Thyroid Nodule in a Child: Applicability of ACR TI-RADS and ATA Recommendations (Pediatrics)
What is Available in the Fragments
The provided sources do not include directly adapted pediatric thresholds for ACR TI-RADS or pediatric-specific ATA criteria. A specialized publication on management of thyroid nodules and differentiated thyroid cancer in children is cited: Francis GL, Waguespack SG, Bauer AJ, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 2015; 25:716-759. Specific pediatric thresholds from this publication are not cited in the fragments [verification needed].
Ultrasound Features Underlying TI-RADS Systems
According to the consensus materials, the set of suspicious features that formed the basis of ACR/EU-TIRADS includes: solidity, hypoechogenicity/marked hypoechogenicity, irregular/indistinct margins, microcalcifications, and taller-than-wide shape.
Regarding Categories with Subcategories 4a/4b (Kwak TI-RADS)
Conclusions such as "TI-RADS 4A" refer to the Kwak TI-RADS classification, not ACR TI-RADS or EU-TIRADS, which do not have subcategories 4a/4b. Kwak categories according to the fragments:
| Category | Interpretation | Malignancy Risk |
|---|---|---|
| 1 | Normal thyroid | — |
| 2 | Benign nodule | ~0% |
| 3 | Probably benign | <5% |
| 4a | Low suspicion, 1 suspicious feature | ~5–10% |
| 4b | Intermediate suspicion, 2 features | ~10–50% |
| 4c | High suspicion, 3–4 features | ~50–85% |
| 5 | All 5 features | >85% |
| 6 | Cytologically/histologically confirmed malignancy | — |
Clinical Conclusion
For pediatric patients, the available materials reference separate recommendations for nodule management and differentiated thyroid cancer in children (Francis et al., Thyroid 2015); specific pediatric thresholds for ACR TI-RADS and ATA are not presented in the fragments and require verification from primary sources [verification needed].
Frequently asked questions
Are there subcategories 4a/4b in ACR TI-RADS?
No. Subcategories 4a/4b/4c belong to the Kwak TI-RADS classification; such subcategories do not exist in ACR TI-RADS or EU-TIRADS.
Which ultrasound features are considered suspicious?
Solidity, hypoechogenicity/marked hypoechogenicity, irregular/indistinct margins, microcalcifications, and taller-than-wide shape.
Are there separate recommendations for thyroid nodules in children?
Yes, the fragments cite the publication by Francis GL, Waguespack SG, Bauer AJ, et al. on management of nodules and differentiated thyroid cancer in children (Thyroid 2015; 25:716-759).
Are pediatric thresholds for ACR TI-RADS/ATA provided in the fragments?
No, specific numerical pediatric criteria are not provided in the available materials [verification needed].
What is the malignancy risk for category 4a according to Kwak classification?
According to the fragments—low suspicion (1 feature), with malignancy risk approximately 5–10%.