Diagnosis of Thyroid Cancer in Children: Value of Gray-Scale and Power Doppler US

PURPOSE: To prospectively analyze the accuracy of various diagnostic criteria for cancer in solid thyroid nodules in children on the basis of gray-scale and power Doppler ultrasonographic (US) findings.

MATERIALS AND METHODS: The study protocol was approved by the institutional review board, and patient’s parents gave full informed consent. One hundred three consecutive pediatric patients with solid thyroid nodules were included in the study. Thirty-five patients had thyroid cancer (mean age, 14.6 years ± 2.6 [standard deviation]; range, 10–18 years), and 68 patients had benign thyroid nodules (mean age, 14.2 years ± 2.9; range 9–18 years). Three-dimensional US was used to determine the volume of thyroid gland and thyroid nodules. Results of nodule cytologic and histologic examination and long-term clinical and US follow-up were used as a proof of final diagnosis. The following US characteristics were evaluated: location, echogenicity, echotexture, outline, presence of a halo, microcalcifications, and type of vascularization. Multivariate logistic regression analysis was used to evaluate the accuracy of US criteria for thyroid cancer in lesions with diameter of 15 mm and smaller and lesions with diameter larger than 15 mm. Qualitative variables were compared by using the χ2 test and quantitative variables were compared by using the Student t test. Significance was defined at P < .05.

RESULTS: In thyroid nodules with diameter of 15 mm and smaller, the most reliable diagnostic criteria for malignancy were an irregular outline (sensitivity, 69.6%; specificity, 86.4%; P < .001), subcapsular location (sensitivity, 65.2%; specificity, 86.4%; P < .001), and increased intranodular vascularization (sensitivity, 69.6%; specificity, 87.9%; P < .01). For thyroid nodules larger than 15 mm in diameter, the accuracy of US diagnosis was much lower than that for smaller nodules. The only reliable criterion for cancer in this group was hypoechogenicity (sensitivity, 60.0%; specificity, 84.0%; P < .01).

CONCLUSION: Study findings indicate that US is most helpful in diagnosis of thyroid malignancy in thyroid nodules with diameter of 15 mm and smaller, with detection of irregular tumor outline, subcapsular location, and increased intranodular vascularization.

© RSNA, 2005


  • 1 Raab SS, Silverman JF, Elsheikh TM, Thomas PA, Wakely PE. Pediatric thyroid nodules: disease demographics and clinical management as determined by fine needle aspiration biopsy. Pediatrics 1995; 95:46-49. Crossref, MedlineGoogle Scholar
  • 2 Gorlin JB, Sallan S. Thyroid cancer in childhood. Endocrinol Metab Clin North Am 1990; 19:649-662. Crossref, MedlineGoogle Scholar
  • 3 Constine L, Paidas C, Schwartz CL, et al. Pediatric solid tumors. In: Rubin P, eds. Clinical oncology. Philadelphia, Pa: Saunders, 2001; 336. Google Scholar
  • 4 Wu XC, Chen VW, Steele B, et al. Cancer incidence in adolescents and young adults in the United States, 1992–1997. J Adolesc Health 2003; 32:405-415. Crossref, MedlineGoogle Scholar
  • 5 Bucsky P, Parlowsky T. Epidemiology and therapy of thyroid cancer in childhood and adolescence. Exp Clin Endocrinol Diabetes 1997; 105(suppl 4):70-73. Google Scholar
  • 6 Kazakov VS, Demidchik EP, Astakhova LN. Thyroid cancer after Chernobyl (letter). Nature 1992; 359:21. CrossrefGoogle Scholar
  • 7 Ron E. Thyroid cancer In: Schottenfeld D, Fraumeni JF Jr, eds. Cancer epidemiology and prevention. 2nd ed. New York, NY: Oxford University Press, 1996. Google Scholar
  • 8 Reiners C. Sequelae of Czernobyl. Internist (Berl) 1998; 39:592-593. Crossref, MedlineGoogle Scholar
  • 9 Grigsby PW, Galor A, Michalski JM, Doherty GM. Childhood and adolescent thyroid carcinoma. Cancer 2002; 95:724-729. Crossref, MedlineGoogle Scholar
  • 10 Pacini F, Vorontsova T, Demidchik EP, et al. Post-Chernobyl thyroid cancer in Belarus children and adolescents: comparison with naturally occurring thyroid cancer in Italy and France. J Clin Endocrinol Metab 1997; 82:3563-3569. MedlineGoogle Scholar
  • 11 Eden K, Mahon S, Helfand M. Screening high-risk populations for thyroid cancer. Med Pediatr Oncol 2001; 36:583-591. Crossref, MedlineGoogle Scholar
  • 12 Yip F, Reeve T, Poole A, Delbridge L. Thyroid nodules in childhood and adolescence. Aust N Z J Surg 1994; 64:676-678. Crossref, MedlineGoogle Scholar
  • 13 Bentley AA, Gillespie C, Malis D. Evaluation and management of a solitary thyroid nodule in a child. Otolaryngol Clin North Am 2003; 36:117-128. Crossref, MedlineGoogle Scholar
  • 14 Degnan B, McClellan D, Francis G. An analysis of fine-needle aspiration biopsy of the thyroid in children and adolescents. J Pediatr Surg 1996; 31:903-907. Crossref, MedlineGoogle Scholar
  • 15 Koike E, Noguchi S, Yamashita H, et al. Ultrasonographic characteristics of thyroid nodules: prediction of malignancy. Arch Surg 2001; 136:334-337. Crossref, MedlineGoogle Scholar
  • 16 Lagalla R, Caruso G, Novara V, Cardinale AE. Flowmetric analysis of thyroid diseases: integration with qualitative color-Doppler imaging. Radiol Med (Torino) 1993; 85:606-610. MedlineGoogle Scholar
  • 17 Schlogl S, Werner E, Lassmann M, et al. The use of three-dimensional ultrasound for thyroid volumetry. Thyroid 2001; 11:569-574. Crossref, MedlineGoogle Scholar
  • 18 World Health Organization & International Council for Control of Iodine Deficiency Disorders. Recommended normative values for thyroid volume in children aged 6–15 years. Bull World Health Organ 1997; 75:95-97. MedlineGoogle Scholar
  • 19 Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993; 118:282-289. Crossref, MedlineGoogle Scholar
  • 20 Hermanek P, Sobin L, eds. TNM classification of malignant tumors: International Union Against Cancer New York, NY: Springer-Verlag, 1987; 248. Google Scholar
  • 21 Riffenburgh RH. Statistics in medicine New York, NY: Academic Press, 1999; 581. MedlineGoogle Scholar
  • 22 Health Consequences of the Chernobyl Accident. Results of the IPHECA pilot project and related national programs Scientific report. Geneva, Switzerland: World Health Organization, 1996; 445. Google Scholar
  • 23 Nagataki S. Atomic bomb survivors. In: Thomas G, Karaoglou A, Williams ED, eds. Radiation and thyroid cancer. Proceedings of an International Seminar on Radiation and Thyroid Cancer. Brussels, Luxembourg: World Scientific, 1999; 35-42. Google Scholar
  • 24 Drozd V, Polyanskaya O, Ostapenko V, Demidchik Y, Biko I, Reiners C. Systematic ultrasound screening as a significant tool for early detection of thyroid carcinoma in Belarus. J Pediatr Endocrinol Metab 2002; 15:979-984. MedlineGoogle Scholar
  • 25 Drozd V, Astachova L, Polyanskaya O, et al. Characteristics of thyroid ultrasound pictures in children with nodular thyroid changes effected by radionuclides. Bildgebung 1995; 62:236-241. MedlineGoogle Scholar
  • 26 Drozd V, Demidchik E, Harabets L, Lyshchik A, Reiners C. Early diagnostics of radiation induced thyroid cancer in children of Belarus by ultrasound. In: Thomas G, Karaoglou A, Williams ED, eds. Radiation and thyroid cancer. Proceedings of an International Seminar on Radiation and Thyroid Cancer. Brussels, Luxembourg: World Scientific, 1999; 425-431. Google Scholar
  • 27 Ross DS. Nonpalpable thyroid nodules-managing an epidemic. J Clin Endocrinol Metab 2002; 87:1938-1940. Crossref, MedlineGoogle Scholar
  • 28 Hagag P, Strauss S, Weiss M. Role of ultrasound-guided fine-needle aspiration biopsy in evaluation of nonpalpable thyroid nodules. Thyroid 1998; 8:989-995. Crossref, MedlineGoogle Scholar
  • 29 Rago T, Vitti P, Chiovato L, et al. Role of conventional ultrasonography and color flow-Doppler sonography in predicting malignancy in “cold” thyroid nodules. Eur J Endocrinol 1998; 138:41-46. Crossref, MedlineGoogle Scholar
  • 30 Solbiati L, Osti V, Cova L, Tonolini M. Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol 2001; 11:2411-2424. Crossref, MedlineGoogle Scholar
  • 31 Brkljacic B, Cuk V, Tomic-Brzac H, Bence-Zigman Z, Delic-Brkljacic D, Drinkovic I. Ultrasonic evaluation of benign and malignant nodules in echographically multinodular thyroids. J Clin Ultrasound 1994; 22:71-76. Crossref, MedlineGoogle Scholar
  • 32 Leenhardt L, Hejblum G, Franc B, et al. Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules. J Clin Endocrinol Metab 1999; 84:24-28. Crossref, MedlineGoogle Scholar
  • 33 Kim EK, Park CS, Chung WY, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002; 178:687-691. Crossref, MedlineGoogle Scholar
  • 34 Papini E, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002; 87:1941-1946. Crossref, MedlineGoogle Scholar

Article History

Published in print: May 2005