Assessing the diagnostic accuracy of TI-RADS in pediatric thyroid nodules: a multi-institutional review

rivatsa S; l-Hadidi A; Stanek J; Horvath K; Parsons L; Martinez-Rios C; Hopp A; Engle S; Plunk M; Shapira-Zaltsberg G; Nagar S; Masters S; Al-Katib S; Tucker R; AAtweh L; hah S; Bobbey A; Hoffman R; Aldrink JH

doi:10.1530/ey.22.3.15

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ESPE Yearbook of Paediatric Endocrinology (2025) 22 3.15 | DOI: 10.1530/ey.22.3.15

ESPEYB25 3. Thyroid Thyroid imaging (2 abstracts)

3.15. Assessing the diagnostic accuracy of TI-RADS in pediatric thyroid nodules: a multi-institutional review

Srivatsa S , Al-Hadidi A , Stanek J , Horvath K , Parsons L , Martinez-Rios C , Hopp A , Engle S , Plunk M , Shapira-Zaltsberg G , Nagar S , Masters S , Al-Katib S , Tucker R , AAtweh L , Shah S , Bobbey A , Hoffman R & Aldrink JH

J Pediatr Surg. 2025 Jan;60(1):161924. doi: 10.1016/j.jpedsurg.2024.161924. PMID: 39358076

Brief Summary: This retrospective multi-institutional study assessed the diagnostic performance of the adult validated American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) system,and a novel developed and tested pediatric (PED) TI-RADS,compared to American Thyroid Association (ATA) size criteria alone to predict malignancy in pediatric thyroid nodules [1]. Data on 291 nodules from 260 patients (aged 1.3 to 21 years) across 4 institutions were analyzed. Fine-needle aspiration biopsy (FNAB) was performed on 236 nodules, and 99 patients underwent surgical resection with subsequent pathological diagnosis. 46 of these 99 (46.5%) patients had malignancy on the surgical pathology report, giving an overall malignancy rate of 17.7%.

Analyses of sensitivity, specificity, accuracy, and positive/negative predictive of the ACR TI-RADS and the novel PED TI-RADS (with smaller thyroid nodule diameters than used for ACR TI-RADS: FNAB for nodules with a ACR TI-RADS 3 >1.5 cm, TI-RADS 4 >1.0 cm, and TI-RADS 5 any feasible size)to predict malignancy showed that,with respect to sensitivity (100%),they outperformed previous ATA nodule size criteria when using malignancy on surgical pathology as the true positive. The PED TI-RADS prevented more unnecessary FNAB than using ATA criteria.

Another study in 2024, by Ortega et al, published a retrospective evaluation of the ACR TI-RADS to predict malignancy in pediatric thyroid nodules [2]. From that analysis of 96 patients, of whom 50 (52%) had a malignant nodule on surgical pathology, they proposed to modify the TI-RADS withlower nodule size thresholds for FNAB: they suggest FNAB for all TR3 nodules ≥1.5 cm, and FNAB for TR4 and TR5 nodules ≥0.5 cm.

Interestingly, size criteria differed between the studies by Srivatsa et al and Ortega et al. If a PED TI-RADS is developed for general use, these should be harmonized.

References: 1. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, CeruttiJM,Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M,Thompson GB, Yamashita S. American thyroid association guidelines taskforce. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 2015 Jul;25(7):716e59. https://doi.org/10.1089/thy.2014.0460. PMID: 25900731.2. Carlos A Ortega, Jean-Nicolas Gallant, IremKilic, Siddharth Patel, Sheau-Chiann Chen 5, C Burton Wood, Ryan Adams, Fadi Azer, Huiying Wang, Jiancong Liang, Sara H Duffus, Ryan H Belcher, Rochelle F Andreotti, Rekha Krishnasarma, Jennifer E Lim-Dunham, Güliz A Barkan, Fei Ye, Vivian L Weiss. Evaluation and application of American College of Radiology Thyroid Imaging Reporting and Data System for improved malignancy detection in paediatric thyroid nodules. Cytopathology. 2024 Nov;35(6):749-756. doi: 10.1111/cyt.13414. PMID: 38946029.