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Piek MW, de Boer JP, Vriens MR, van Leeuwaarde RS, Stokkel M, Hartemink KJ, van Duijnhoven F, Kessels R, van der Ploeg IMC. Retrospective Analyses of 18FDG-PET/CT Thyroid Incidentaloma in Adults: Incidence, Treatment, and Outcome in a Tertiary Cancer Referral Center. Thyroid 2021; 31:1715-1722. [PMID: 34340567 DOI: 10.1089/thy.2021.0226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: A thyroid incidentaloma (TI) is an unexpected, asymptomatic thyroid lesion discovered during the investigation of an unrelated condition. The aim of the present study is to examine the incidence of 18Fluorodeoxyglucose (FDG)-positron emission tomography (PET) TI, the associated management strategies and the outcomes in a tertiary cancer referral center. Methods: This study involves a retrospective cohort study of 1003 patients with TI found on 18FDG-PET/CT scans performed between January 2010 and January 2020 for a nonthyroidal malignancy. The Kaplan-Meier method was used for survival analyses in patients concerning an underlying malignancy, with a prevalence of 5% or higher in this cohort. Logistic- and cox regression analyses were performed to analyze predictors of thyroid malignancy and mortality. A propensity score weighted method was used to control for baseline differences between the intervention (additional TI diagnostics) and control (no TI diagnostics) group. Results: FDG-positive TI occurred in 1.9% (1003/52,693) of the oncologic 18FDG-PET/CT scans performed in our center. Thyroid surgery was performed in 47 patients (6%) and a thyroid malignancy was detected in 31 of them, which is 66% of those who had an operation and 4% of all patients. During the follow-up (median 6 years), 334 deaths (42%) related to different types of cancer (38%) or other causes (4%) were observed. One patient died from medullary thyroid cancer. In multivariate analysis adjusted for age, gender and the type- and stage of nonthyroidal malignancy, were independent predictors of survival (P < .05). Conclusions: The incidence of TI in this tertiary cancer referral center was comparable to current literature. Further thyroid workup was performed in less than half of the patients, and only a minority of patients underwent thyroid surgery. Since only one patient died from thyroid cancer, the strategy to withhold from thyroid diagnostics and treatment seems valid for most TI. Active thyroid treatment might benefit a subgroup of patients in whom the primary nonthyroidal malignancy is successfully treated or presumably stable. A wait-and-see policy with ultrasound follow-up could be an alternative strategy. These considerations should be part of the shared decision making in cancer patients with a TI.
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Affiliation(s)
- Marceline W Piek
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jan Paul de Boer
- Department of Internal Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Menno R Vriens
- Department of Surgery and University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Rachel S van Leeuwaarde
- Department of Internal Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Internal Medicine, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Marcel Stokkel
- Department of Nuclear Medicine, and Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Koen J Hartemink
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rob Kessels
- Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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2
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Panareo S, Urso L, Nieri A, Caracciolo M, Valpiani G, Torricelli P, Frassoldati A, Cittanti C, Rollo M, Bartolomei M. Clinical-Diagnostic Relevance of Breast "Incidentaloma" Detected During 18F-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography: Correlation with Radiological Imaging and Histopathology. Indian J Nucl Med 2021; 36:385-390. [PMID: 35125756 PMCID: PMC8771069 DOI: 10.4103/ijnm.ijnm_52_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022] Open
Abstract
Aim: This study aims to study the clinical-diagnostic relevance of incidental breast uptake (“incidentaloma”) on 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan performed for other indications and to correlate it with radiological imaging and histopathology. Materials and Methods: We retrospectively evaluated 3675 FDG-PET scans, identifying 43 patients with breast “incidentaloma.” Thirty of these findings were further investigated with clinical examination, mammography (MMX), UltraSound (US) and/or magnetic resonance (MR). Cases suspected for malignancy underwent US-guided macro-biopsy (USMB) or MR-guided biopsy. Correlations between FDG-PET, radiology findings, age, and histopathology were evaluated. Results: patients who performed both US and MMX were 19. Ten consequently underwent USMB, one MR-guided biopsy, the remaining 8 were not further investigated. Nine patients had a diagnosis of malignancy. Among 11 patients who performed only US and consequently, USMB 6 had a diagnosis of malignancy. Histopathology of the 22 patients with both morphological and glucometabolic alterations showed different types of benign or malignant neoplasia, with a cumulative 68.2% incidence of malignancy. Seven lesions showed a SUVmax >2.5, while the remaining 15 a SUVmax <2.5. There was no statistically significant correlation between SUVmax and histology, therefore SUVmax parameter should not be used to discriminate between benign and malignant findings. No significant correlation between patient age and tumor characterization was found. Conclusions: incidental mammary uptake during an FDG-PET scan may represent a clue suggesting to investigate PET findings. In this subset of patients, early diagnosis may lead to a change in clinical management with a favorable impact on prognosis and a significant reduction in healthcare costs.
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Affiliation(s)
- Stefano Panareo
- Oncological Medical and Specialists Department, Nuclear Medicine Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Luca Urso
- Oncological Medical and Specialists Department, Nuclear Medicine Unit, University Hospital of Ferrara, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Alberto Nieri
- Oncological Medical and Specialists Department, Nuclear Medicine Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Matteo Caracciolo
- Oncological Medical and Specialists Department, Nuclear Medicine Unit, University Hospital of Ferrara, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Pietro Torricelli
- Department of Radiology, University Hospital of Modena, Modena, Italy
| | - Antonio Frassoldati
- Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Corrado Cittanti
- Oncological Medical and Specialists Department, Nuclear Medicine Unit, University Hospital of Ferrara, Ferrara, Italy.,Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Marco Rollo
- Department of Radiology, Breast Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Mirco Bartolomei
- Oncological Medical and Specialists Department, Nuclear Medicine Unit, University Hospital of Ferrara, Ferrara, Italy
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3
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Characteristics of malignant thyroid lesions on [ 18F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT). Eur J Radiol Open 2021; 8:100373. [PMID: 34458507 PMCID: PMC8379667 DOI: 10.1016/j.ejro.2021.100373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the imaging variables that can best differentiate malignant from benign thyroid lesions incidentally found on F-18 FDG PET/CT scans. Methods All F-18 FDG PET/CT studies starting from 2011 to end of 2016 were reviewed for incidental thyroid lesions or metabolic abnormalities. Only patients who were found to have FNAB or histopathology were included. Patients with known thyroid malignancy were excluded. Patients were analyzed for age, sex, SUVmax, non-enhanced CT tissue density in mean Hounsfield units (HU), uptake pattern (focal or diffuse) and gland morphology (MNG or diffuse). A control group of 15 patients with normal thyroid glands were used to assess the tissue density in HU for normal thyroid tissue. Sensitivity, specificity, PPV, NPV and accuracy to detect malignancy were calculated. Pearson Chi-square test was used to compare categorical variables while unpaired T-test and one way ANOVA test were used to compare means of continuous variables. ROC analysis was used to assess the best cut off points for SUVmax and HU. Regression analysis was used to detect the independent predictors for malignant lesions. Results Biopsy was unsatisfactory or indeterminate in 4/48 patients (8%). Only 44 patients (mean age 55.2 ± 14.7; 30 females (68 %)) with unequivocal FNAB or histopathology were included for further analysis. MNG was noted in 17/44 patients (38.6 %). Thyroid malignancy was found in 16/44 (36.4 %), benign thyroid lesions in 28/44 (63.6 %). Thyroid malignancies were 12 papillary, 1 follicular, 1 Hurthle cell neoplasm and 2 lymphoma. Benign lesions were 23 benign follicular or colloid nodules and 5 autoimmune thyroiditis. Focal FDG uptake pattern was more frequently associated with malignant lesions compared to benign lesions (75 % vs. 43 %; p = 0.039). The mean SUVmax and tissue density (HU) were both higher in malignant than benign lesions (8.8 ± 8.3 vs. 3.6 ± 1.9, p = 0.024) and (48.9 ± 12.7 vs. 32.9 ± 17.5, p = 0.003) respectively. The mean HU in the control group with normal thyroid tissue was 90 ± 7.4 significantly higher than in both the benign and malignant lesions (p < 0.001). ROC analysis revealed SUVmax cutoff of >4.7 and HU cutoff of >42 to best differentiate malignant from benign lesions. The sensitivity, specificity, PPV, NPV and accuracy to detect malignancy for SUVmax>4.7 were 68.8 %, 78.6 %, 64.8 %, 81.5 & 75.0 % (p = 0.002), for HU > 42 were 81.3.0 %, 75.0 %, 65.0 %, 87.5 & 77.3 % (p = 0.0003) and for both parameters combined were 87.5 %, 60.7 %, 56.0 %, 89.5 % and accuracy of 70.5 % (p = 0.002) respectively. Only HU > 42 and SUVmax>4.7 were independent predictors for malignancy with odd ratios 8.98 and 4.93 respectively. Conclusion A higher tissue density (HU > 42) and SUVmax>4.7 as well as tendency for focal uptake pattern are the most significant characteristics associated with malignant thyroid lesions occasionally detected on PET/CT.
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How J, Tabah R, Mitmaker EJ. Clinical significance of thyroid incidentalomas detected on fluorodeoxyglucose positron emission tomography scan (PETomas): Its original description and now. World J Nucl Med 2020; 19:179. [PMID: 32939215 PMCID: PMC7478301 DOI: 10.4103/wjnm.wjnm_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/23/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jacques How
- Division of Endocrinology, McGill University Health Center, Montreal, Quebec, Canada
| | - Roger Tabah
- Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Elliot J Mitmaker
- Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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5
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Loo CH, Khoo ACH, Tan WC, Khor YH, Tang JJ, Tang MM, Chan LC. The findings of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography scan in patients with hidradenitis suppurativa in Malaysia: A multicenter study. World J Nucl Med 2020; 20:32-37. [PMID: 33850487 PMCID: PMC8034800 DOI: 10.4103/wjnm.wjnm_33_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/27/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is known to have association with systemic diseases with chronic inflammation such as psoriasis. We aim to describe the concomitant systemic inflammation in patients with HS using 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET/CT) scan. This was a case–control study conducted in three tertiary hospitals in Northern Malaysia from January to December 2017, involving HS patients aged 18 years and above. Thirty-two HS patients with age- and sex-matched controls were recruited with a mean age of 31.4 years (range: 18–56). Numerous cutaneous inflammatory foci were detected on FDG-PET/CT scan in clinically unapparent sites (27/32, 84.4%). Approximately 90.6%, 93.8%, and 50.0% of the patients had significantly higher cutaneous uptake over nasal, mandibular, and scalp regions, respectively (P < 0.0001). PET/CT scan did not detect any systemic inflammation unlike those found in psoriasis. Three (9.4%) patients had thyroid nodules with high uptake (maximum standard uptake values ranging from 2.9 to 11.3). Two of them were confirmed to have papillary thyroid carcinoma, while the third patient has inconclusive finding. 18F-FDG PET/CT scan may be useful to map disease burden of HS. Nonlesional inflammatory foci on the skin of the nose, mandibular, and scalp are probably significant. The association of thyroid carcinoma in HS warrants further evaluation.
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Affiliation(s)
- Chai Har Loo
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.,Department of Dermatology, Hospital Pulau Pinang, Malaysia
| | | | | | - Yek Huan Khor
- Department of Dermatology, Hospital Pulau Pinang, Malaysia
| | - Jyh Jong Tang
- Department of Dermatology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Min Moon Tang
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Lee Chin Chan
- Department of Dermatology, Hospital Pulau Pinang, Malaysia
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6
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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7
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Bellido-Calduch S, Martín-Ontiyuelo C, Pijuan L, Puig de Dou J, Suárez-Piñera M, Curull V, Sánchez-Font A. Endoscopic Diagnosis of Small Cell Lung Carcinoma and Follicular Thyroid Cancer. Arch Bronconeumol 2020; 56:328-329. [PMID: 35373742 DOI: 10.1016/j.arbr.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/06/2019] [Indexed: 06/14/2023]
Affiliation(s)
- Salomé Bellido-Calduch
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, UAB, CIBERES, ISCIII, Barcelona, Spain
| | - Clara Martín-Ontiyuelo
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, UAB, CIBERES, ISCIII, Barcelona, Spain; IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Lara Pijuan
- Servei d'Anatomia Patològica, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Jaume Puig de Dou
- Servei d'Endocrinologia i Nutrició, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Marina Suárez-Piñera
- Servei de Medicina Nuclear i Diagnòstic per Imatge, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Víctor Curull
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, UAB, CIBERES, ISCIII, Barcelona, Spain; IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Albert Sánchez-Font
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, UAB, CIBERES, ISCIII, Barcelona, Spain; IMIM, Hospital del Mar Medical Research Institute, Barcelona, Spain.
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8
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Bellido-Calduch S, Martín-Ontiyuelo C, Pijuan L, Puig de Dou J, Suárez-Piñera M, Curull V, Sánchez-Font A. Diagnóstico endoscópico de carcinoma pulmonar de célula pequeña y neoplasia folicular de tiroides. Arch Bronconeumol 2020. [DOI: 10.1016/j.arbres.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Kaliszewski K, Diakowska D, Ziętek M, Knychalski B, Aporowicz M, Sutkowski K, Wojtczak B. Thyroid incidentaloma as a "PAIN" phenomenon- does it always require surgery? Medicine (Baltimore) 2018; 97:e13339. [PMID: 30544397 PMCID: PMC6310517 DOI: 10.1097/md.0000000000013339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A thyroid nodule discovered during imaging study performed due to unrelated thyroid disease is known as a thyroid incidentaloma, while positron emission tomography (PET) associated incidental neoplasm of thyroid is known as a "PAIN" phenomenon.To evaluate which patients with "PAIN" phenomenon should undergo surgery in regards to cytology results.Retrospective review of 4716 patients consecutively admitted and surgically treated in tertiary surgical center. 49 (1.04%) patients with "PAIN" phenomenon were identified. All of them had ultrasound-guided fine needle aspiration biopsy (UG-FNAB) performed and cytological results were evaluated according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Patients were divided into 2 subgroups according to histopathological diagnosis: group 1 (n = 25) with benign tumor and group 2 (n = 24) with thyroid cancer.Cytology results were the significant predictors of cancer occurrence in patients with "PAIN" phenomenon (P < .0001). Logistic regression analysis confirmed that category III or higher of TBSRTC in patients with "PAIN" phenomenon significantly increased the risk of cancer (OR = 168.7, P < .0001).Patients with "PAIN" phenomenon and cytology assigned to category III or higher of the Bethesda system should undergo surgery due to significant risk of thyroid malignancy.
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Affiliation(s)
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University
| | | | | | - Michał Aporowicz
- First Department and Clinic of General, Gastroenterological and Endocrine Surgery
| | - Krzysztof Sutkowski
- First Department and Clinic of General, Gastroenterological and Endocrine Surgery
| | - Beata Wojtczak
- First Department and Clinic of General, Gastroenterological and Endocrine Surgery
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10
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Shaha AR. Solid organ transplant and thyroid cancer. J Surg Oncol 2017; 115:103-104. [PMID: 28054336 DOI: 10.1002/jso.24497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/15/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Ashok R Shaha
- Memorial Sloan Kettering Cancer Center, New York, New York
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11
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Dubernard X, Dabakuyo S, Ouedraogo S, Amroun K, Kere D, Nasser T, Deguelte S, Pochart JM, Merol JC, Makeieff M, Chays A, Schvartz C. Prophylactic neck dissection for low-risk differentiated thyroid cancers: Risk-benefit analysis. Head Neck 2016; 38:1091-6. [PMID: 26873677 DOI: 10.1002/hed.24402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The benefit of neck dissection is the subject of debate in differentiated thyroid cancer (DTC). We analyze the risk-benefit of neck dissection for low-risk DTC without detectable lymph nodes. METHODS We conducted a retrospective study from 1983 to 2003; which included 295 patients without detectable lymph nodes who were treated by thyroidectomy with (C+) or without (C-) neck dissection. All patients had iodine131 therapy. We compared the frequency of remission, disease progression, and permanent complications between groups. RESULTS Two hundred twelve patients comprised the C+ group, and 83 patients the C- group. Respectively for C+ versus C-, remission rates were 92% versus 89.2% (p = .40), and progressive disease observed was 3.3% versus 7.2% (p = .10). Permanent hypoparathyroidism occurred in 15.1% in C+ versus 3.6% in C- (p = .006). CONCLUSION The risk-benefit analysis of neck dissection in patients with low-risk DTC shows no benefit in terms of complete remission or occurrence of progression. However, risk of complications seems to be higher in patients with neck dissection. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1091-1096, 2016.
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Affiliation(s)
- Xavier Dubernard
- Thyroïde Marne-Ardennes Register, CLCC Institut Jean Godinot, Reims, France.,Otolaryngology Department, Centre Hospitalier Robert Debré, Reims, France
| | - Sandrine Dabakuyo
- Thyroïde Marne-Ardennes Register, CLCC Institut Jean Godinot, Reims, France
| | | | - Koceila Amroun
- General Surgery Department, CLCC Institut Jean Godinot, Reims, France
| | - David Kere
- General Surgery Department, CLCC Institut Jean Godinot, Reims, France
| | - Talal Nasser
- Otolaryngology Department, Polyclinique de Courlancy, Reims, France
| | - Sophie Deguelte
- General Surgery Department, Centre Hospitalier Robert Debré, Reims, France
| | - Jean-Marie Pochart
- Thyroïde Marne-Ardennes Register, CLCC Institut Jean Godinot, Reims, France
| | - Jean-Claude Merol
- Otolaryngology Department, Centre Hospitalier Robert Debré, Reims, France
| | - Marc Makeieff
- Otolaryngology Department, Centre Hospitalier Robert Debré, Reims, France
| | - André Chays
- Otolaryngology Department, Centre Hospitalier Robert Debré, Reims, France
| | - Claire Schvartz
- Thyroïde Marne-Ardennes Register, CLCC Institut Jean Godinot, Reims, France
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12
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Murphy JD, Ma GL, Baumgartner JM, Madlensky L, Burgoyne AM, Tang CM, Martinez ME, Sicklick JK. Increased risk of additional cancers among patients with gastrointestinal stromal tumors: A population-based study. Cancer 2015; 121:2960-7. [PMID: 25930983 DOI: 10.1002/cncr.29434] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/22/2015] [Accepted: 02/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most gastrointestinal stromal tumors (GISTs) are considered nonhereditary or sporadic. However, single-institution studies suggest that GIST patients develop additional malignancies at increased frequencies. It was hypothesized that greater insight could be gained into possible associations between GISTs and other malignancies with a national cancer database inquiry. METHODS Patients diagnosed with GISTs (2001-2011) in the Surveillance, Epidemiology, and End Results database were included. Standardized prevalence ratios (SPRs) and standardized incidence ratios (SIRs) were used to quantify cancer risks incurred by GIST patients before and after GIST diagnoses, respectively, in comparison with the general US population. RESULTS There were 6112 GIST patients, and 1047 (17.1%) had additional cancers. There were significant increases in overall cancer rates: 44% (SPR, 1.44) before the GIST diagnosis and 66% (SIR, 1.66) after the GIST diagnosis. Malignancies with significantly increased occurrence both before and after diagnoses included other sarcomas (SPR, 5.24; SIR, 4.02), neuroendocrine-carcinoid tumors (SPR, 3.56; SIR, 4.79), non-Hodgkin lymphoma (SPR, 1.69; SIR, 1.76), and colorectal adenocarcinoma (SPR, 1.51; SIR, 2.16). Esophageal adenocarcinoma (SPR, 12.0), bladder adenocarcinoma (SPR, 7.51), melanoma (SPR, 1.46), and prostate adenocarcinoma (SPR, 1.20) were significantly more common only before the GIST diagnosis. Ovarian carcinoma (SIR, 8.72), small intestine adenocarcinoma (SIR, 5.89), papillary thyroid cancer (SIR, 5.16), renal cell carcinoma (SIR, 4.46), hepatobiliary adenocarcinoma (SIR, 3.10), gastric adenocarcinoma (SIR, 2.70), pancreatic adenocarcinoma (SIR, 2.03), uterine adenocarcinoma (SIR, 1.96), non-small cell lung cancer (SIR, 1.74), and transitional cell carcinoma of the bladder (SIR, 1.65) were significantly more common only after the GIST diagnosis. CONCLUSIONS This is the first population-based study to characterize the associations and temporal relations between GISTs and other cancers by both site and histological type. These associations may carry important clinical implications for future cancer screening and treatment strategies.
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Affiliation(s)
- James D Murphy
- Department of Radiation and Applied Sciences, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Grace L Ma
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel M Baumgartner
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Lisa Madlensky
- Department of Family and Preventive Medicine, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Adam M Burgoyne
- Division of Medical Oncology, Department of Internal Medicine, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Chih-Min Tang
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Maria Elena Martinez
- Department of Family and Preventive Medicine, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California
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Thyroid lesions incidentally detected by (18)F-FDG PET-CT - a two centre retrospective study. Radiol Oncol 2015; 49:121-7. [PMID: 26029022 PMCID: PMC4387987 DOI: 10.2478/raon-2014-0039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/22/2014] [Indexed: 11/20/2022] Open
Abstract
Background. Incidental 18F-FDG uptake in the thyroid on PET-CT examinations represents a diagnostic challenge. The maximal standardized uptake value (SUVmax) is one possible parameter that can help in distinguishing between benign and malignant thyroid PET lesions. Patients and methods. We retrospectively evaluated 18F-FDG PET-CT examinations of 5,911 patients performed at two different medical centres from 2010 to 2011. If pathologically increased activity was accidentally detected in the thyroid, the SUVmax of the thyroid lesion was calculated. Patients with incidental 18F-FDG uptake in the thyroid were instructed to visit a thyroidologist, who performed further investigation including fine needle aspiration cytology (FNAC) if needed. Lesions deemed suspicious after FNAC were referred for surgery. Results. Incidental 18F-FDG uptake in the thyroid was found in 3.89% — in 230 out of 5,911 patients investigated on PET-CT. Malignant thyroid lesions (represented with focal thyroid uptake) were detected in 10 of 66 patients (in 15.2%). In the first medical centre the SUVmax of 36 benign lesions was 5.6 ± 2.8 compared to 15.8 ± 9.2 of 5 malignant lesions (p < 0.001). In the second centre the SUVmax of 20 benign lesions was 3.7 ± 2.2 compared to 5.1 ± 2.3 of 5 malignant lesions (p = 0.217). All 29 further investigated diffuse thyroid lesions were benign. Conclusions. Incidental 18F-FDG uptake in the thyroid was found in 3.89% of patients who had a PET-CT examination. Only focal thyroid uptake represented a malignant lesion in our study — in 15.2% of all focal thyroid lesions. SUVmax should only serve as one of several parameters that alert the clinician on the possibility of thyroid malignancy.
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Kwon D, McFarland K, Velanovich V, Martin RC. Borderline and locally advanced pancreatic adenocarcinoma margin accentuation with intraoperative irreversible electroporation. Surgery 2014; 156:910-20. [DOI: 10.1016/j.surg.2014.06.058] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/24/2014] [Indexed: 02/08/2023]
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Chaikhoutdinov I, Mitzner R, Goldenberg D. Incidental Thyroid Nodules: Incidence, Evaluation, and Outcome. Otolaryngol Head Neck Surg 2014; 150:939-42. [PMID: 24618501 DOI: 10.1177/0194599814524705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/30/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine patients with incidentally discovered thyroid nodules (IDTNs) with a focus on identification, evaluation, surgical intervention, and rates of malignancy. STUDY DESIGN Case series with chart review. SETTING Tertiary care medical center. SUBJECTS AND METHODS A total of 1408 patients were identified by cross-referencing thyroid diagnosis codes with ultrasound (US) codes between July 2008 and June 2009. Information regarding demographics, follow-up, and outcomes was extracted from the medical record. RESULTS A total of 249 patients with IDTNs were identified. Most were discovered on computed tomography (CT) scans (59.8%); the most common indication for obtaining imaging was for evaluation of an unrelated malignancy (26.9%). Malignant IDTNs were identified on 23.8% of positron emission tomography/CT scans and 6.8% of CT scans. Initial evaluation of IDTNs was performed by US in 62.2% and by US with fine-needle aspiration (FNA) in 36.1% of patients. The most common pathology on FNA of IDTNs was benign follicular nodule (64.1%) followed by papillary thyroid cancer (PTC; 13.5%); however, 31.7% of all cytology indicated suspicion for malignancy. Fifty-five patients (22.1%) were treated surgically. On final surgical pathology, 33 malignancies were present, of which 28 were PTC. The overall malignancy rate for incidental thyroid nodules was 13.3%. CONCLUSION We identified a malignancy of at least 13.3% in IDTNs, reaffirming that IDTNs should undergo thorough workup.
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Affiliation(s)
- Irina Chaikhoutdinov
- Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, Pennsylvania, USA
| | - Ron Mitzner
- Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, Pennsylvania, USA
| | - David Goldenberg
- Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, Pennsylvania, USA
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Training of a thyroid surgeon: From Scalpel to Robot. Surgery 2012; 152:943-52. [DOI: 10.1016/j.surg.2012.08.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/29/2012] [Indexed: 11/20/2022]
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How has the management of medullary thyroid carcinoma changed with the advent of 18F-FDG and non-18F-FDG PET radiopharmaceuticals. Nucl Med Commun 2012; 33:679-88. [DOI: 10.1097/mnm.0b013e3283529bf7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Thyroid incidentaloma is defined as an unsuspected, asymptomatic thyroid lesion that is discovered on an imaging study or during an operation unrelated to the thyroid gland. Thyroid incidentalomas are most commonly detected on ultrasound, followed in frequency by computed tomography (CT) and magnetic resonance imaging (MRI), carotid duplex scanning and 2-(18)[F] fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET). The incidence of carcinoma in incidentally discovered thyroid disease is not insignificant. There are significant shortcomings of CT, MRI and PET imaging of the thyroid gland. As result, a thorough sonographic evaluation of the thyroid gland should be performed in all patients with a thyroid incidentaloma, regardless of the radiographic features identified on the "non thyroid "imaging modality. A sonographically confirmed thyroid nodule should be managed in an identical fashion to a clinically apparent thyroid nodule.
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Affiliation(s)
- Judy Jin
- Cleveland Clinic Foundation, Cleveland, OH, United States, USA
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Hsiao YC, Wu PS, Chiu NT, Yao WJ, Lee BF, Peng SL. The use of dual-phase 18F-FDG PET in characterizing thyroid incidentalomas. Clin Radiol 2011; 66:1197-202. [DOI: 10.1016/j.crad.2011.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/04/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
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20
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Wong C, Lin M, Chicco A, Benson R. The clinical significance and management of incidental focal FDG uptake in the thyroid gland on positron emission tomography/computed tomography (PET/CT) in patients with non-thyroidal malignancy. Acta Radiol 2011; 52:899-904. [PMID: 21873505 DOI: 10.1258/ar.2011.110078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Incidental focal fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG) uptake in the thyroid is not uncommon. A significant proportion is due to intercurrent thyroid cancer on further evaluation. PURPOSE To investigate and discuss the clinical significance and management of incidental focal FDG uptake in the thyroid gland on positron emission tomography/computed tomography (PET/CT) in patients with non-thyroidal malignancy. MATERIAL AND METHODS We investigated 188/7896 (2.4%) patients who had incidental focal thyroid uptake on FDG PET/CT in an oncology population over a 45-month period. Diagnosis was confirmed in 63 patients of whom 59 patients had histopathological verification. RESULTS Thirty-two percent of confirmed cases were malignant comprising intercurrent thyroid cancer in three-quarters of these patients. Maximum standardized uptake values of the thyroid lesions and SUV ratios compared with background thyroid and mediastinal uptake were not predictive of a benign or malignant etiology. In patients with incidental thyroid cancers, more than half had non-papillary and intermediate to high-risk pathology. CONCLUSION Focal FDG uptake in the thyroid gland on PET/CT showed a malignancy risk of 32%. The intensity of uptake does not predict histology and underpins the importance of further investigations to exclude intercurrent thyroid cancer in suitable patients.
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Affiliation(s)
| | - Michael Lin
- University of New South Wales, Australia
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Andrew Chicco
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Rhonda Benson
- Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, New South Wales, Australia
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Lang BHH, Law TT. The role of 18F-fluorodeoxyglucose positron emission tomography in thyroid neoplasms. Oncologist 2011; 16:458-66. [PMID: 21378078 DOI: 10.1634/theoncologist.2010-0256] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has established itself as an important imaging modality in many oncological and nononcological specialties and, as a consequence, it is increasingly being used in clinical practice. Since the first report of FDG being taken up by metastatic differentiated thyroid carcinoma (DTC) cells >20 years ago, various groups of investigators have explored the potential role of FDG-PET scanning in patients with benign and malignant thyroid neoplasms. With the increasing demand for FDG-PET scanning, clinicians are faced with the challenge of managing an increasing number of FDG-PET-detected thyroid incidentalomas because their significance remains unclear. The aims of this review are to address some of these issues, specifically, the clinical significance of FDG-PET-detected thyroid incidentalomas, the ability of FDG-PET to characterize thyroid nodules, especially those with indeterminate fine needle aspiration cytology results, and the role of FDG-PET in patients with confirmed primary DTC and with suspected recurrent DTC, by reviewing the current literature.
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Abstract
The increased use of sensitive imaging modalities has led to increased identification of the incidental liver mass (ILM). A combination of careful consideration of patient factors and imaging characteristics of the ILM enables clinicians to recommend a safe and efficient course of action. Using an algorithmic approach, this article includes pertinent clinical factors and the specific radiologic criteria of ILMs and discusses the indications for potential procedures. It is the aim of this article to assist with the development of an individualized strategy for each patient with an ILM.
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Affiliation(s)
- Cherif Boutros
- Department of Hepatobiliary and Surgical Oncology, Roger Williams Medical Center, 825 Chalkstone Avenue, Prior 4, Providence, RI 02908, USA
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Iyer NG, Shaha AR. Management of thyroid nodules and surgery for differentiated thyroid cancer. Clin Oncol (R Coll Radiol) 2010; 22:405-12. [PMID: 20381323 DOI: 10.1016/j.clon.2010.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 03/16/2010] [Indexed: 11/19/2022]
Abstract
The incidence of well-differentiated thyroid cancer has seen a worldwide increase in the last three decades. Whether this is due to a 'true increase' in incidence or simply increased detection of otherwise subclinical disease remains unclear. The treatment of thyroid cancer revolves around appropriate surgical intervention, minimising complications and the use of adjuvant therapy in select circumstances. Prognostic features and risk stratification are crucial in determining the appropriate treatment. There continues to be considerable debate in several aspects of management in these patients. Level 1 evidence is lacking, and there are limited prospective data to direct therapy, hence limiting decision-making to retrospective analyses, treatment guidelines based on expert opinion and personal philosophies. This overview focuses on the major issues associated with the investigation of thyroid nodules and the extent of surgery. As overall survival in well-differentiated thyroid cancer exceeds 95%, it is important to reduce over-treating the large majority of patients, and focus limited resources on high-risk patients who require aggressive treatment and closer attention. The onus is on the physician to avoid treatment-related complications from thyroid surgery and to offer the most efficient and cost-effective therapeutic option.
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Affiliation(s)
- N G Iyer
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York 10065, USA
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Thyroid incidentalomas: to treat or not to treat. Eur Arch Otorhinolaryngol 2010; 267:1019-26. [PMID: 20155360 DOI: 10.1007/s00405-010-1207-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 01/12/2010] [Indexed: 12/24/2022]
Abstract
Incidental lesions of the thyroid gland are an increasing problem facing clinicians. While asymptomatic palpable lesions are detected in only 4-7% of the population, currently available imaging modalities are sensitive enough to detect lesions in 20-30% of the population. Guidelines for managing these incidentalomas are limited, largely due to lack of well-powered prospective studies. This review will address the currently available data on thyroid incidentalomas, detected through clinical examination, cross-sectional imaging, ultrasound, and PET scans. We will focus on the modalities of detection and risk of malignancy, further investigation and management options and the deficiencies therein. We propose a pragmatic algorithm when faced with this clinical dilemma under differing circumstances.
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Controversies and challenges in the management of well-differentiated thyroid cancer. Indian J Surg 2009; 71:299-307. [PMID: 23133181 DOI: 10.1007/s12262-009-0084-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 11/24/2009] [Indexed: 12/11/2022] Open
Abstract
The incidence of well-differentiated thyroid cancer has seen a worldwide increase in the last three decades, although whether this is due to a 'true increase' in incidence or simply increased detection of otherwise subclinical disease remains undetermined. Nonetheless, this rising incidence has fuelled an interest in early diagnosis, treatment and follow-up of thyroid cancer along with greater public awareness. The treatment of thyroid cancer revolves around appropriate surgical intervention, minimising complications and the use of adjuvant therapy in select circumstances. Prognostic features and risk stratification are crucial in determining the appropriate treatment. There continues to be considerable debate in several aspects of management in these patients, and there is limited prospective data to direct therapy, hence limiting decision-making to retrospective analyses, treatment guidelines based on expert opinion and personal philosophies. The major controversies are related to diagnostic work-up, extent of surgery and postoperative management including the role of radioactive iodine. There are also differences in opinion regarding management of nodal metastases and follow-up protocols. As overall survival in well-differentiated thyroid cancer exceeds 95%, it is important to reduce over-treating the large majority of patients, and focus limited resources on high-risk patients who require aggressive treatment and closer attention. There needs to be a concerted effort on the part of a multidisciplinary team to recognise the nuances in treating well-differentiated thyroid cancer.
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Robbins RJ, Larson SM. The value of positron emission tomography (PET) in the management of patients with thyroid cancer. Best Pract Res Clin Endocrinol Metab 2008; 22:1047-59. [PMID: 19041831 DOI: 10.1016/j.beem.2008.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
For more than a decade, positron emission tomography (PET) has had an important role in the management of thyroid cancer patients. It may be involved in initial, sometimes inadvertent, diagnosis; in postoperative evaluation; in detection of occult metastases; in the evaluation of thyroid nodules; and in prognostication of metastatic disease. In this review we will update the advances in the application of PET scanning to optimal patient management. The majority of the published studies to date have used 18F-fluoro-deoxyglucose (FDG) as the PET isotope, and unless specifically noted, all references to PET scanning will imply that this tracer has been used.
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Affiliation(s)
- Richard J Robbins
- Endocrine Division, Department of Medicine, The Methodist Hospital, Houston, TX 77030, USA.
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