Physical examination of pediatric thyroid nodules valuable in diagnosis

In study findings presented at the Pediatric Academic Societies annual meeting, more than 25% of pediatric patients with a thyroid nodule >0.8 cm had thyroid cancer with lymphadenopathy, palpability and nodule size significantly associated with malignancy.

“Physical examination of the pediatric patient with a possible thyroid nodule still plays a vitally important role in helping to differentiate which children have a higher likelihood of thyroid cancer,” Melissa A. Buryk, MD, of the Children’s Hospital of Pittsburgh, said in an email interview. “In any child who has a palpable nodule, concern for a nodule with lymphadenopathy or 1 cm or greater nodule on ultrasound, a fine needle aspiration (with molecular markers if the cytology reveals equivocal findings) will help best determine which patients should go on to surgery and which can be followed clinically.”

In a retrospective chart review, Buryk and colleagues looked at pediatric patients younger than 18 years diagnosed with a thyroid nodule from January 2007 to January 2012. Of those patients, 89 met the criteria of having a thyroid nodule >0.8 cm and fine needle aspiration (FNA) or thyroid biopsy.

Forty patients underwent surgery and 24 (27%) were found to have thyroid cancer. Those with thyroid cancer had a median nodule size of 2.2 cm, whereas those without thyroid cancer had a median nodule size of 1.5 cm (P=.047). Lymphadenopathy was present in 34% of malignant cases vs. 5% of benign (P<.001), and the nodule was palpable in 86% of malignant cases vs. 58% of benign cases (P=.018).

Yet, incidental imaging finding was present in only 4% of thyroid cancer cases, whereas 20% of non-cancerous cases had that finding.

“Patients referred for nodules found ‘incidentally’ on imaging performed for another reason are an increased source of referral,” Buryk said. “Appropriate management is important to avoid patient and parent anxiety and the vast majority of nodules identified incidentally were benign and could be safely followed.”

In addition, a molecular mutation panel was routinely performed on FNA specimens and identification of a molecular mutation was associated with malignancy in 100% of cases in which a mutation was present. Of the mutation-negative cases, 44% were malignant.

“Molecular mutation analysis plays an important role in understanding in pediatric thyroid cancer,” Buryk said.

She said the researchers will continue to perform more comprehensive molecular panels in children to better understand the biological differences between pediatric and adult thyroid cancer and guide follow-up care.

“This is not a trivial diagnosis, nor is it rare,” Buryk said. “It is not uncommon for children with a thyroid nodule to have thyroid cancer; therefore, physicians should be able to appropriately examine and refer for additional studies as part of a multidisciplinary team to provide the best care for these patients.” — by Katrina Altersitz

For more information:

Buryk MA. Platform presentation #3545.8. Presented at: Pediatric Academic Societies and Asian Society for Pediatric Research joint meeting; May 3-6, 2014; Vancouver, British Columbia.

Disclosure: Buryk reports no relevant financial relationships.