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Accuracy of Fine Needle Aspiration Biopsy of Thyroid Nodules in Detecting Malignancy in Childhood: Comparison with Conventional Clinical, Laboratory, and Imaging Approaches

Division of Pediatric Endocrinology, Regina Margherita Children Hospital (A.C., S.E., M.A., L.d.S.), 10100 Turin, Italy; Pediatric Unit, Department of Medical Sciences, University of Piemonte Orientale (E.C., G.B.), 28100 Novara, Italy; Endocrine Unit, Department of Pediatrics, University of Milan (G.W., M.V.), 20100 Milan, Italy; Unit of Autoimmune Endocrine Diseases, Bambino Gesu Hospital Research Institute (A.C., S.S.), 00100 Rome, Italy; Department of Pediatrics, University of Pisa (G.C.), 56100 Pisa, Italy; Institute of Pediatrics, University of Messina (M.F.M., F.d.L.), 98100 Messina, Italy; Department of Pediatric University La Sapienza (M.S., A.M.P.), Rome, Italy; Department of Pediatrics, Caldarelli Hospital (M.C.), 86100 Campobasso, Italy; and Department of Pediatrics, University of Turin (G.C.M.), 10100 Turin, Italy

Address all correspondence and requests for reprints to: Dr. A. Corrias, Division of Pediatric Endocrinology, Regina Margherita Children Hospital, 10126 Turin, Italy.

Abstract

In childhood the traditional diagnostic approach to thyroid nodules consists of clinical, laboratory, and imaging evaluations. A safe and accurate procedure is needed to promptly identify patients who require surgery.

In regard to the usefulness of fine needle aspiration biopsy, the data in the literature concerning children and adolescents are scanty. The aim of this study was to evaluate and compare the diagnostic accuracies of clinical, laboratory, and imaging data collected retrospectively in a group of pediatric patients with thyroid nodules submitted to fine needle aspiration biopsy.

Forty-two patients who underwent surgery for thyroid nodules, recruited in 9 Italian pediatric endocrine units, were retrospectively studied. According to histological diagnosis, they were divided into 2 groups, 22 patients with benign lesions and 20 patients with malignant lesions. From clinical records we obtained data about 1) symptoms of neck compression; 2) cervical adenopathy; 3) thyroid function, calcitonin level, and antithyroid antibody titers; 4) ultrasonography; 5) ^99mTc scintiscanning; and 6) cytology obtained with fine needle aspiration biopsy. Patients and nodule characteristics were analyzed statistically for associations with the presence of thyroid cancer.

Among clinical findings, only adenopathy was significantly higher in the group with cancer (8 of 22 benign lesions vs. 16 of 20 malignant lesions; P = 0.006). Thyroid function and antibody titers were similar in the 2 groups, whereas the serum calcitonin level was elevated only in 1 patient with malignant lesions. Among ultrasonography findings, no significant statistical difference was found between the 2 groups with regard to number, dimensions, growth progression, or hypoechogenic pattern of the nodules. Regarding scintigraphic findings, no significant difference was found between the 2 groups. However, a positive correlation (r = 0.90; P < 0.0001) was found between fine needle aspiration biopsy cytological findings and histological diagnoses. The sensitivity, specificity, and accuracy of fine needle aspiration biopsy were 95%, 86.3%, and 90.4%, respectively. A multiple regression analysis showed that only fine needle aspiration biopsy (ß coefficient = 0.963; P < 0.0001) significantly contributed to detecting malignancy (multiple r = 0.973; P < 0.0001).

This study provides strong evidence that fine needle aspiration biopsy is a safe technique even in childhood and adolescence, offering the best sensitivity, specificity, and accuracy in detecting malignancy compared with conventional approaches.

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