Cherella CE, et al. - Researchers aimed at describing the natural history and outcomes of cytologically benign, pediatric thyroid nodules. They noted a low false-negative rate with benign cytology in pediatric thyroid nodules, like that observed in adults, and in the rare cases of malignancy, excellent prognosis is seen. Most false-negative results could be identified via resection of nodules > 4 cm plus surveillance of smaller nodules and repeated aspiration for growth. For most cytologically benign pediatric nodules, follow-up ultrasound in 12 months is appropriate, but in large, predominantly cystic nodules, delaying surveillance up to 24 months may be reasonable.

Methods

• Researchers performed a cohort study at a multidisciplinary thyroid clinic at an academic medical center.
• Participants were comprised of consecutive pediatric patients (≤ 18 years old) with cytologically benign thyroid nodules evaluated between 1998 and 2016.

Results

• In 181 patients, researchers followed the cytologically benign nodules (N=237) by ultrasound for a median follow-up period of 3.4 years (range, 0.5 to 13.9 years) or to resection.
• Six nodules (2.5%) were found to be malignant, and all six patients were disease-free after a median follow-up of 4.9 years.
• Nodules > 4 cm (15.4%; P=0.037) or that grew during follow-up (6.0%; P=0.048) were more frequently malignant.
• At 6, 12, and 24 months, the likelihood of nodule growth (±SE) was 15% ± 3%, 24% ± 4%, and 49% ± 10%, respectively.
• Among nodules > 2 cm, growth rate was relatively low in those with ≥25% cystic content vs nodules < 25% cystic; nodules < 2 cm grew similarly regardless of cystic content.