Thyroid nodules are relatively rare in the pediatric population compared with the adult population, affecting 1.6 to 1.8% of children and adolescents. However, the risk of malignancy at presentation is much higher and the presentation of a patient with a thyroid nodule in pediatrics represents a diagnostic challenge for physicians as management decisions often depend on whether a nodule is malignant or benign. As part of the clinical workup for thyroid nodules, a variety of diagnostic studies are indicated to detect or dismiss malignancy, including thyroid function tests (eg, T3 and T4, TSH, and thyroid antibodies), radioiodine scanning, ultrasound imaging, and fine-needle aspiration biopsy. Of the available preoperative diagnostic tools, fine-needle aspiration cytology (FNAC) seems to be the most accurate tool in the diagnosis of a thyroid nodule. In adults, FNAC has been established in large reviews as a useful test in the differentiation of a thyroid nodule as malignant or benign. As a result, FNAC has significantly reduced the number of surgeries for nodules preoperatively diagnosed as benign. Due to the higher risk of malignancy in pediatric thyroid nodules, it is common practice in many institutions to remove surgically any with FNAC playing a limited role in the treatment algorithm. This is partly because of the lack of consensus and available literature regarding the utility of FNAC of thyroid nodules in the pediatric population. Many research groups have found that FNAC in children and adolescents is a highly sensitive and accurate test in differentiating benign from malignant nodules. Of these, most groups have also suggested that FNAC can reduce the need for surgery for those with benign cytology results. However, other studies have shown the opposite: that FNAC in pediatrics is not as accurate as physicians had hoped for and that surgery and subsequent pathology diagnosis are still required to rule out a malignant thyroid nodule. This study is a systematic review of all available studies that look at the diagnostic value of fine-needle aspiration biopsy of the thyroid in the pediatric population. Studies that looked at sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were included. Finally, the studies were analyzed for quality according to items on the QUADAS quality checklist for diagnostic studies developed by Whiting et al.
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