Thyroid nodules in pediatrics: a 4 year prospective study

PAPENDIECK, PATRICIA; GRUÑEIRO-PAPENDIECK L; VENARA, MARCELA; ACHA, OSCAR; COZZANI, HUGO; MATTEOS, FERNANDA; MAGLIO S; BERGADÁ, IGNACIO; CHIESA, ANA

Milan

Congreso; 9th Joint Meeting of Pediatric Endocrinology; 2013

ENDO, SLEP

Page 361/2 Abstr P2 d1 1173 Introduction: Pediatric thyroid nodules have a greater risk of malignancy than in adults. Objective and bypotheses: To study a pediatric cohort of patients with thyroid nodules. Methods: We prospectively studied 66 consecutive patients referred to our center between 2007 and 2011. Clinical features, thyroid function, Doppler ultrasound (US), 99m Te sean, US guided FNAB, cytology categorized according to the Bethesda System for Reporting Thyroid Cytopathology and histol-ogy ofthose patients wbo underwent surgery were evaluated. Also differences between benign and malignant nodules were characterized. 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 US finding (3,4%), 5 % had risk factors. 86,7% were euthyroid, 8,9% hypothyroid and 4,4% hyperthyroid. 22,2% had positive antithyroid antibodies. Median US greatest nodular diameter was 21mm (r:8-80), 63% were solid, 19% had central microcaJcifications, 5% undefined limits, 22% central vascularization and 8% pathologic Iymphadenopathies. 62% were cold. FNAB diagnostic performance (exeluding 15,9% nondiagnostic samples) showed a 67% sensitivity, 93% specificity, 67% PPV and 90% NPV (diagnostic efficiency 86%).45 patients underwent surgery: 10 papillary carcinoma, 35 benigno Global malignancy rate was 22%. Papillary carcinoma was found in 38,5% of MNG and 15,6% of solitary nodules. Al! carcinomas were euthyroid, solid on US (p< 0,05) and 50% presented pathologic lymphadenopathies (p< 0,05). Malignant results in FNAB were always cancer. Malignancy rates for each cytology subtype were: I 28,6%, II 8,7%,I1I 16,7%, IV and VO% and VI 100%. Conclusions: Our findings confirm that most pediatric nodular disease is benign, however with a greater incidence of cancer that usually reported in adults. US and US guided FNAB were the most useful tools in our strategic approach.