| Summary: | Background and Purpose: The incidence rate of thyroid cancer in children and adolescents is increasing year by year, and there is a high rate of metastasis and recurrence. The application of diagnostic criteria for thyroid nodules based on adult characteristics in children has a high rate of missed diagnosis rate, misdiagnosis rate and unnecessary biopsy. This study aimed to establish a graded diagnostic model of thyroid nodules in children and adolescents, and to compare its diagnostic efficacy with American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Methods: One Hundred and forty-four patients with thyroid nodules aged 0-18 years in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2000 to October 2017 were included as the training set, and 41 patients with thyroid nodules aged 0-18 years in China-Japan Friendship Hospital and Civil Aviation General Hospital from November 2015 to January 2022 were included as the testing set. Taking pathological diagnosis as the gold standard, the statistically significant ultrasonic characteristics were analyzed by multivariate binary logistic regression. The ultrasonic grading diagnostic model was established and brought into the testing set to compare its diagnostic efficiency with ACR TI-RADS. Results: There was significant difference in solidity, hypoechoic, taller-than-wide shape, irregular edge and microcalcification between the two groups (P<0.05). Logistic regression analysis showed that hypoechoic, solidity, irregular margin and calcification were independent predictors for the diagnosis of thyroid cancer in children and adolescents. When the ultrasonic grade was established based on the above independent predictors, this graded model had higher diagnostic accuracy in the testing set compared with ACR TI-RADS (92.7% vs 82.9%). Conclusion: The graded diagnostic model based on solidity, hypoechoic, irregular margin and microcalcification can be used in the diagnosis of thyroid nodules in children and adolescents. Compared with ACR TI-RADS, it has higher diagnostic accuracy.
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