Pediatric thyroid nodules: ultrasonographic characteristics and inter-observer variability in prediction of malignancy

• Published in: Journal of Pediatric Endocrinology & Metabolism Vol. 29; no. 7; pp. 789 - 794
• Main Authors: Koltin, Dror, O’Gorman, Clodagh S., Murphy, Amanda, Ngan, Bo, Daneman, Alan, Navarro, Oscar M., García, Cristián, Atenafu, Eshetu G., Wasserman, Jonathan D., Hamilton, Jill, Rachmiel, Marianna
• Format: Journal Article
• Language: English
• Published: Germany De Gruyter 01.07.2016; Walter de Gruyter GmbH
• Subjects: Adolescent; Carcinoma - diagnostic imaging; Carcinoma - epidemiology; Carcinoma - pathology; Carcinoma - surgery; Child; Child, Preschool; Cohort Studies; Decalcification, Pathologic - diagnostic imaging; Decalcification, Pathologic - epidemiology; Decalcification, Pathologic - pathology; Decalcification, Pathologic - surgery; Diagnosis, Differential; Female; Hospitals, Pediatric; Humans; inter-observer variability; Male; Observer Variation; Ontario - epidemiology; prediction model; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk; thyroid carcinoma; Thyroid Gland - diagnostic imaging; Thyroid Gland - pathology; Thyroid Gland - surgery; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - epidemiology; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroid Nodule - diagnostic imaging; Thyroid Nodule - epidemiology; Thyroid Nodule - pathology; Thyroid Nodule - surgery; thyroid nodules; Tumor Burden; Ultrasonography; ultrasound
• ISSN: 0334-018X; 2191-0251
• DOI: 10.1515/jpem-2015-0242

Pediatric thyroid nodules, while uncommon, have high malignancy risk. The objectives of the study were (1) to identify sonographic features predictive of malignancy; (2) to create a prediction model; and (3) to assess inter-observer agreement among radiologists. All available cases of thyroid nodules, surgically removed between 2000 and 2009. Three radiologists reviewed the sonographic images; 2 pathologists reviewed the tissue specimens. Adult prediction models were applied. Interobserver variability was assessed. Twenty-seven subjects, mean age 13.1±3.4 years, were included. Nineteen nodules were differentiated thyroid carcinomas. On multivariate analysis, size was the only significant predictor of malignancy. On recursive partitioning analysis, size >35 mm with microcalcification and ill-defined margins yielded the best prediction model. Radiologist inter-observer agreement regarding malignancy was moderate (κ=0.50). Larger size, microcalcifications and ill-defined margins on ultrasound demonstrate the best predictive model for malignancy in the pediatric population. Experienced pediatric radiologists demonstrate moderate inter-observer agreement in prediction of malignancy.