MAYWOOD, IL – A Loyola Medicine study has found that new ultrasound guidelines can reliably identify pediatric patients who should be biopsied for thyroid cancer. The study by radiologist Jennifer Lim-Dunham, MD, and colleagues was presented May 18 during the Society for Pediatric Radiology's annual meeting in Nashville.

Thyroid cancer is a common cause of cancer in teenagers, and the incidence is increasing for reasons that are unclear. Adolescents have a 10-fold greater incidence than younger children, and the disease is five times more common in girls than boys.

The thyroid is a butterfly-shaped gland at the base of the neck that secretes hormones needed for regulation of growth, development and metabolism. Cancer may occur within lumps in the thyroid called nodules.

Thyroid nodules typically are found during routine physical exams or on imaging tests such as CT scans done for other reasons. A definitive diagnosis requires a percutaneous fine-needle aspiration biopsy – a minimally invasive procedure in which a physician uses a very small needle to withdraw cells from the nodule. The cells are sent to a pathologist, who makes the diagnosis.

Since most nodules are benign, not all of them require biopsy. Ultrasound exams are used to identify those nodules that look suspicious enough to require biopsy. In 2017, the American College of Radiology (ACR) released a system for grading nodules on a 1 to 5 scale, with 1 being benign and 5 being highly suspicious of cancer. The grades are based on ultrasound features, such as how white or black the nodule appears (echogenicity), whether the edges of the nodule are jagged or smooth and whether there are white dots inside the nodule (echogenic foci).

In the Loyola study, two radiologists used the ACR system to retrospectively grade 74 thyroid nodules from 62 pediatric patients. The ACR grading system proved to be accurate and reproducible. For every one unit increase in the 1-to-5 ACR scale, nodules were 2.63 times more likely to have a malignant diagnosis confirmed by biopsy or surgery.

The findings should reassure physicians and parents that the ACR system can be reliably used to differentiate between thyroid nodules in children that require biopsy and those that do not, Dr. Lim-Dunham said. An earlier study led by Dr. Lim-Dunham found that a different set of thyroid nodule ultrasound guidelines from the American Thyroid Association also are reliable in children.

The new study is titled "Malignancy Risk Stratification of Pediatric Thyroid Nodules Using ACR Thyroid Imaging, Reporting and Data System (ACR TI-RADS)."

In addition to Dr. Lim-Dunham, other co-authors are Iclal Erdem Toslak, MD, Michael Reiter, MD, and Brendan Martin, PhD.

About Loyola Medicine

Loyola Medicine, a member of Trinity Health, is a nationally ranked academic, quaternary care system based in Chicago's western suburbs. The three-hospital system includes Loyola University Medical Center (LUMC), Gottlieb Memorial HospitalMacNeal Hospital, as well as convenient locations offering primary care, specialty care and immediate care services from nearly 2,000 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, the John L. Keeley, MD, Emergency Department, a Level 1 trauma center, Illinois's largest burn center, the Nancy W. Knowles Orthopaedic Institute, a certified comprehensive stroke centertransplant center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its academic affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing.   

For more information, visit loyolamedicine.org. You can also follow Loyola Medicine on LinkedIn, Facebook, Instagram or X (formerly known as Twitter).

About Trinity Health

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 127,000 colleagues and more than 38,300 physicians and clinicians caring for diverse communities across 26 states. Nationally recognized for care and experience, the Trinity Health system includes 93 hospitals, 107 continuing care locations, the second largest PACE program in the country, 142 urgent care locations and many other health and well-being services. In fiscal year 2024, the Livonia, Michigan-based health system invested $1.3 billion in its communities in the form of charity care and other community benefit programs. For more information, visit us at www.trinity-health.org, or follow us on LinkedIn, Facebook, and X (formerly known as Twitter).