Age-specific risk of malignancy in pediatric thyroid cytology: Reframing risk-of-malignancy (ROM) based on pre-test probability
Authors' conclusion
Age substantially modifies both pretest and post-test malignancy probabilities in pediatric thyroid cytology.
Study context
- Population
- Patients aged 0–25 years with thyroid fine-needle aspirations (FNAs), multiple tertiary centers (2000–2023), classified by 2023 Bethesda System
- Participants
- 2,728 FNAs
- Comparison
- 0-8 years vs 9-14 years vs 15-18 years vs 19-25 years
- Outcome
- Age-specific ROM, LRs and post-test malignancy probabilities by Bethesda category
Methodological detailstertiary centres, age-stratified, Bayesian post-test probability analysis
- Tertiary centres
- Age-stratified
- Bayesian post-test probability analysis
Performance
As reported in the abstract
Malignancy prevalence among operated nodules
- Malignancy prevalence, lower-bound assumption
- 24.6% (671/2728)
- Malignancy prevalence among surgical cases
- 67.7% (671/991)
- Upper-bound vs lower-bound ROM across categories
- 2-10 times higher
- Benign cytology likelihood ratios (LRs)
- 0.07-0.15
- Post-test malignancy probability after benign cytology
- 0-25%
- Follicular neoplasm post-test risk, 9-year-old
- ∼71%
- Follicular neoplasm post-test risk, 24-year-old
- ∼49%
Original publication
Age-specific risk of malignancy in pediatric thyroid cytology: Reframing ROM based on pre-test probability. J Clin Endocrinol Metab. Published 25 February 2026. doi:10.
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