Nódulos tireoidianos e carcinoma papilífero na infância e adolescência: preditores clínico patológicos de malignidade e metástase cervical

Abstract

The incidence of thyroid nodules and differentiated thyroid carcinomas in children and adolescents has increased in recent decades, with a biological behavior distinct from that observed in adults and a higher frequency of lymph node metastasis. This study had three objectives: (1) to describe the clinical, laboratory, ultrasonographic, cytological, and histopathological profile of children and adolescents undergoing thyroidectomy; (2) to identify predictors of benignity and malignancy in thyroid nodules; and (3) to investigate clinicopathological predictors of cervical metastasis in patients with papillary thyroid carcinoma. A retrospective study was conducted including patients younger than 18 years who underwent thyroid surgery between January 2013 and May 2023. Surgical indications, ultrasonography findings, and fine-needle aspiration biopsy results were analyzed, along with histopathological findings standardized according to the 5th edition of the World Health Organization (WHO) classification and the College of American Pathologists (CAP) protocol, staging based on the 8th edition of the American Joint Committee on Cancer (AJCC), risk stratification according to the American Thyroid Association pediatric guidelines (ATA, 2015), use of radioiodine therapy, and oncological outcomes. Factors associated with outcomes were evaluated using bivariate analyses, multivariate logistic regression, and Firth’s penalized regression. Among 91 patients, 40.6% had malignant neoplasms, predominantly papillary thyroid carcinoma, with cervical lymph node involvement in 78.1% of cases (25/32). Ultrasonographic microcalcifications (OR 28.64; 95%CI 3.29–249.31; p = 0.002) and age ≤ 10 years (OR 5.69; 95%CI 1.21–26.75; p = 0.028) were independent predictors of malignancy. In the subcohort of 32 papillary thyroid carcinomas, only extrathyroidal extension remained an independent predictor of cervical metastasis after multivariate adjustment (OR 14.29; 95%CI 1.28–2028.82; p = 0.028). These findings reinforce the high rate of locoregional dissemination of papillary thyroid carcinoma and highlight the role of structured ultrasonographic assessment and detailed histopathological analysis in risk stratification and surgical planning.