Objective: Our study objectives were to evaluate the relationship between Thyroid Imaging Reporting and Data System (TI-RADS) and Bethesda classification and to compare both TI-RADS and Bethesda classification for the diagnosis of papillary thyroid carcinoma (PTC) within the pediatric population.
Study design: Retrospective case series.
Setting: Academic pediatric hospital.
Methods: A 13-year retrospective review was performed of all pediatric patients undergoing thyroid fine needle aspiration (FNA) and ultrasound at our institution. Demographics, TI-RADS scoring, FNA results, surgical history, and final pathology were collected. High-risk ultrasonography and cytopathology were defined as TI-RADS 3-5 and Bethesda 5-6, respectively. Spearman's rank correlation was determined for TI-RADS and Bethesda classification. Relative risks of high-risk TI-RADS and Bethesda classification for predicting PTC were calculated.
Results: A total of 157 patients (21.7% male, median age at time of FNA 15 years, and range 2.7-21 years) underwent ultrasound and FNA during the study. The Spearman's rank correlation coefficient for TI-RADS compared with the Bethesda classification was 0.41 (P < .001). The relative risk of high-risk TI-RADS scores to predict the presence of PTC was 7.99 (95% CI 1.16-54.90). High-risk Bethesda classification demonstrated a relative risk for predicting PTC of 6.62 (95% CI 4.22-10.41).
Conclusion: In our cohort, there was a moderate correlation between TI-RADS and Bethesda classifications. Patients with a TI-RADS score ≥3 and Bethesda classification 3 or 4 are at intermediate risk for harboring PTC and should be counseled accordingly.
Keywords: Bethesda; TI‐RADS; papillary thyroid cancer; pediatrics.
© 2025 American Academy of Otolaryngology–Head and Neck Surgery Foundation.