Ultrasound‐Based Evaluation and Diagnostic Discordance in Pediatric Thyroglossal Duct Cysts

ABSTRACT Background Ultrasonography is the first‐line imaging modality for evaluating thyroglossal duct cysts (TGDCs); however, its diagnostic accuracy in differentiating TGDCs from other congenital midline cystic neck lesions remains limited. This study aimed to evaluate the concordance between preoperative clinical and ultrasonographic diagnoses and final pathological findings in pediatric patients with presumed TGDC. Methods This retrospective single‐center study included pediatric patients who underwent surgery for a presumed TGDC between January 2015 and December 2025. Preoperative diagnosis was based on combined clinical examination and ultrasonographic findings. Demographic characteristics, presenting symptoms, imaging findings, pathological diagnoses, and postoperative outcomes were analyzed. Ultrasound findings were retrospectively assessed using the SIST scoring system. Comparisons were performed between patients with pathologically confirmed TGDC and those with non‐TGDC pathology. Results A total of 42 pediatric patients were included; 78.6% were male, and the mean age was 5.97 ± 3.79 years. Final pathological examination confirmed TGDC in 32 patients (76.2%), whereas 10 patients (23.8%) had alternative diagnoses. Preoperative SIST scores were significantly higher in patients with TGDC than in those with non‐TGDC pathology ( p = 0.028). Despite preoperative findings suggestive of TGDC in all patients, a substantial rate of diagnostic discordance was observed. Postoperative outcomes were favorable, with low complication and recurrence rates. Conclusion Ultrasonography plays a central role in the evaluation of pediatric TGDC; however, it has limitations in accurately distinguishing TGDCs from other midline cystic lesions. Structured ultrasound‐based scoring systems such as SIST may improve diagnostic confidence but cannot fully predict final pathology. Clinical and intraoperative findings should therefore be considered alongside imaging in surgical decision‐making.