title: Predictors of Malignancy in Children with Thyroid Nodules.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of clinical, laboratory, and ultrasound (US) imaging characteristics of thyroid nodules in assessing the likelihood of malignancy.
  
  
  METHODS
  Data from 184 children and adolescents with thyroid nodules were evaluated and compared with respective cytologic/histologic outcomes. A regression model was designed to assess the predictors associated with malignancy and to calculate ORs.
  
  
  RESULTS
  Twenty-nine malignant neoplasms (25 papillary, 1 medullary, 3 Hurtle-cell carcinomas), 8 follicular adenomas, and 147 goitrous nodules (92 based on cytology, 55 on follow-up) were diagnosed. Fine-needle aspiration biopsy diagnostic accuracy, sensitivity, and specificity were 91%, 100%, and 88%, respectively. Male sex, compression symptoms, palpable lymphopathy, thyroid stimulating hormone concentration, microcalcifications, indistinct margins, hypoechoic US pattern, pathologic lymph node alterations, and increased intranodular vascularization were associated with malignancy. Regular margins, mixed echoic pattern, and peripheral-only vascularization were associated with benignity. During follow-up, nodule growth was associated with malignant disease, especially with levothyroxine therapy. A multivariate analysis confirmed that microcalcifications, hypoechoic pattern, intranodular vascularization, lymph node alterations, and thyroid stimulating hormone concentration were independent predictors of malignant outcome. For each predictor, we provide sensitivity, specificity, and positive/negative predictive values.
  
  
  CONCLUSIONS
  Clinical, laboratory, and US features of nodules can be used as predictors of malignancy in children. Although none has diagnostic accuracy as high as that of fine-needle aspiration biopsy, these predictors should be considered in deciding the diagnostic approach of children with thyroid nodules.
authors.affiliation: Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy. Electronic address: alessandro.mussa@unito.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mussa
authors.affiliation: Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy.
authors.forename: Maurilio
authors.initials: M
authors.lastname: De Andrea
authors.affiliation: Anatomical Pathology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Motta
authors.affiliation: Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mormile
authors.affiliation: General Surgery, Department of Medical and Surgical Sciences, University of Torino, Ospedale Molinette, Città della Salute e della Scienza di Torino, Torino, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Palestini
authors.affiliation: Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corrias
mesh_terms: D000293:Adolescent; D001706:Biopsy; D044963:Biopsy, Fine-Needle; D002648:Child; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D016606:Thyroid Nodule / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D013972:Thyrotropin; D013974:Thyroxine