PREVALENCE AND DIAGNOSTIC PERFORMANCE OF PREOPERATIVE EVALUATION IN PEDIATRIC PATIENTS UNDERGOING SISTRUNK PROCEDURE FOR THYROGLOSSAL DUCT CYST

Abstract

Background: Thyroglossal duct cyst (TGDC) is the most common congenital midline neck lesion arising from persistence of the thyroglossal duct. The standard treatment is the Sistrunk procedure. Accurate preoperative diagnosis is essential for surgical planning and prevention of recurrence, yet the diagnostic performance of ultrasound combined with clinical and laboratory findings relative to histopathological confirmation remains incompletely characterized. Aims: To determine the prevalence of histopathologically confirmed TGDC among pediatric patients undergoing Sistrunk procedure at Queen Rania Al Abdullah Hospital for Children, Royal Medical Services, Amman, Jordan between January 2023 and January 2026. And to evaluate the diagnostic performance of preoperative ultrasound combined with thyroid function tests, compared with postoperative histopathology. Methods: This retrospective observational study included patients who underwent Sistrunk procedure for suspected TGDC at a Royal Medical Services hospital. Demographic, clinical, imaging, laboratory, and histopathological data were extracted from medical records. Prevalence was calculated, and diagnostic accuracy metrics (sensitivity, specificity, positive and negative predictive values) were assessed using histopathology as the reference standard Results: Totally 312 children were analyzed with an average age of 6.36 ± 3.32 years. Of those, 237 cases had TGDC pathology with confirmation rates reaching 76.0% (95% CI 70.9%–80.4%). Other possible conditions included dermoid/epidermoid cyst, reactive lymph nodes, branchial abnormalities, lymphatic malformation, among others. Preoperatively, ultrasound showed sensitivity of 0.87, specificity of 0.73, positive predictive value of 0.91, and negative predictive value of 0.64. Composite preoperative diagnostic process increased sensitivity up to 0.94 and negative predictive value to 0.76, whereas specificity dropped down to 0.59. In the multivariate model, bigger cyst diameter and positive preoperative ultrasound significantly increased histopathologic confirmation, while history of neck operation significantly decreased it. Conclusion: Within this group of children requiring surgery, about 75% had TGDC, as confirmed through histopathology after the performance of the Sistrunk operation for suspected TGDC. The preoperative ultrasound had excellent sensitivity and positive predictive value, reinforcing its use as the primary diagnostic test. Combination of preoperative testing led to an improvement in sensitivity while decreasing specificity. This study reflects a surgically selected cohort of children undergoing Sistrunk procedure, and therefore diagnostic performance measures may not represent unselected patients with pediatric neck masses.