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Cytological evaluation of thyroid nodules in children and young adults: a multi-institutional experience

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Abstract

Purpose

The utility of the Bethesda system for reporting thyroid cytopathology is debatable in determining the risk of malignancy in pediatric patients. Moreover, the upper age limit for defining the pediatric group has varied across different studies. The aim of this study is to compare the risk of malignancy (ROM) and risk of neoplasia (RON) across different Bethesda categories between the pediatric, young adult, and adult patients.

Methods

This is a retrospective multi-institutional study performed in three Indian hospitals. ROM was calculated and compared across Bethesda categories in adult (>18 years) and pediatric age groups (≤18 years), with a subgroup analysis in young adults (19–21 years).

Results

Thyroid nodules from a total of 5958 patients were subjected to fine needle aspiration. Of these 199 were pediatric (3.3%) and follow-up histology was available in 2276. The ROM and RON rates, including overall ROM/RON, were significantly higher in pediatric age group as compared to adults. Overall ROM of suspicious for malignancy and malignant categories was higher in children as compared to adults. The overall surgical resection rates were also higher in pediatric patients (45.2% vs. 35.7%; p < 0.01). The similar trend of increased ROM, RON and resection rates was seen among young adults as compared to adult age group.

Conclusion

Thyroid nodules presenting in children are more likely to be malignant than those in adults. Importantly, the young adult group behaved in a similar manner with regard to surgical resection rates, ROM and RON to pediatric.

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Author contributions

All authors contributed to the study conception and design. C.R., N.N., A.S., and S.A. performed material preparation and data collection. C.R., P.M., and A.B. performed analysis. C.R. wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Chanchal Rana & Akanksha Singh

  2. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India

    Neha Nigam

  3. Department of Pathology, All India Institute of Medical Science, New Delhi, India

    Shipra Agarwal

  4. Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India

    Prabhakar Mishra

  5. Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan

    Andrey Bychkov

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  1. Chanchal Rana
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Correspondence to Andrey Bychkov.

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Rana, C., Nigam, N., Agarwal, S. et al. Cytological evaluation of thyroid nodules in children and young adults: a multi-institutional experience. Endocrine 80, 580–588 (2023). https://doi.org/10.1007/s12020-022-03297-0

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  • DOI: https://doi.org/10.1007/s12020-022-03297-0

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