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The use of the Bethesda system for reporting thyroid cytopathology in pediatric thyroid nodules - A meta-analysis.

Background Little is known about the application of The Bethesda System for Reporting Thyroid Classification (TBSRTC) in pediatric thyroid nodules. This meta-analysis was aimed to investigate the use of TBSRTC in the pediatric population. Methods Relevant articles were searched in PubMed and Web of Science. Meta-analysis of proportion and its 95% confidence interval (CI) were computed utilizing the random-effect model. We used subgroup analyses and meta-regression to explore the sources of heterogeneities. Egger's regression test and funnel plot visualization were used to examine the publication bias. Results We included 17 articles comprising of 3687 pediatric thyroid nodules for meta-analyses. TBSRTC outputs including frequency and risk of malignancy (ROM) for the majority of categories were not statistically different from recently published meta-analysis of 145,066 thyroid nodules in adult patients. The resection rate (RR) in the pediatric group was significantly higher in most of the categories as compared to the published adult data: benign, 23.2% (95% CI = 18.6 to 27.9) versus 13.0% (95% CI = 9.5 to 16.5); atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 62.6% (95% CI = 50.3 to 74.9) versus 36.2% (95% CI = 29.9 to 42.5); follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 84.3% (95% CI = 75.2 to 93.4) versus 60.5% (95% CI = 54.5 to 66.5); and suspicious for malignancy, 93.8% (95% CI = 90.1 to 97.6) versus 69.7% (95 % CI = 64.0 to 75.5). Conclusion TBSRTC is a valuable tool to make clinical decisions for pediatric patients with thyroid nodules. Pediatric patients with benign and indeterminate thyroid nodules had a higher RR than adult counterpart but ROM of these categories in adults and children was not statistically different suggesting a potential risk of overtreatment in pediatric patients. Determining the best treatment guidelines and additional tools for risk stratification must be a top priority to precisely identify the target patient groups for surgical intervention.