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Title: Fine-needle aspiration biopsy in the diagnosis of nodular thyroid disease in children

Ewa Małecka-Tendera, Paweł Matusik, Barbara Jarząb, Barbara Dobrowolska-Wiciak
Original articles
Pediatric Endocrinology, Diabetes and Metabolism
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Final page:
fine-needle aspiration biopsy, nodular thyroid disease, children

Background: Fine-needle aspiration biopsy (FNAB) is a standard diagnostic procedure for adult patients withthyroid nodules. However, it is still controversial whether in pediatric patients thyroid nodules should be aspirated or excised. The aim of the study was to determine the usefulness of FNAB in clinical evaluation andfollow up of children with nodular thyroid disease.Material and methods: The study group comprised 36 children (33 girls and 3 boys) aged from 10 to 18 years(mean age 13.6 years) with nodular goiter. All children were in euthyreosis and their goiter size ranged fromIAo to IIIo according to WHO criteria. In all the patients FNAB was performed and in 13 it was repeated after 4-8 months.Results: Cytology of the first FNAB in 25 (69.5%) children showed colloid nodules, in 3 (8.3%) - carcinoma papillare, in 3 (8.3%) - neoplasma folliculare (NF), in 4 (11.1%) - Hashimoto thyroiditis and in 1 (2.8%) - thyroiditis granulosa de Quervaine. In one girl, in whom colloid nodule was cytologically diagnosed, FNABwas repeated after 4 months because of the nodule growth and change in the USG structure revealed papillarycarcinoma. In one boy NF diagnosed in first biopsy was not confirmed in the second one (patientís parentsrefused the consecutive biopsy). All children with malignant or suspicious cytology and three with goitersize IIIo were operated and postoperative histopathological examination was performed. All colloid nodules were confirmed histopathologically, but in one patient with a large colloid goiter follicular adenoma was found.In two children with NF in cytology - follicular adenoma was found and in three patients with papillarycarcinoma in FNAB - the diagnosis was confirmed. In all children in whom thyroid nodules did not expandin the volume, did not change their structure or regressed on USG, repeated FNAB confirmed the first diagnosis.Conclusions: 1. FNAB is useful in diagnosis and management of nodular thyroid disease in children. 2. Cytologyof repeated biopsies of the nodules that decreased or did not increase in size confirms the primary diagnosis.3. All children with thyroid nodules have to be carefully followed-up, and in case of nodule growth and/or change of the USG picture, repeated FNAB is necessary.