Application of the Bethesda System for Reporting Thyroid Cytopathology in the Pediatric Population

Abstract

Objectives: We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules.

Methods: Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries.

Results: Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories.

Conclusions: Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population.

Keywords: Children; Fine-needle aspiration; Pediatric; Resection rate; Risk of malignancy; The Bethesda System; Thyroid; Thyroid cancer; Thyroid nodules.