ETA2024 Poster Presentations Diagnosis of thyroid cancer-1 (10 abstracts)
Performance of eu-tirads, ATA and AACE/ACE-AME ultrasound risk stratification system (RSS) in pediatric patients with thyroid nodules
Carla Gambale 1 , Elisa Minaldi 1 , Alessandro Prete 1 , Eleonora Molinaro 1 , Teresa Rago 1 , Maria Scutari 1 , Liborio Torregrossa 2 , Rossella Elisei 1 & Antonio Matrone 3
1University Hospital of Pisa, Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa, Italy; 2University Hospital of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - Pathology Unit, Pisa, Italy; 3University Hospital of Pisa, Unit of Endocrinology, Department of Clinical and Experimental Medicine, Pisa, Italy
Objectives: Thyroid nodules in patients ≤18 years are less frequent than in adults, however several studies showed a higher rate of malignancy. The aim of the present study is to analyze the ultrasound (US) features of nodules in patients ≤18 years and to test the ability of the main US risk stratification system (RSS) in identifying malignancy. Moreover, we also evaluated the potential correlation between the results of US RSS and cytology.
Methods: We analyzed the US reports and cytology results of series of a consecutive thyroid nodules in patients ≤18 years diagnosed in our department for the first time, between 2016 and 2022. The nodules were classified according to EU-TIRADS, 2015-ATA, and AACE/ACE-AME while the cytology was classified according to Italian Consensus.
Results: The whole study group consisted of 271 nodules in 221 patients. Most patients were females (74.2%), and the median age at cytology was 16 years (IQR 14-17). The median nodule diameter was 1.9 cm (IQR 1.4-2.9). Cytology result was TIR5 in 9.3%, TIR4 in 4%, TIR3b in 8.8%, TIR3a in 19.5%, TIR2 in 32.7%, TIR1C in 13.6% and TIR1 in 12.1% of cases. Ultrasound features were available in 216/271 nodules (79.7%). The thyroid was multinodular in 34.3% of cases. The nodules were mostly solid (74.1%), isoechoic (49.1%), “wider than tall” (80.6%) with well-defined margins (82.9%) and without calcifications (77.8%). Approximately one third of the nodules had a high suspicion of malignancy in accordance with the 3 RSS evaluated [EU-TIRADS 5: 35.2%; 2015-ATA High Suspicion 30.6%; AACE/ACE-AME High-risk: 35.2%]. The rate of cytology suspicious for malignancy (TIR4 and TIR5) was 23.7-27.3% in the high and 10.5-11.4% in the low/intermediate ultrasound risk.
Conclusions: Our data show a lower performance of US RSS in thyroid nodules for pediatric patients compared to adults. However, in patients ≤18 years, the 3 main US RSS were able to identify about 75% of the nodules as low/intermediate suspicious for malignancy of which about 90% were not suspicious for malignancy by cytology. Therefore, in these cases a careful approach and a conservative management should be a viable option.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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