Diagnostic Features of Pediatric ThyroidNodule: A 4 Year Prospective Study

PAPENDIECK, PATRICIA; GRUÑEIRO-PAPENDIECK, LAURA; VENARA, MARCELA; BERGADA, IGNACIO; ACHA, OSCAR; COZZANI, HUGO; MATTEOS, FERNANDA; CHIESA, ANA

Montevideo

Congreso; XXIIIAnnual Meeting of the Paediatrics Endocrinology Latinoamerican Society; 2012

XXIIIAnnual Meeting of the Paediatrics Endocrinology Latinoamerican Society

Pediatric thyroid nodules have a greater risk of malignancy than in adults. Objective: To study a pediatric cohort of patients with thyroid nodules. Material and Methods: We prospectively studied 66 consecutive patients that came to consultation in our center between 2007 and 2011. Clinical features, thyroid function, Doppler ultrasound (US), Tc99m scan, ultrasound guided FNAB cytology and histology of those patients who underwent surgery were evaluated as well as the differences between the characteristics of benign and malignant nodules. Results: 59 patients were analyzed (7 lost to follow up) 83% girls, median age 13.9 years. 88% pubertal. Cause of referral: palpable nodule (78%), multinodular goiter (MNG) (13.5%), goiter (5%) and ultrasound finding (3.4%). 5 % had risk factor. 86.7% were euthyroid, 8.9% hypothyroid and 4.4% hyperthyroid. 22.2% had positive antythyroid antibodies. Median ultrasound greatest nodular diameter was 21mm (r: 8–80). 63% were solid, 19.2% had central microcalcifications, 5.2% irregular limits, 22.8% central vascularization and 8.8% pathologic lymphadenopathies. 62% were cold. Malignant and suspicious for malignancy FNAB results showed a positive and negative predictive value for malignancy of 57.1% and 92.3% respectively (diagnostic efficiency 65.1%). 43 patients underwent surgery: 10 papillary carcinoma, 5 colloid cyst, 16 nodular hyperplasia, 3 MNG, 7 follicular adenoma 1 thyroglosal, 1 lymphoep- ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. Conclusions: Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Objective: To study a pediatric cohort of patients with thyroid nodules. Material and Methods: We prospectively studied 66 consecutive patients that came to consultation in our center between 2007 and 2011. Clinical features, thyroid function, Doppler ultrasound (US), Tc99m scan, ultrasound guided FNAB cytology and histology of those patients who underwent surgery were evaluated as well as the differences between the characteristics of benign and malignant nodules. Results: 59 patients were analyzed (7 lost to follow up) 83% girls, median age 13.9 years. 88% pubertal. Cause of referral: palpable nodule (78%), multinodular goiter (MNG) (13.5%), goiter (5%) and ultrasound finding (3.4%). 5 % had risk factor. 86.7% were euthyroid, 8.9% hypothyroid and 4.4% hyperthyroid. 22.2% had positive antythyroid antibodies. Median ultrasound greatest nodular diameter was 21mm (r: 8–80). 63% were solid, 19.2% had central microcalcifications, 5.2% irregular limits, 22.8% central vascularization and 8.8% pathologic lymphadenopathies. 62% were cold. Malignant and suspicious for malignancy FNAB results showed a positive and negative predictive value for malignancy of 57.1% and 92.3% respectively (diagnostic efficiency 65.1%). 43 patients underwent surgery: 10 papillary carcinoma, 5 colloid cyst, 16 nodular hyperplasia, 3 MNG, 7 follicular adenoma 1 thyroglosal, 1 lymphoep- ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. Conclusions: Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Material and Methods: We prospectively studied 66 consecutive patients that came to consultation in our center between 2007 and 2011. Clinical features, thyroid function, Doppler ultrasound (US), Tc99m scan, ultrasound guided FNAB cytology and histology of those patients who underwent surgery were evaluated as well as the differences between the characteristics of benign and malignant nodules. Results: 59 patients were analyzed (7 lost to follow up) 83% girls, median age 13.9 years. 88% pubertal. Cause of referral: palpable nodule (78%), multinodular goiter (MNG) (13.5%), goiter (5%) and ultrasound finding (3.4%). 5 % had risk factor. 86.7% were euthyroid, 8.9% hypothyroid and 4.4% hyperthyroid. 22.2% had positive antythyroid antibodies. Median ultrasound greatest nodular diameter was 21mm (r: 8–80). 63% were solid, 19.2% had central microcalcifications, 5.2% irregular limits, 22.8% central vascularization and 8.8% pathologic lymphadenopathies. 62% were cold. Malignant and suspicious for malignancy FNAB results showed a positive and negative predictive value for malignancy of 57.1% and 92.3% respectively (diagnostic efficiency 65.1%). 43 patients underwent surgery: 10 papillary carcinoma, 5 colloid cyst, 16 nodular hyperplasia, 3 MNG, 7 follicular adenoma 1 thyroglosal, 1 lymphoep- ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. Conclusions: Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.99m scan, ultrasound guided FNAB cytology and histology of those patients who underwent surgery were evaluated as well as the differences between the characteristics of benign and malignant nodules. Results: 59 patients were analyzed (7 lost to follow up) 83% girls, median age 13.9 years. 88% pubertal. Cause of referral: palpable nodule (78%), multinodular goiter (MNG) (13.5%), goiter (5%) and ultrasound finding (3.4%). 5 % had risk factor. 86.7% were euthyroid, 8.9% hypothyroid and 4.4% hyperthyroid. 22.2% had positive antythyroid antibodies. Median ultrasound greatest nodular diameter was 21mm (r: 8–80). 63% were solid, 19.2% had central microcalcifications, 5.2% irregular limits, 22.8% central vascularization and 8.8% pathologic lymphadenopathies. 62% were cold. Malignant and suspicious for malignancy FNAB results showed a positive and negative predictive value for malignancy of 57.1% and 92.3% respectively (diagnostic efficiency 65.1%). 43 patients underwent surgery: 10 papillary carcinoma, 5 colloid cyst, 16 nodular hyperplasia, 3 MNG, 7 follicular adenoma 1 thyroglosal, 1 lymphoep- ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. Conclusions: Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Results: 59 patients were analyzed (7 lost to follow up) 83% girls, median age 13.9 years. 88% pubertal. Cause of referral: palpable nodule (78%), multinodular goiter (MNG) (13.5%), goiter (5%) and ultrasound finding (3.4%). 5 % had risk factor. 86.7% were euthyroid, 8.9% hypothyroid and 4.4% hyperthyroid. 22.2% had positive antythyroid antibodies. Median ultrasound greatest nodular diameter was 21mm (r: 8–80). 63% were solid, 19.2% had central microcalcifications, 5.2% irregular limits, 22.8% central vascularization and 8.8% pathologic lymphadenopathies. 62% were cold. Malignant and suspicious for malignancy FNAB results showed a positive and negative predictive value for malignancy of 57.1% and 92.3% respectively (diagnostic efficiency 65.1%). 43 patients underwent surgery: 10 papillary carcinoma, 5 colloid cyst, 16 nodular hyperplasia, 3 MNG, 7 follicular adenoma 1 thyroglosal, 1 lymphoep- ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. ithelial intrathyroid cysts. Papillary carcinoma was found in 38.5% of MNG and 16.7% of solitary nodules. All carcinomas were euthyroid, solid on ultrasound (p <0.05) and 50% presented pathologic lymphadenopathies (p <0.05). Malignant results in FNAB were always cancer. Conclusions: Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer than in adults. US and US guided FNAB were the most useful tools in our strategic approach.