September 2019 HSC Section 1 Congenital and Pediatric Problems

Otolaryngology–Head and Neck Surgery 157(4)

sensitive, as all subjects in our study with a score 10 were diagnosed with benign nodular disease. The combination of these findings shows promise for this tool to be utilized clini- cally in decision making regarding the management of pediatric thyroid nodules—specifically, those that have indeterminate cytology. As the distribution of MTNSs differ from that in the original MTNS study, 12 a multi-institutional study is the next step to validate modifications. Our hope is that this pilot study opens the conversation for the need of tools similar to the MTNS in the pediatric population, which will ultimately assist families and patients in the process of weighing the risks and benefits of surgical intervention with their physicians. This study should be interpreted in light of several poten- tial limitations. There is an inherent selection bias within the cohort, as it included only patients with thyroid nodules that underwent surgical resection. However, our patient pop- ulation had wide variation, ranging from those with nodules highly suspicious for malignancy to those with lower suspicion—for example, 1 family elected surgery for cos- metic concerns related to goiter and another, for anxiety related to the continual surveillance of a neoplasm (ie, in a young child who had frequent biopsies and ultrasounds). This study is also limited by the novel cytologic scoring system developed per the consensus of surgeons and pathol- ogists from Connecticut Children’s Medical Center and McGill University. Last, given the rarity of pediatric well- differentiated thyroid cancer, the sample size of this study was fairly small. A multi-institutional investigation would help overcome this limitation. Conclusion The results of this pilot study suggest that a combined scor- ing system, such as the MTNS, may be a useful preopera- tive tool in discriminating benign from malignant thyroid disease in children and adolescents—specifically, nodules with indeterminate cytology. Further development of this comprehensive clinical suspicion index will help facilitate communication with physicians, guide clinical management, and assist families in the informed consent process. Larger, multi-institutional studies are warranted to validate a modi- fied MTNS for the pediatric population. Acknowledgments We thank Louise Rochon, MD (Department of Pathology, Jewish General Hospital, McGill University, Montreal, Canada), and Preetha Krishnamoorthy, MD (Division of Endocrinology and Metabolism, McGill University, Montreal, Canada), for their con- tributions in the development of the modified MTNS. Author Contributions Michael Canfarotta , conception and design of work; drafting of initial manuscript and revision; approval of manuscript; agreement to be accountable for all aspects of work; Douglas Moote , concep- tion and design of work; drafting of initial manuscript and revision; approval of manuscript; agreement to be accountable for all aspects of work; Christine Finck , conception and design of work; drafting of initial manuscript and revision; approval of manuscript;

agreement to be accountable for all aspects of work; Rebecca Riba-Wolman , conception and design of work; drafting of initial manuscript and revision; approval of manuscript; agreement to be accountable for all aspects of work; Shefali Thaker , conception and design of work; drafting of initial manuscript and revision; approval of manuscript; agreement to be accountable for all aspects of work; Trudy J. Lerer , conception and design of work; review of manuscript; approval of manuscript; agreement to be accounta- ble for all aspects of work; Richard J. Payne , conception and design of work; review of manuscript; approval of manuscript; agreement to be accountable for all aspects of work; Valerie Cote , conception and design of work; drafting of initial manuscript and revision; approval of manuscript; agreement to be accountable for all aspects of work. References 1. Raab SS, Silverman JF, Elsheikh TM, Thomas PA, Wakely PE. Pediatric thyroid nodules: disease demographics and clini- cal management as determined by fine needle aspiration biopsy. Pediatrics . 1995;95:46-49. 2. Siegel DA, King J, Tai E, Buchanan N, Ajani UA, Li J. Cancer incidence rates and trends among children and adoles- cents in the United States, 2001-2009. Pediatrics . 2014;134; e945-e955. 3. Hogan AR, Zhuge Y, Perez EA, Koniaris LG, Lew JI, Sola JE. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surg Res . 2009;156:167-172. 4. O’Gorman CS, Hamilton J, Rachmiel M, Gupta A, Ngan BY, Daneman D. Thyroid cancer in childhood: a retrospective review of childhood course. Thyroid . 2010;20:375-380. 5. Welch Dinauer CA, Tuttle RM, Robie DK, et al. Clinical fea- tures associated with metastasis and recurrence of differen- tiated thyroid cancer in children, adolescents and young adults. Clin Endocrinol . 1998;49:619-628. 6. Harness JK, Thompson NW, McLeod MK, Pasieka JL, Fukuuchi A. Differentiated thyroid carcinoma in children and adolescents. World J Surg . 1992;16:547-553. 7. Vassilopoulou-Sellin R, Klein MJ, Smith TH, et al. Pulmonary metastases in children and young adults with differentiated thyroid cancer. Cancer . 1993;71:1348-1352. 8. Frankenthaler RA, Sellin RV, Cangir A, Goepfert H. Lymph node metastasis from papillary-follicular thyroid carcinoma in young patients. Am J Surg . 1990;160:341-343. 9. Gupta A, Ly S, Castroneves LA, et al. A standardized assess- ment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab . 2013;98: 3238-3245. 10. Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Encocrin Relat Cancer . 2006;13:427-453. 11. Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Asssociazone Medici Endocrinolgi medical guidelines for clinical practice for the diagnosis and man- agement of thyroid nodules. Endocr Pract . 2006;12:63-102. Disclosures Competing interests: None. Sponsorships: None. Funding source: None.

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