recommendation to use the Bethesda System for Reporting Thyroid Cytology (TBSRTC) as first step in the evaluation of paediatric thyroid nodules [3,6]
In the current study we found that 20% (24 + 57) of 405 fine needle aspiration cytology (FNAC) cases were assigned in suspicious for malignancy (SFM) and M categories, whereas 50% (77/153) of the nodules who had surgical pathology follow-up (SPFU) were diagnosed as cancer

Summary

Introduction

Thyroid nodules are uncommon in paediatric population and most of them are expected to be benign. At clinical presentation paediatric differentiated TCs are prone to be more aggressive with a high frequency of local or distant metastasis at the time of the diagnosis, despite the paradox of showing more indolent course compared to adult population [3]. Due to these peculiarities, distinct profile and to the restricted data in paediatric thyroid nodules in the literature, the differential management of these nodules in comparison with the ones from adults have become at the centre of the literature. Considering that more than half of the nodules in AUS/FLUS category were benign, direct surgery recommendation could be questionable as proposed in ATA 2015 guidelines

Methods

Results

Conclusion