title: A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults.
abstract: BACKGROUND
  Thyroid cancer is the most common endocrine malignancy, but due to its rare occurrence in the pediatric population, the cancer risk of childhood thyroid nodules is incompletely defined, and optimal management of children with suspected nodules is debated.
  
  
  OBJECTIVE
  The aim was to study the presenting features and cancer risk of sporadic childhood thyroid nodules using a standardized clinical assessment and management plan.
  
  
  METHODS
  Boston Children's Hospital and Brigham and Women's Hospital collaborated to create a multidisciplinary pediatric thyroid nodule clinic and implement a standardized assessment plan. Upon referral for a suspected nodule, serum TSH was measured and hypothyrotropinemic patients underwent (123)I scintigraphy. All others underwent thyroid ultrasonography, and if this confirmed nodule(s) ≥ 1 cm, ultrasound-guided fine-needle aspiration was performed. Medical records were retrospectively reviewed and compared to a control population of 2582 adults evaluated by identical methods.
  
  
  RESULTS
  Of 300 consecutive children referred for the initial evaluation of suspected thyroid nodules from 1997 to 2011, 17 were diagnosed with autonomous nodules by scintigraphy. Neck ultrasonography performed in the remainder revealed that biopsy was unnecessary in over half, either by documenting only sub-centimeter nodules or showing that no nodule was present. A total of 125 children met criteria for thyroid biopsy, which was performed without complication. Their rate of cancer was 22%, significantly higher than the adult rate of 14% (P = .02).
  
  
  CONCLUSIONS
  Neck ultrasonography and biopsy were key to the evaluation of children with suspected thyroid nodules. Although the relative cancer prevalence of sonographically confirmed nodules ≥ 1 cm is higher in pediatric patients than adults, most children referred for suspected nodules have benign conditions, and efforts to avoid unnecessary surgery in this majority are warranted.
authors.affiliation: Thyroid Program of the Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Anjuli
authors.initials: A
authors.lastname: Gupta
authors.forename: Samantha
authors.initials: S
authors.lastname: Ly
authors.forename: Luciana A
authors.initials: LA
authors.lastname: Castroneves
authors.forename: Mary C
authors.initials: MC
authors.lastname: Frates
authors.forename: Carol B
authors.initials: CB
authors.lastname: Benson
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Ari J
authors.initials: AJ
authors.lastname: Wassner
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Smith
authors.forename: Ellen
authors.initials: E
authors.lastname: Marqusee
authors.forename: Erik K
authors.initials: EK
authors.lastname: Alexander
authors.forename: Justine
authors.initials: J
authors.lastname: Barletta
authors.forename: Peter M
authors.initials: PM
authors.lastname: Doubilet
authors.forename: Hope E
authors.initials: HE
authors.lastname: Peters
authors.forename: Susan
authors.initials: S
authors.lastname: Webb
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
authors.forename: Harriet J
authors.initials: HJ
authors.lastname: Paltiel
authors.forename: Harry
authors.initials: H
authors.lastname: Kozakewich
authors.forename: Edmund S
authors.initials: ES
authors.lastname: Cibas
authors.forename: Francis D
authors.initials: FD
authors.lastname: Moore
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: P Reed
authors.initials: PR
authors.lastname: Larsen
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D013964:Thyroid Neoplasms / Q000453:epidemiology*; D016606:Thyroid Nodule / Q000150:complications* / Q000473:pathology; D014463:Ultrasonography