Objective:

To evaluate the correlation between fine needle aspiration (FNA) results using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and postoperative histopathological findings in pediatric patients, highlighting the importance of accurate diagnosis in this population.

Key Findings:

• Overall ROM ranged from 32.76% (ROM-C) to 92.68% (ROM-H), indicating a significant variability in malignancy risk.
• ROM increased progressively across Bethesda categories: II (1.11%-27.27%), III (25.40%-66.67%), IV (22.22%-100%), V (74.70%-100%), VI (82.39%-100%), underscoring the importance of accurate categorization.
• Papillary thyroid carcinoma predominated (88.62%), emphasizing the need for vigilant monitoring.
• BRAF V600E mutation detected in 51.53% of histologically confirmed malignancies, suggesting its role in malignancy risk assessment.
• Sensitivity of 98.58%, specificity of 100%, and accuracy of 98.63% for the Bethesda system in definitive categories, reinforcing its diagnostic utility.

Interpretation:

The Bethesda system provides high diagnostic accuracy for definitive cytological categories in pediatric thyroid nodules, indicating elevated malignancy risk even in indeterminate categories, which has significant implications for clinical practice.

Limitations:

• Retrospective design may introduce selection bias, potentially affecting the generalizability of the findings.
• Limited generalizability due to single-center study, suggesting the need for multi-center research.

Conclusion:

The study supports careful surgical consideration and the value of BRAF V600E testing for preoperative risk stratification in pediatric thyroid nodules, highlighting the need for further research in this area.