Needle core biopsy in the diagnosis of pediatric thyroid neoplasms: a single institution retrospective review.

PURPOSE: Our institution routinely utilizes needle core biopsy (NCB), instead of fine needle aspiration, in the evaluation of pediatric thyroid nodules. This practice initially arose from limited cytopathology services in our hospital. Given the lack of information regarding the utility of NCB in diagnosing pediatric thyroid neoplasms, we set out to review our institution's experience with this technique. METHODS: We performed a single institution retrospective chart review of all children who underwent thyroidectomy for primary thyroid pathology. RESULTS: Seventy-four patients, with a mean age of 12.9 ± 4.5 (SD) years, underwent partial or total thyroidectomy between 2002 and 2010. Seven of these patients had medically refractive hyperthyroidism. The remaining 67 patients had one or more thyroid nodules as identified by ultrasound. 24 (36 %) of these cases were malignant on final pathology. 14 (58 %) of the malignant cases were papillary thyroid carcinoma. 46 of the thyroid nodule cases underwent pre-operative NCB. Biopsy results for these patients were non-diagnostic in 6 (13 %), benign in 11 (24 %), atypical in 17 (37 %), and malignant in 12 (26 %). There were no complications arising from NCB. Sensitivity of NCB for diagnosing papillary carcinoma (PC) and follicular neoplasm was calculated at 0.88 (0.47-1.0, 95 % CI) and 0.84 (0.60-0.97, 95 % CI), respectively. Of the 28 patients not undergoing preoperative NCB, 12 underwent hemithyroidectomy, with one patient (8 %) requiring completion thyroidectomy for PC. Overall, the sensitivity of NCB in diagnosing PC and follicular thyroid neoplasms was 0.85 (0.55-0.99, 95 % CI), while the specificity was 0.63 (0.42-0.82, 95 % CI). CONCLUSIONS: Needle core biopsy appears to have a low rate of associated complications, and its sensitivity for diagnosing PC and follicular neoplasm is comparable to what has been reported for fine needle aspiration biopsy in a similar patient population.

Morbidly obese paediatric patients are not adequately screened for comorbidities.

Although childhood obesity is common, many paediatric practitioners are not familiar with screening for its associated, serious comorbidities. We aimed to determine the adequacy of screening for nine well-recognized comorbidities in outpatients with severe morbid obesity (body mass index [BMI] ≥50 kg m(-2) ) seen in a large tertiary paediatric hospital. Patients with a BMI of ≥50 kg m(-2) seen at Texas Children's Hospital during calendar year 2009 were identified. Their medical records were reviewed for any documentation where hypertension, cardiac dysfunction, sleep apnoea, hepatosteatosis, diabetes, pseudotumour cerebri, dyslipidemia, orthopaedic issues and depression were noted and/or addressed as evidence of clinician awareness of these problems. We identified 123 patients seen at least once in 2009, with an average of 3.4 physician visits per patient and by an average of 2 different specialists. Hypertension screening was the most documented (91% of patients) and depression screening was the least documented (41%) in this patient cohort. Twelve patients (10%) had documented screening for all nine comorbidities. Overall, 55 patients (45%) had five or fewer of the nine comorbidities noted and/or addressed in the medical record. Adequate screening for comorbidities occurs in approximately half of children with severe morbid obesity, which means that many of these comorbidities are not being identified or treated. Educational programmes and new methodologies are needed to ensure comprehensive care of children with morbid obesity.