Updates about Thyroid Lesions in Pediatric Population Focusing on the ROM from 3rd Edition of The Bethesda System for Reporting Thyroid Cytopathology Categories from Distinct Pediatric Series: A Review Article.

[BACKGROUND] The interpretation of pediatric thyroid lesion represents a challenging diagnostic tool for fine-needle aspiration cytology (FNAC). As for the adult lesions, it represents the first diagnostic tool for correct characterization of these nodules. Recent data from the National Cancer Institute (NCI) have proven that the incidence of thyroid malignancy has been increasing, especially in adolescents. These data are mostly linked to an estimated higher prevalence of well-differentiated cancers with 90% diagnosed as papillary thyroid cancer; some specific malignant subtypes, such as diffuse sclerosing subtype, are more frequently diagnosed in children, with, not uncommonly, a more aggressive behavior, which justifies the increased number of surgical procedures. For this reason, the American Thyroid Association (ATA) recommended the performance of neck ultrasonography and FNAC in the evaluation of pediatric thyroid nodules. In this regard, the performance of an FNAC has high sensitivity and diagnostic accuracy in pediatric series, sharing the same problematic issues encountered in adult population, mostly in the diagnosis of the indeterminate lesions.

[SUMMARY] Since 2023, the diagnosis of a pediatric lesion was based on the risk of malignancy used for the adulthood. The introduction of the third edition of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) introduced, for the first time, a specific adoption of diagnostic categories combined with their own and personalized ROM and management in pediatric thyroid lesions. In this review, we focused on the analysis of the ROM and data from literature hinged on the evaluation of the adoption of the 3rd edition of TBSRTC in pediatric thyroid lesions.

[KEY MESSAGE] Briefly, the primary source of the reviewed publications was the PubMed, Scopus, and Web of Science database using the keywords (thyroid) and (carcinoma or neoplasm or cancer) AND (Bethesda or TBSRTC) and (Paediatric). The search consisted of literature published from January 2023 to September 2025 with the objective of calculating the risk of malignancy for III, IV, V, and VI diagnostic categories of the 3rd edition of TBSRTC in pediatric group. We limited our search to English-language articles.