Faculty Collaboration Database

Assessing the Diagnostic Accuracy of TI-RADS in Pediatric Thyroid Nodules: A Multi-institutional Review. J Pediatr Surg 2025 Jan;60(1):161924

Date

10/03/2024

Pubmed ID

39358076

DOI

10.1016/j.jpedsurg.2024.161924

Scopus ID

2-s2.0-85205374747 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

PURPOSE: Thyroid nodules are uncommon in children and adolescents but carry an increased risk of malignancy when present. The Thyroid Imaging Reporting and Data System (TI-RADS) is an adult-validated ultrasound-based risk assessment providing a prediction of malignant potential for thyroid nodules, thereby guiding recommendations for fine needle aspiration biopsy (FNAB). Minimal data exist regarding the applicability of TI-RADS to predict malignancy in pediatric thyroid nodules. This study aims to analyze the performance of TI-RADS for children and adolescents with thyroid nodules, hypothesizing that applying TI-RADS criteria would improve accuracy and reduce the number of recommended FNAB compared to American Thyroid Association (ATA) size criteria alone.

METHODS: A multi-institutional retrospective analysis was conducted including patients ≤21 years with a thyroid nodule by sonographic thyroid imaging between 2015 and 2020. TI-RADS scores were assigned at each institution by a pediatric radiologist trained in thyroid imaging and TI-RADS criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of TI-RADS scoring were compared to existing ATA size-based recommendation for performing a FNAB. Accounting for relative size differences between adults and children, a novel PED TI-RADS category was developed and tested, recommending FNAB for thyroid nodules with a TI-RADS 3 and ≥ 1.5 cm, TI-RADS 4 and ≥ 1.0 cm, and TI-RADS 5 any feasible size.

RESULTS: 291 nodules from 260 patients (median age 14.9 years, 78.8% female) were assessed using TI-RADS. Applying adult TI-RADS criteria resulted in recommendation of FNAB for 35.1% of nodules, in contrast to 76.6% recommended by ATA guidelines (p < 0.0001) (Table). Utilizing the adult TI-RADS score ≥3 as an FNAB indicator resulted in 100% sensitivity and 28.5% specificity, with 0 cases of missed malignant nodules on pathology. When novel PED TI-RADS criteria were applied, 88 patients would have been spared an unnecessary FNAB with improved sensitivity and accuracy over ATA criteria.

CONCLUSIONS: The application of adult and PED TI-RADS scoring to thyroid nodules in pediatric patients enhances the accuracy of malignancy prediction compared to current American Thyroid Association size criteria alone. The utilization of PED TI-RADS scoring eliminated unnecessary biopsies in many children while not missing a single thyroid malignancy.

LEVEL OF EVIDENCE: Level III.

Author List

Srivatsa S, Al-Hadidi A, Stanek J, Horvath K, Parsons L, Martinez-Rios C, Hopp A, Engle S, Plunk M, Shapira-Zaltsberg G, Nagar S, Masters S, Al-Katib S, Tucker R, Atweh LA, Shah S, Bobbey A, Hoffman R, Aldrink JH

Authors

Amanda Hopp MD Assistant Professor in the Pathology and Laboratory Medicine department at Medical College of Wisconsin
Lauren Parsons MD Associate Professor in the Pathology and Laboratory Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Biopsy, Fine-Needle
Child
Child, Preschool
Female
Humans
Male
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Thyroid Gland
Thyroid Neoplasms
Thyroid Nodule
Ultrasonography
Young Adult