Validity of the American College of Radiology Thyroid Imaging Reporting and Data System in Children
Presented at the American Society of Pediatric Otolaryngology Annual Meeting, Combined Otolaryngology Spring Meetings (COSM), Virtual Meeting, April 9, 2021 and at the Pennsylvania Academy of Otolaryngology Annual Scientific Meeting, Virtual Meeting, June 19, 2021.
The authors have no conflicts of interest to disclose.
Editor's Note: This Manuscript was accepted for publication on September 14, 2022.
Abstract
Objective
To assess the validity of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for evaluating thyroid nodules in children.
Methods
Patients aged <19 years with thyroid nodule(s) evaluated by ultrasound (US) from 2007–2018 at a tertiary children's hospital were included. Two radiologists scored de-identified thyroid US images using ACR TI-RADS (from 1, “benign” to 5, “highly suspicious”). The radiologists recorded size and rated vascularity for each nodule. Ultrasound findings were compared to pathology results (operative cases, n = 91) and clinical follow-up without disease progression (non-operative cases, n = 15).
Results
Thyroid images from 115 patients were reviewed. Nine patients were excluded due to the absence of an evaluable nodule. Forty-seven benign and 59 malignant nodules were included. Median age at ultrasound was 15 years (range 0.9–18 years). Twenty (18.9%) patients were male. There was moderate agreement between TI-RADS levels assigned by the two raters (kappa = 0.57, p < 0.001). When the raters' levels were averaged, >3 as the threshold for malignancy correctly categorized the greatest percentage of nodules (68.9%). Eleven (18.6%) malignant nodules received a TI-RADS level of 2 (n = 3) or 3 (n = 8). Sensitivity, specificity, and positive and negative predictive values were 81.4%, 53.2%, 68.6%, and 69.4%, respectively. Although not part of TI-RADS, vascularity was similar between benign and malignant nodules (p = 0.56).
Conclusion
In a pediatric population, TI-RADS can help distinguish between benign and malignant nodules with comparable sensitivity and specificity to adults. However, the positive and negative predictive values suggest TI-RADS alone cannot eliminate the need for FNA.
Level of Evidence
3 Laryngoscope, 133:2394–2401, 2023
