Certain ultrasound characteristics can help clinicians identify malignant thyroid nodules in children, according to a study published online May 1 in Radiology.
A team led by Dr. Danielle Richman of Brigham and Women's Hospital used data from 404 thyroid nodules in 314 patients (age range: 2-18 years) between January 2004 and July 2017. All nodules received ultrasound-guided fine-needle biopsy; the researchers recorded age, sex, background appearance of the thyroid gland for each patient, sonographic characteristics, and pathologic diagnosis for each nodule.
Of all the nodules, 77 (19.1%) were malignant, and most of these were papillary thyroid carcinoma (88.3%). The likelihood of malignancy did not differ by patient sex or puberty status, Richman and colleagues found. The cancer rate in children with a solitary nodule was higher than in those with multiple nodules (29.4% versus 14.2%, p = 0.003).
The researchers also identified a number of sonographic characteristics associated with malignant nodules, such as larger size, solid parenchyma, taller-than-wide shape, presence of speckled calcifications, lack of a smooth margin, and presence of abnormal lymph nodes.
"In children with thyroid nodules ... [these characteristics] raise concern for malignancy," they concluded.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
