ESPE Abstracts

Objectives: The aim of this study was to report on the frequency and describe the clinical characteristics of the ones diagnosed as thyroid cancer among all suspicious nodules diagnosed in the pediatric endocrinology department and to compare the findings with recent published literature.

Methods: Retrospective study during the last 5 years. Patients aged <18 years, with suspected thyroid nodule malignancy, according to sonographic features (nodule size ≥1 cm, hypo-echogenicity, calcifications, taller-than-wide shape, irregular margin and increased vascularization or a combination of the above), who underwent fine needle aspiration biopsy (FNA) under ultrasound (U/S) guidance and/or thyroidectomy, were included.

Results: A total of 37 patients (56.7% girls) with mean age 12.9±3.88 years, were studied. Thirty-six of them underwent FNA, while one patient was diagnosed intraoperatively, during thyroglossal duct cyst excision. Hashimoto's thyroiditis coexisted in 37.8% of all patients, 24.3% reported family history of thyroid nodule or malignancy, while 24.3% of patients had previous malignancy. Among patients with a malignant nodule, 19.1% had medical history of previous malignancy. Microcalcifications were detected in 34.4% of the nodules, 16.2% had irregular margin, while suspicious pathological lymph nodes were found in 13.5%. The FNA results according to the Bethesda System were II in 38.9 %, III in 8.3%, IV in 2.8%, V in 8.3% and VI in 41.7% of the patients. Fifty nine point five per cent (59.5%) of all patients underwent total thyroidectomy. Histopathology revealed malignancy in 91.3%, and in 100 % of those with malignancy in FNA. In 87% the histological type was papillary and in 4.3% follicular carcinoma. Regarding the extent of the disease, 23.8% of children had capsular infiltration, 33.3% had lymph node metastases, and 4.8% had lung metastases. One patient had postoperative permanent and 34.8% of patients had transient hypocalcemia. Radioactive iodine was administered in 66.7% of patients with malignancy, while two children required a second administration. Comparing children with and without malignancy, Hashimoto's thyroiditis coexisted in a significantly higher proportion among those with malignancy (P=0.006), while the presence of microcalcifications was significantly more frequent in malignant nodules (P=0.024).

Conclusions: Our findings are consistent with those reported in the literature. Girls predominated among children with suspicious nodules. Possible predisposing factors are medical history of previous malignancy and Hashimoto's thyroiditis. The most common histological type of thyroid malignancy was papillary carcinoma. The reliability of our medical team was high in the diagnosis of pediatric thyroid cancer by ultrasonography and FNA.