PDF(Pubmed)
Abstract：
UNASSIGNED: There is currently insufficient data to validate adult-based US risk stratification systems (RSSs) for the identification of malignant thyroid nodules in a pediatric population.
UNASSIGNED: From October 2016 and May 2023, 173 thyroid nodules of pediatric patients (age ≤ 18 years) with definitive pathology results and ultrasound (US) examination within 1 month before surgery or fine-needle aspiration (FNA) biopsy in our institution were enrolled in this study. The clinical and US characteristics of these nodules were retrospectively reviewed and categorized according to the ACR-TIRADS, C-TIRADS, and ATA guidelines. The diagnostic performance of US-based FNA criteria (original and simulating) of the three guidelines in thyroid cancer detection was estimated.
UNASSIGNED: The three RSSs had similar AUC according to the categories(0.849-0.852, all P > 0.05). When combined with the original FNA criteria of the three RSSs to manage the nodules, the FNA rate of ACR-TIRADS and C-TIRADS were significantly less than ATA guidelines (53.18% vs. 64.63%, P < 0.05, and 52.60% vs. 64.63%, P < 0.05). The missed malignancy rate (MMR) and unnecessary FNA rate (UFR) of ATA guidelines (50.00%, 35.85%) was highest among the three RSSs, followed by the C-TIRADS (37.80%, 19.57%) and the ACR-TIRADS (37.04%, 19.57%). When nodules < 1 cm with the highest category in each RSS biopsied, that is when using the simulating FNA thresholds, the MMR was reduced overall (all P < 0.001), without a change in the UFR (all P > 0.05). All the three RSSs showed a substantial improvement in accuracy and malignant detection rate (all P < 0.05).
UNASSIGNED: The ACR-TIRADS, C-TIRADS, and ATA guidelines showed high missed malignancy rates when using their original recommended FNA criteria. When nodules < 1 cm with the highest category in each RSS biopsied, the missed malignancy rate of each RSS was decreased. Decreasing the FNA thresholds for highly suspicious malignant nodules may therefore be an effective means of managing malignant thyroid nodules in pediatric patients.
UNASSIGNED: From October 2016 and May 2023, 173 thyroid nodules of pediatric patients (age ≤ 18 years) with definitive pathology results and ultrasound (US) examination within 1 month before surgery or fine-needle aspiration (FNA) biopsy in our institution were enrolled in this study. The clinical and US characteristics of these nodules were retrospectively reviewed and categorized according to the ACR-TIRADS, C-TIRADS, and ATA guidelines. The diagnostic performance of US-based FNA criteria (original and simulating) of the three guidelines in thyroid cancer detection was estimated.
UNASSIGNED: The three RSSs had similar AUC according to the categories(0.849-0.852, all P > 0.05). When combined with the original FNA criteria of the three RSSs to manage the nodules, the FNA rate of ACR-TIRADS and C-TIRADS were significantly less than ATA guidelines (53.18% vs. 64.63%, P < 0.05, and 52.60% vs. 64.63%, P < 0.05). The missed malignancy rate (MMR) and unnecessary FNA rate (UFR) of ATA guidelines (50.00%, 35.85%) was highest among the three RSSs, followed by the C-TIRADS (37.80%, 19.57%) and the ACR-TIRADS (37.04%, 19.57%). When nodules < 1 cm with the highest category in each RSS biopsied, that is when using the simulating FNA thresholds, the MMR was reduced overall (all P < 0.001), without a change in the UFR (all P > 0.05). All the three RSSs showed a substantial improvement in accuracy and malignant detection rate (all P < 0.05).
UNASSIGNED: The ACR-TIRADS, C-TIRADS, and ATA guidelines showed high missed malignancy rates when using their original recommended FNA criteria. When nodules < 1 cm with the highest category in each RSS biopsied, the missed malignancy rate of each RSS was decreased. Decreasing the FNA thresholds for highly suspicious malignant nodules may therefore be an effective means of managing malignant thyroid nodules in pediatric patients.
摘要：
■目前没有足够的数据来验证基于成人的美国风险分层系统（RSSs），以识别儿科人群中的恶性甲状腺结节。
■自2016年10月至2023年5月，纳入我院173例甲状腺结节患儿（年龄≤18岁），在手术前1个月内或细针穿刺活检（FNA）进行明确的病理检查和超声检查。这些结节的临床和US特征进行回顾性分析，并根据ACR-TIRADS进行分类。C-TIRADS,ATA指南评估了三个指南在甲状腺癌检测中基于美国的FNA标准（原始和模拟）的诊断性能。
■根据类别，三个RSS的AUC相似（0.849-0.852，均P>0.05）。当结合三个RSS的原始FNA标准来管理结节时，ACR-TIRADS和C-TIRADS的FNA率显着低于ATA指南（53.18％vs.64.63%，P<0.05，52.60%vs.64.63%，P<0.05)。ATA指南的恶性率（MMR）和不必要的FNA率（UFR）（50.00%，35.85%)在三个RSS中最高，其次是C-TIRADS(37.80%，19.57%)和ACR-TIRADS(37.04%，19.57%）。当结节<1厘米时，每个RSS活检的类别最高，也就是说，当使用模拟FNA阈值时，MMR总体上降低（所有P<0.001），UFR无变化(均P>0.05)。3种RSSs的准确率和恶性检出率均有显著提高(P均<0.05)。
■ACR-TIRADS，C-TIRADS,和ATA指南在使用其最初推荐的FNA标准时显示,恶性肿瘤漏诊率高.当结节<1厘米时，每个RSS活检的类别最高，每个RSS的漏诊恶性率均降低。因此，降低高度可疑恶性结节的FNA阈值可能是管理儿科患者恶性甲状腺结节的有效手段。
■自2016年10月至2023年5月，纳入我院173例甲状腺结节患儿（年龄≤18岁），在手术前1个月内或细针穿刺活检（FNA）进行明确的病理检查和超声检查。这些结节的临床和US特征进行回顾性分析，并根据ACR-TIRADS进行分类。C-TIRADS,ATA指南评估了三个指南在甲状腺癌检测中基于美国的FNA标准（原始和模拟）的诊断性能。
■根据类别，三个RSS的AUC相似（0.849-0.852，均P>0.05）。当结合三个RSS的原始FNA标准来管理结节时，ACR-TIRADS和C-TIRADS的FNA率显着低于ATA指南（53.18％vs.64.63%，P<0.05，52.60%vs.64.63%，P<0.05)。ATA指南的恶性率（MMR）和不必要的FNA率（UFR）（50.00%，35.85%)在三个RSS中最高，其次是C-TIRADS(37.80%，19.57%)和ACR-TIRADS(37.04%，19.57%）。当结节<1厘米时，每个RSS活检的类别最高，也就是说，当使用模拟FNA阈值时，MMR总体上降低（所有P<0.001），UFR无变化(均P>0.05)。3种RSSs的准确率和恶性检出率均有显著提高(P均<0.05)。
■ACR-TIRADS，C-TIRADS,和ATA指南在使用其最初推荐的FNA标准时显示,恶性肿瘤漏诊率高.当结节<1厘米时，每个RSS活检的类别最高，每个RSS的漏诊恶性率均降低。因此，降低高度可疑恶性结节的FNA阈值可能是管理儿科患者恶性甲状腺结节的有效手段。
