Abstract
PurposeThe rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5 and 28.9% respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report ROM of 14.2% for TIR3a and 44.6% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, no performance data are available about SIAPEC classification in pediatric age.MethodsRetrospective data were collected from 200 pediatric subjects with thyroid nodules in the period 2000–2020.ResultsThe distribution of cytological categories after fine needle aspiration biopsy (FNAB) was 7 TIR1, 4 TIR1c, 22 TIR2, 14 TIR3a, 9 TIR3b, 3 TIR4, and 16 TIR5. The surgical approach was performed in 40/200 subjects, with total ROM of 65% (0% for TIR1-TIR3a, 77.8% for TIR3b, and 100% for TIR4–TIR5). Total FNAB accuracy was 95%, while the sensibility and specificity were 92.3 and 92.6%, respectively.ConclusionsThe reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.
Highlights
Nodular thyroid disease in pediatric age has a lower prevalence (0.2–5.1%) than in adulthood (1–10%) [1–3], but Anamnestic and clinical data, thyroid hormone profile, and ultrasound evaluation are critical for the initial assessment [11– 21]
Each category has a rate of malignancy (ROM) that varies according to the classification system used; to date few data on pediatric age are available
Nodular thyroid disease in pediatric age is a rare condition with prevalence of 0.2–5.1%, much lower than the adult population (1–10%); children and adolescents are known to have a higher malignancy rate (12.5–50%), with an average rate of 20–25%, much higher than the adult population of 5–10% [1–7]
Summary
Nodular thyroid disease in pediatric age has a lower prevalence (0.2–5.1%) than in adulthood (1–10%) [1–3], but Anamnestic and clinical data, thyroid hormone profile, and ultrasound evaluation are critical for the initial assessment [11– 21]. The most widely used cytological classifications are the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and the British Thyroid Association (BTA) Guidance on the reporting thyroid cytology; in Italy, the Italian Society of Anatomic Pathology and Cytology (SIAPEC) in 2014 reviewed the cytological categories, indicating a five-tiered classification and subdividing the ‘indeterminate for malignancy’ class into the ‘TIR3a’ low-risk indeterminate lesion (LRIL) and the ‘TIR3b’ high-risk indeterminate lesion (HRIL) due to the follicular features of the neoplasia (Table 1) [29–31]. Each category has a ROM that varies according to the classification system used; to date few data on pediatric age are available. All classification systems include categories for non-diagnostic cytology samples, benign lesions, and malignant lesions, but differ in the terminology of borderline lesions. The British system uses the “ThyIII” category for all borderline cases, differentiating in “ThyIIIa” the possible neoplasm with atypia and in “ThyIIIf” the possible follicular neoplasm, similar to the SIAPEC classification
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