ORIGINAL ARTICLE Fine-Needle Aspiration in the Evaluation of Thyroid Lesions in Children Jasleen Kaur, M.D., 1 Radhika Srinivasan, M.D., Ph.D., 1 * Sandeep Kumar Arora, M.D., 1 Arvind Rajwanshi, M.D., M.I.A.C., F.R.C.Path., 2 Uma Nahar Saikia, M.D., 3 Pinaki Dutta, M.D., D.M., 1 Nalini Gupta, M.D., 1 Raje Nijhawan, M.D., 1 and Pranab Dey, M.D. 1 The role of fine-needle aspiration (FNA) cytology in the evaluation of thyroid lesions in not as well established in children when com- pared with adults. Hence we aimed to ascertain the utility and limi- tations of FNA in childhood thyroid lesions. This was a retrospec- tive analysis of all thyroid FNA performed in children less than 14 years of age over a 4-year period (2005–2009). Histopathological follow-up was available in six cases. A total of 77 cases were included in the analysis. The most common cytological diagnosis was lymphocytic thyroiditis (49.3%), followed by colloid goiter (18.2%), hyperplasia (10.4%), and benign aspirate (7.8%); malig- nancy was identified in six cases (7.8%). Of these six cases, three were papillary thyroid carcinoma. There was one false-positive case reported as a Hurthle-cell neoplasm, which on histology showed Hashimoto’s thyroiditis. One case each of rhabdomyosar- coma and spindle epithelial tumor with thymus like differentiation was wrongly diagnosed as thyroid neoplasm, NOS, and medullary carcinoma (spindle variant), respectively. The overall diagnostic accuracy was 98.6% with 100% sensitivity, 98.6% specificity, 80% positive predictive value, and 100% negative predictive value. FNA is extremely valuable in the initial evaluation of thyroid swelling in children. Rare neoplasms masquerading as thyroid nodules in chil- dren can pose difficulties in diagnosis; however, papillary carci- noma is easily recognized. In lymphocytic thyroiditis, it provides a tissue diagnosis, thereby avoiding more invasive procedure for merely diagnostic purposes. Diagn. Cytopathol. 2010;00:000– 000. ' 2010 Wiley-Liss, Inc. Key Words: pediatric thyroid FNA; children; thyroid neoplasm; diagnosis; fine-needle aspiration cytology Thyroid nodules are rare in children, affecting 1–2% of the pediatric population at large. 1–3 As in adults, the need to differentiate malignancy from benign lesions in these children is the most challenging dilemma in manage- ment. 1 Thyroid carcinoma can be identified in 14–40% of asymptomatic solitary thyroid nodules in children in stud- ies from different geographic regions. 2,4 The ideal goal is to identify and surgically excise malignant nodules while avoiding a neck procedure in children with benign nod- ules. Some previous studies 5,6 have focused on fine-needle aspiration (FNA) cytology as a diagnostic test to decide whether a thyroid nodule should be removed or observed. FNA of thyroid is very challenging in children as utmost co-operation is required for accurate placement of needle; many times the procedure requires sedation. As minimal amount of material is aspirated, it requires cytopathologi- cal expertise for correct interpretation, which may not be available in all centers. Ours is a tertiary referral center with a large volume of cases being subjected to FNA cy- tology. Approximately 5% of all FNAs is performed in the pediatric population. The aim of our study was to as- certain the role and limitations of FNA in childhood thy- roid lesions by performing a retrospective review of cases. Materials and Methods The study population consisted of 82 children younger than 14 years with palpable thyroid nodules/thyromegaly, who were subjected to FNAC at PGIMER, Chandigarh, 1 Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India 2 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India 3 Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India *Correspondence to: Radhika Srinivasan, M.D., Ph.D., Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medi- cal Education and Research, Chandigarh 160012, India. E-mail: drsradhika@gmail.com Received 11 June 2010; Accepted 9 September 2010 DOI 10.1002/dc.21568 Published online in Wiley Online Library (wileyonlinelibrary.com). ' 2010 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 00, No 00 1