Clinical Thyroidology® for the Public
Summaries for the Public from recent articles in Clinical Thyroidology
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THYROID NODULES
How useful is the Bethesda system for reporting cytology results in children and adolescents with thyroid nodules?
BACKGROUND
A thyroid nodule is an abnormal growth of thyroid cells that form a lump within the thyroid. Thyroid nodules are uncommon in children and therefore little is known about the diagnostic characteristics and outcomes of pediatric thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology is often used in adults to determine the chance a thyroid nodule is cancerous. A biopsy of the thyroid nodule in which cells from the thyroid nodule are obtained, can often help establish if the thyroid nodule is a cancer or not. The Bethesda system is used to report six categories of cytology results (diagnostic information after cells are examined from the fine needle aspiration biopsy). Bethesda system categories include: nondiagnostic, benign (not cancer), atypia of uncertain significance/follicular neoplasm of undetermined significance (AUS/FLUS), follicular neoplasm/ suspicious for follicular neoplasm (FN/SFN), suspicious for malignancy, and malignant (cancer). The chance that a thyroid nodule is cancer in a child or adolescent is much higher than in adults. Little is known about the use of the Bethesda system for thyroid nodules in children and adolescents. This study investigates the use of the Bethesda system in pediatrics.
THE FULL ARTICLE TITLE
Vuong HG et al 2021 The use of the Bethesda System for reporting thyroid cytopathology in pediatric thyroid nodules: A meta-analysis. Thyroid 31:1203–1211. PMID: 33504264.
SUMMARY OF THE STUDY
This analysis involved reviewing articles published between 2007 and 2020 using PubMed or Web of Science. Articles included in the analysis included the Bethesda system or an equivalent reporting system and pediatric cases with thyroid biopsy, surgery and final pathology. A total of 17 articles including a total of 3687 pediatric thyroid nodules were analyzed. Of the 3687 thyroid nodules, 1426 (38.7%) were removed by surgery and 683 (47.9%) of those were cancerous. The most common cancer found was papillary thyroid carcinoma (88.4%). Rates of surgical resection (where thyroid tissue is removed) in children and adolescents were greater than those for adults in all Bethesda system categories, except the nondiagnostic group. However, the risk for cancer was similar for pediatric and adult thyroid nodules in all Bethesda system categories.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The Bethesda system is a useful tool to make decisions for children and adolescents with thyroid nodules. Compared to adults, pediatric patients with benign and indeterminate thyroid nodules had a higher surgery rate but the risk for having cancer was not statistically different. Therefore, there may be a potential to over treat children and adolescents. Establishing treatment guidelines and risk stratification tools are needed to identify which children need thyroid surgery.
— Priya Mahajan, MD
ATA THYROID BROCHURE LINKS
Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/
Thyroid Surgery: https://www.thyroid.org/thyroid-surgery/
Fine Needle Aspiration Biopsy of Thyroid Nodules in Children and Adolescents: https://www.thyroid.org/
fna-thyroid-nodules-children-adolescents/
ABBREVIATIONS & DEFINITIONS
Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous.
Thyroid biopsy: a simple procedure that is done in the doctor’s office to determine if a thyroid nodule is benign (non-cancerous) or cancer. The doctor uses a very thin needle to withdraw cells from the thyroid nodule. Patients usually return home or to work after the biopsy without any ill effects.
Non-diagnostic thyroid biopsy: this happens when some atypical cells are found but not enough to provide a diagnosis. This occurs in 5-10% of biopsies. This often results in the need to repeat the biopsy.
Indeterminate thyroid biopsy: this happens a few atypical cells are seen but not enough to be abnormal (atypia of unknown significance (AUS) or follicular lesion of unknown significance (FLUS)) or when the diagnosis is a follicular or hurthle cell lesion. Follicular and hurthle cells are normal cells found in the thyroid. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. This occurs in 15-20% of biopsies and often results in the need for surgery to remove the nodule.
Atypical thyroid biopsy: this happens when there are some abnormal/atypical cells in the biopsy sample but not enough to diagnose a cancer. However, because there are abnormal cells in the biopsy sample, the specimen cannot be called benign. Sometimes a repeat biopsy may be helpful but often surgery is recommended to remove the nodule.
Suspicious thyroid biopsy: this happens when there are atypical cytological features suggestive of, but not diagnostic for malignancy. Surgical removal of the nodule is required for a definitive diagnosis.
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