September 2019 HSC Section 1 Congenital and Pediatric Problems

Reprinted by permission of Otolaryngol Head Neck Surg. 2017; 157(4):589 - 595.

Original Research—Endocrine Surgery

Otolaryngology– Head and Neck Surgery 2017, Vol. 157(4) 589–595 American Academy of Otolaryngology—Head and Neck

McGill Thyroid Nodule Score in Differentiating Benign and Malignant Pediatric Thyroid Nodules: A Pilot Study

Surgery Foundation 2017 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599817715629 http://otojournal.org

Michael Canfarotta, MD 1 , Douglas Moote, MD 2 , Christine Finck, MD 3 , Rebecca Riba-Wolman, MD 4 , Shefali Thaker, MPH 5 , Trudy J. Lerer, MS 5 , Richard J. Payne, MD 6 , and Valerie Cote, MD, FRCSC 7

Received January 20, 2017; revised April 13, 2017; accepted May 26, 2017. T hyroid nodules are relatively uncommon in the pediatric population, with an estimated prevalence of 1% to 2%. 1 Nevertheless, thyroid carcinoma is the most common endocrine malignancy in childhood, and the incidence has been steadily increasing over the last several decades. 2,3 Although thyroid cancer is more common in adults, children tend to present with more advanced disease, as well as higher rates of lymph node involvement, extra- thyroidal extension, and distant metastases upon diagno- sis. 2,4-8 Nodules also carry a greater risk, with malignancy rates of 22% to 26% in children and adolescents versus 5% to 10% in adults. 9-11 Therefore, early detection with preo- perative differentiation between benign and malignant nodules is important for patient counseling and manage- ment. The McGill Thyroid Nodule Score (MTNS) is a com- bined scoring system that was developed as a predictor for thyroid carcinoma in a specific nodule given clinical, 1 School of Medicine University of Connecticut, Farmington, Connecticut, USA 2 Division of Pediatric Radiology, Connecticut Children’s Medical Center, Connecticut, USA 3 Division of Pediatric Surgery, Connecticut Children’s Medical Center, Connecticut, USA 4 Department of Pediatrics and Endocrinology, Connecticut Children’s Medical Center, Hartford, Connecticut, USA 5 Department of Research, Connecticut Children’s Medical Center, Hartford, Connecticut, USA 6 Department of Otolaryngology–Head and Neck Surgery, McGill University Health Center, Montre´al, Canada 7 Division of Pediatric Otolaryngology–Head and Neck Surgery, Connecticut Children’s Medical Center, Hartford, Connecticut, USA Corresponding Author: Valerie Cote, MD, FRCSC, Division of Pediatric Otolaryngology–Head and Neck Surgery, Advocate Children’s Hospital, 4440 West 95th Street, Oak Lawn, IL 60453, USA. Email: valerie.cote@advocatehealth.com

No sponsorships or competing interests have been disclosed for this article.

Abstract Objective. The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well- differentiated thyroid cancer given a specific nodule in adults. We evaluated the clinical utility of a modified pedia- tric MTNS with children and adolescents.

Study Design. Case series with chart review.

Setting. Tertiary care children’s hospital.

Subjects and Methods. This is a retrospective chart review of 46 patients 18 years of age presenting with a solitary or dominant thyroid nodule treated with surgical resection between September 2008 and December 2015. The cumula- tive MTNS for each nodule was calculated and compared with the final pathology. Results. Of 46 patients, 10 (21.7%) were diagnosed with well- differentiated thyroid cancer (80% papillary thyroid carci- noma, 10% follicular variant of papillary thyroid carcinoma, 10% follicular thyroid carcinoma). Malignant nodules were associated with a greater mean MTNS (benign, 5.72 6 3.03; malignant, 16 6 3.13; P \ .05). The sensitivity, specificity, and positive predictive value of malignancy were 100%, 94.4%, and 83.3% for scores 10 and 80%, 100%, and 100% for scores 11, respectively. In nodules with indeterminate cytol- ogy (Bethesda III and IV), the pediatric MTNS showed good differentiation between benign and malignant disease, with mean scores of 7.95 and 12.5, respectively ( P = .006). Conclusion. This pilot study suggests that a comprehensive scoring system may help assess the risk of malignancy in pedia- tric thyroid nodules and differentiate nodules with indetermi- nate cytology into higher- and lower-risk categories. Given these findings, larger, multi-institutional studies are warranted. Keywords pediatric, well-differentiated thyroid carcinoma, thyroid nodules, McGill Thyroid Nodule Score, fine-needle aspira- tion biopsy, thyroid ultrasound

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