Accuracy of fine needle aspiration biopsy of thyroid nodules in detecting malignancy in childhood: Comparison with conventional clinical, laboratory,and imaging approaches

In childhood the traditional diagnostic approach to thyroid nodules consist s of clinical, laboratory, and imaging evaluations. A safe and accurate pro cedure is needed to promptly identify patients who require surgery. In regard to the usefulness of fine needle aspiration biopsy, the data in t he literature concerning children and adolescents are scanty. The aim of th is study was to evaluate and compare the diagnostic accuracies of clinical, laboratory, and imaging data collected retrospectively in a group of pedia tric patients with thyroid nodules submitted to fine needle aspiration biop sy. Forty-two patients who underwent surgery for thyroid nodules, recruited in 9 Italian pediatric endocrine units, were retrospectively studied. Accordin g to histological diagnosis, they were divided into 2 groups, 22 patients w ith benign lesions and 20 patients with malignant lesions. From clinical re cords we obtained data about 1) symptoms of neck compression; 2) cervical a denopathy; 3) thyroid function, calcitonin level, and antithyroid antibody titers; 4) ultrasonography; 5) Tc-99m scintiscanning; and 6) cytology obtai ned with fine needle aspiration biopsy. Patients and nodule characteristics were analyzed statistically for associations with the presence of thyroid cancer. Among clinical findings, only adenopathy was significantly higher in the gr oup with cancer (8 of 22 benign lesions vs. 16 of 20 malignant lesions; P = 0.006). Thyroid function and antibody titers were similar in the 2 groups, whereas the serum calcitonin level was elevated only in I patient with mal ignant lesions. Among ultrasonography findings, no significant statistical difference was found between the 2 groups with regard to number, dimensions , growth progression, or hypoechogenic pattern of the nodules. Regarding sc intigraphic findings, no significant difference was found between the 2 gro ups. However, a positive correlation (r = 0.90; P < 0.0001) was found betwe en fine needle aspiration biopsy cytological findings and histological diag noses. The sensitivity, specificity, and accuracy of fine needle aspiration biopsy were 95%, 86.3%, and 90.4%, respectively. A multiple regression ana lysis showed that only fine needle aspiration biopsy (<beta> coefficient = 0.963; P < 0.0001) significantly contributed to detecting malignancy (multi ple r = 0.973; P < 0.0001). This study provides strong evidence that fine needle aspiration biopsy is a safe technique even in childhood and adolescence, offering the best sensit ivity, specificity, and accuracy in detecting malignancy compared with conv entional approaches.