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Chandekar KR, Satapathy S, Bal C. Positron Emission Tomography/Computed Tomography in Thyroid Cancer: An Updated Review. PET Clin 2024; 19:131-145. [PMID: 38212213 DOI: 10.1016/j.cpet.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
PET/computed tomography (CT) is a valuable hybrid imaging modality for the evaluation of thyroid cancer, potentially impacting management decisions. 18F-fluorodeoxyglucose (FDG) PET/CT has proven utility for recurrence evaluation in differentiated thyroid cancer (DTC) patients having thyroglobulin elevation with negative iodine scintigraphy. Aggressive histologic subtypes such as anaplastic thyroid cancer shower higher FDG uptake. 18F-FDOPA is the preferred PET tracer for medullary thyroid cancer. Fibroblast activation protein inhibitor and arginylglycylaspartic acid -based radiotracers have emerged as promising PET agents for radioiodine refractory DTC patients with the potential for theranostic application.
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Qichang W, Jinming S, Lu L, Bin J, Renjie W, Xiuying Z. Comparison of 18F-FDG-PET and 18F-FDG-PET/CT for the diagnostic performance in thyroid nodules with indeterminate cytology: A meta-analysis. Medicine (Baltimore) 2020; 99:e20446. [PMID: 32481449 DOI: 10.1097/md.0000000000020446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDS We performed a meta-analysis to compare F-FDG-PET and F-FDG-PET/CT for the diagnostic performance in thyroid nodules with indeterminate cytology by Bethesda classification. METHODS PubMed and Embase databases were searched for eligible studies from the earliest available date of indexing through September 2019. Only studies with clearly stated histopathology confirmation were included. Publication bias was assessed by Deeks funnel plot. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and diagnostic odds ratio was determined by random-effect analysis, respectively. All diagnostic estimate indexes were determined separately for PET alone and PET/CT and were compared pair-wisely using Z-test. RESULTS We included 214 patients from five PET alone studies and 420 patients from 8 PET/CT studies in this meta-analysis. The range of the prevalence of malignancy was 11% to 27% for PET alone studies (Median, 20%) and 4% to 50% for PET/CT studies (Median, 24%). The sensitivity (0.95 vs 0.73, P < .01), negative likelihood ratio (0.20 vs 0.53, P = .04) and negative predictive value (0.99 vs 0.91, P < .01) of PET alone are significantly better than those of PET/CT. For PET/CT, Fagan nomogram indicated that when the pre-test probability was set at 24%, the negative post-test probability could decrease to 12%. CONCLUSION This meta-analysis reveals that in evaluating thyroid nodules with indeterminate cytology by Bethesda classification, the rule-out performance of F-FDG-PET is significantly better than F-FDG-PET/CT, although the latter represents a more objective and accurate technique. We hypothesize that the lack of precise localization of suspicious FDG uptake in the neck region may have contributed to this overvaluation for PET alone studies, and advocate that future studies be performed with PET/CT rather than PET alone to avoid misinterpretation and overvaluation in this scenario.
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Affiliation(s)
- Wan Qichang
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shen Jinming
- Department of Intensive Care, Xinyu People's Hospital, Xinyu, China
| | - Li Lu
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ji Bin
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wang Renjie
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zheng Xiuying
- Department of Discipline Inspection, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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Castellana M, Trimboli P, Piccardo A, Giovanella L, Treglia G. Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis. J Clin Med 2019; 8:jcm8091333. [PMID: 31466411 PMCID: PMC6780221 DOI: 10.3390/jcm8091333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
Thyroid nodules with indeterminate fine-needle aspiration cytology (FNA) represent a major challenge in clinical practice. We conducted a systematic review and meta-analysis evaluating the ability of hybrid imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to appropriately select these nodules for surgery. PubMed, CENTRAL, Scopus, and Web of Science were searched until July 2019. Original articles reporting data on the performance of 18F-FDG PET/CT in thyroid nodules with indeterminate FNA were included. Summary operating points including 95% confidence interval values (95% CI) were estimated using a random-effects model. Out of 786 retrieved papers, eight studies evaluating 104 malignant and 327 benign thyroid nodules were included. The pooled positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of 18F-FDG PET/CT were 1.7 (95% CI: 1.4-2.0), 0.4 (95% CI: 0.2-0.7), and 3.5 (95% CI: 1.7-7.1), respectively. No heterogeneity was found for LR+ and DOR. In patients with thyroid nodules with indeterminate FNA, 18F-FDG PET/CT has a moderate ability to correctly discriminate malignant from benign lesions and could represent a reliable option to reduce unnecessary diagnostic surgeries. However, further studies using standardized criteria for interpretation are needed to confirm the reproducibility of these findings.
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Affiliation(s)
- Marco Castellana
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, IT-70124 Bari, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, IT-16128 Genoa, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland
- Department of Nuclear Medicine, University Hospital of Zürich and University of Zürich, CH-8091 Zürich, Switzerland
| | - Giorgio Treglia
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland.
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Yun KJ, Ha J, Kim MH, Seo YY, Kim MK, Kwon HS, Song KH, Kang MI, Baek KH. Comparison of Natural Course between Thyroid Cancer Nodules and Thyroid Benign Nodules. Endocrinol Metab (Seoul) 2019; 34:195-202. [PMID: 31257747 PMCID: PMC6599907 DOI: 10.3803/enm.2019.34.2.195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The natural course of thyroid cancer nodules and benign nodules is different. This study was to compare the changes in size between thyroid cancer nodules and thyroid benign nodules. The risk factors associated with the changes of thyroid cancer nodules were assessed. METHODS This study contains retrospective observational and prospective analysis. A total of 113 patients with 120 nodules were recruited in the cancer group, and 116 patients with 119 nodules were enrolled in the benign group. Thyroid ultrasonography was performed at least two times at more than 1-year interval. RESULTS The mean follow-up durations were 29.5±18.8 months (cancer group) and 31.9±15.8 months (benign group) (P=0.32). The maximum diameter change in length was 0.36±0.97 mm/year in the cancer group and -0.04±0.77 mm/year in the benign group (P<0.01). The volume was significantly increased in the cancer group compared with the benign group (0.06±0.18 mL/year vs. 0.004±0.05 mL/year, respectively, P<0.01; 26.9%±57.9%/year vs. 1.7%±26.0%/year, P<0.01). Initial maximum diameter (β=0.02, P<0.01) and initial volume (β=0.13, P<0.01) were significantly associated with volume change (mL)/year. Initial maximum standardized uptake value did not predict the nodule growth. CONCLUSION It is suggested that thyroid cancer nodules progress rapidly compared with benign nodules. Initial size and volume of nodule were independent risk factors for cancer nodule growth.
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Affiliation(s)
- Kyun Jin Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ye Young Seo
- Department of Nuclear Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Tatlıdil S, Akgün A. FDG PET/BT görüntülemede tiroid bezinde rastlantısal saptanan fokal artmış FDG tutulumunun klinik önemi. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.417340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kumar AA, Datta G, Singh H, Mukherjee PB, Vangal S. Clinical significance of thyroid incidentalomas detected on fluorodeoxyglucose positron emission tomography scan (PETomas): An Indian experience. World J Nucl Med 2019; 18:273-282. [PMID: 31516371 PMCID: PMC6714148 DOI: 10.4103/wjnm.wjnm_46_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Thyroid incidentalomas (TIs) are being frequently detected on positron emission tomography (PET) scan. The risk of malignancy in these focal hot spots is substantially high as compared to incidentalomas detected on ultrasonography (USG)/magnetic resonance imaging/computed tomography (CT). Majority of the studies on the prevalence of TIs in PET and the risk of malignancy in them are retrospective and have had varied results. Very few prospective studies are available and very few Indian studies have been done on the subject. Hence, this study was undertaken to evaluate the clinical significance of TIs detected on fluorodeoxyglucose (FDG)-PET scan. The study included all patients undergoing FDG-PET scan for nonthyroid illness from October 2015 to October 2016. Twenty-three consecutive patients detected to have focal TI (FTI) were prospectively evaluated with detailed history and clinical examination, serum thyroid-stimulating hormone, total T4 and total T3 levels, USG neck, fine-needle aspiration cytology (FNAC), and surgery when indicated. The prevalence of FTI was 2.26%. Out of the 23 FTI cases, 19 patients agreed to undergo further evaluation and malignancy was detected in 5 patients (all papillary carcinomas) making a risk of malignancy of 26.3%. There was no significant correlation between CT attenuation characteristics and size of benign and malignant PETomas or between the maximum standardized uptake value (SUVmax) of benign and malignant PETomas. Hence, the risk of malignancy in thyroid PETomas is substantially high and warrants USG-guided FNAC and further work-up. Their SUVmaxvalues, size, and CT attenuation characteristics do not contribute in differentiating benign from malignant lesions.
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Affiliation(s)
- Avs Anil Kumar
- Department of Nuclear Medicine, Command Hospital, C/O Armed Forces Medical College, Pune, Maharashtra, India
| | - Gaurav Datta
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Harkirat Singh
- Department of Nuclear Medicine, Command Hospital, C/O Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Shashindran Vangal
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India
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Lin YH, Tsai YC, Lin KJ, Der Lin J, Wang CC, Chen ST. Computer-Aided Diagnostic Technique in 2-Deoxy-2-[ 18F]fluoro-D-glucose-Positive Thyroid Nodule: Clinical Experience of 74 Non-thyroid Cancer Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:108-121. [PMID: 30336966 DOI: 10.1016/j.ultrasmedbio.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/01/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
This study verified the value of a computer-aided diagnosis (CAD) technique assisting in ultrasonography (US) diagnosis of 2-deoxy-2-[18F]fluoro-D-glucose (18FDG)-avid thyroid incidentalomas on positron emission tomography. A total of 82 18FDG-avid thyroid incidentalomas from 74 non-thyroid cancer patients were retrospectively analyzed with respect to US and CAD parameters (anechoic area, hyper-echoic foci, hypo-echogenicity, heterogeneity, margin, taller-than-wide shape, eccentric area) and were compared with 38 other non-18FDG-avid nodules found in the same patient group. Fine-needle aspiration cytology or surgical intervention pathology was performed for diagnosis. No significant differences in nodule size or CAD parameters were found in 18FDG-avid nodules reported as benign, indeterminate or malignant. Significantly more taller-than-wide nodules were thyroid originating than metastatic (0.30 vs. 0.16, p < 0.05). Nevertheless, combined CAD and positron emission tomography/computed tomography scores and a discrimination point of 4 resulted in a sensitivity of 75% and a specificity of 80% in prediction of incidentaloma benignity.
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Affiliation(s)
- Yi-Hsuan Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | | | - Kun Ju Lin
- Departments of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen- Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chih-Ching Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
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Jackson BS. Controversy regarding when clinically suspicious thyroid nodules should be subjected to surgery: Review of current guidelines. Medicine (Baltimore) 2018; 97:e13634. [PMID: 30558052 PMCID: PMC6320209 DOI: 10.1097/md.0000000000013634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/19/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The work-up of a thyroid nodule to diagnose malignancy is not always straightforward. There are various international thyroid societies each with their own guidelines on the approach to a thyroid nodule. The aim is therefore to determine whether a clinically suspicious thyroid nodule should be subjected to surgery. METHOD A review of various international thyroid society guidelines on their approach to a suspicious thyroid nodule. RESULTS Sixty-two relevant articles were identified of which 4 current international thyroid guidelines, consisting of 6 different international societies, were reviewed. The commonalities of each of the thyroid society guidelines are imaging, with ultrasound, and cytopathology as the main diagnostic investigations. The description and the size of the nodule are the 2 most important factors on ultrasound; however, the guidelines vary in their recommendations whether to biopsy a suspicious thyroid nodule. An indeterminate group exists whereby thyroid nodules cannot be confirmed as malignant even with fine needle aspiration cytology (FNA). Although further investigations (Technetium-99m -sestamethoxyisobutylisonitryl scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan, and molecular testing) may assist in the diagnosis, there are limitations. There are differences in the guidelines whether suspicious nodules should be subjected to surgery. CONCLUSION Ultrasound and cytopathology are the 2 most appropriate investigations to diagnose whether a suspicious thyroid nodule is benign or malignant. The clinician needs to be aware of the differences between the guidelines from the various international thyroid societies, specifically concerning the indeterminate group of patients where a definitive diagnosis cannot be made. Management decisions should be discussed with a thyroid multidisciplinary team for a consensus decision whether or not to subject a patient with a suspicious thyroid nodule to surgery.
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PET/CT and prediction of thyroid cancer in patients with follicular neoplasm or atypia. Eur Arch Otorhinolaryngol 2018; 275:2109-2117. [PMID: 29909471 DOI: 10.1007/s00405-018-5030-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine whether addition of 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to fine needle aspiration biopsy (FNAB) would improve prediction of thyroid cancer in patients with FNAB-derived follicular neoplasm or atypia, classified according to focal, multifocal, diffuse, or no FDG uptake. MATERIALS AND METHODS Consecutive patients with FNAB-derived follicular neoplasm or atypia planned for surgery from September 2013 to March 2016 were prospectively included and considered for analysis. All patients underwent preoperative PET/CT and a clinical head and neck examination, including ultrasound of the neck and the thyroid gland. Patients with obvious signs of thyroid malignancy were excluded from the study. Histology of the surgical specimen was used as reference standard for statistical analysis. RESULTS Of the 108 patients included (85 women, median age 53.4 years), 31 (29%) had a thyroid nodule that was histologically verified as malignant. Sensitivity and specificity for PET/CT in detection of thyroid cancer was 79 and 32%, respectively, including a derived positive predictive value (PPV) of 31%, and a negative predictive value (NPV) of 79%. Univariate and multivariate analyses showed no significant increase in the risk of thyroid cancer among patients with focal or multifocal FDG uptake compared to patients with no FDG uptake. CONCLUSION Addition of PET/CT to FNAB did not improve prediction of thyroid cancer in patients with FNAB-derived follicular neoplasm or atypia.
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Merten MM, Castro MR, Zhang J, Durski J, Ryder M. Examining the Role of Preoperative Positron Emission Tomography/Computerized Tomography in Combination with Ultrasonography in Discriminating Benign from Malignant Cytologically Indeterminate Thyroid Nodules. Thyroid 2017; 27:95-102. [PMID: 27762671 DOI: 10.1089/thy.2016.0379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cytologically defined indeterminate thyroid nodules are a diagnostic challenge. Surgical lobectomy remains the gold standard for definitive diagnosis. However, 70-85% of nodules are ultimately benign. The primary objective of this study was to evaluate the negative predictive value (NPV) of F18-fluorodeoxyglucose (FDG) positron emission computed tomography (PET/CT) in excluding cancer among cytologically indeterminate thyroid nodules within the authors' institution using surgical pathology as the gold-standard reference. In addition, a systematic review was performed of published prospective studies on the NPV of PET/CT in evaluating indeterminate thyroid nodules. METHODS A retrospective review was performed of all patients aged ≥18 years seen at the Mayo Clinic between January 1, 2000, and December 31, 2014, with cytologically defined indeterminate thyroid nodules (suspicious for Hürthle cell neoplasm or follicular neoplasm; N = 858), who had a PET/CT within one year of fine-needle aspiration (n = 80) and underwent definitive diagnostic lobectomy (n = 51). Nodules were considered PET negative if they had a standardized uptake value (SUV) <5. Additionally, a systematic review was performed of published prospective studies on the NPV of PET/CT across multiple sites. RESULTS Fifty-one patients met the eligibility criteria. The retrospective review combined with a systematic review of eight prospective studies suggests that indeterminate nodules with a negative PET (SUV <5) have a low risk of malignancy (NPV 94%). The cancer prevalence in the institution is 14% and 27% in the combined prospective studies. CONCLUSIONS PET/CT represents a preoperative, non-invasive tool that when combined with sonographic features can identify indeterminate nodules at low risk for malignancy.
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Affiliation(s)
| | - M Regina Castro
- 1 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Jun Zhang
- 2 Division of Laboratory Medicine/Pathology, Mayo Clinic , Rochester, Minnesota
| | - Jolanta Durski
- 3 Department of Radiology, Mayo Clinic , Rochester, Minnesota
| | - Mabel Ryder
- 1 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
- 4 Division of Medical Oncology, Mayo Clinic , Rochester, Minnesota
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Zhu C, Liu W, Yang J, Yang J, Shao K, Yuan L, Chen H, Lu W, Zhu Y. Multidetector computed tomography analysis of benign and malignant nodules in patients with chronic lymphocytic thyroiditis. Oncol Lett 2016; 12:238-242. [PMID: 27347131 DOI: 10.3892/ol.2016.4585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/08/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to compare the multidetector computed tomography (MDCT) features of benign and malignant nodules in patients with chronic lymphocytic thyroiditis (CLT). MDCT findings, including the size, solid percentage, calcification, margin, capsule, anteroposterior-transverse diameter ratio as well as the mode and the degree of enhancement of 137 thyroid nodules in 127 CLT cases were retrospectively analyzed. Furthermore, the correlation between MDCT findings and pathological results combined with the CT perfusion imaging was analyzed for the differences between benign and malignant nodules. A total of 77.5% (31/40) of malignant nodules were completely solid, and 33% (32/97) of benign nodules were predominantly cystic. Compared with the benign nodules, micro-calcification and internal calcification were more frequently observed in the malignant nodules (P<0.05). MDCT features such as ill-defined margin, absence of capsule or incomplete capsule or homogeneous enhancement were more likely to be present in the malignant nodules (P<0.05). Nevertheless, no significant difference was observed in the enhancement degree at arterial or venous phase between benign and malignant nodules (P>0.05). MDCT features are useful in differentiating the benign and malignant nodules in CLT patients, and it may be essential for a radiologist to review the MDCT characteristics of nodules in the clinical practice.
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Affiliation(s)
- Caisong Zhu
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Wei Liu
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Jun Yang
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Jing Yang
- Department of Pathology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Kangwei Shao
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Lixin Yuan
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Hairong Chen
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Wei Lu
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
| | - Ying Zhu
- Department of Radiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, P.R. China
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Chong A, Ha JM, Han YH, Kong E, Choi Y, Hong KH, Park JH, Kim SH, Park JM. Preoperative Lymph Node Staging by FDG PET/CT With Contrast Enhancement for Thyroid Cancer: A Multicenter Study and Comparison With Neck CT. Clin Exp Otorhinolaryngol 2016; 10:121-128. [PMID: 27334517 PMCID: PMC5327587 DOI: 10.21053/ceo.2015.01424] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/31/2015] [Accepted: 03/11/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives The purpose of this study was to compare lymph node (LN) staging using 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) with contrast-enhancement (CE) PET/CT and contrast-enhanced neck CT (neck CT) in patients with thyroid cancer with level-by-level comparison with various factors. Methods This was a retrospective multicenter study. A total of 85 patients were enrolled. Patients who underwent a preoperative evaluation by CE PET/CT and neck CT for thyroid cancer were enrolled. The gold standard for LN was the combination of surgical pathology and clinical follow-up. We compared CE PET/CT with neck CT using a level-by-level method. Factors, including age, sex, camera, arm position, tumor size, extra-thyroidal extension, tumor location, number of primary tumors, primary tumor maximum standardized uptake value, and the interval from scan to operation were also analyzed. Results Overall accuracy was 81.2% for CE PET/CT and 68.2% for neck CT. CE PET/CT was more sensitive than neck CT (65.8% vs. 44.7%). Also, CE PET/CT showed higher negative predictive value (77.2% vs. 66.1%). CE PET/CT showed good agreement with the gold standard (weighted kappa [κ], 0.7) for differentiating N0, N1a, and N1b, whereas neck CT showed moderate agreement (weighted κ, 0.5). CE PET/CT showed better agreement for the number of levels involved with the gold standard (weighted κ, 0.7) than that of neck CT with the gold standard (weighted κ, 0.5). The accuracies for differentiating N0, N1a, and N1b were 81.2% for CE PET/CT and 68.2% for neck CT. Level-by-level analysis showed that CE PET/CT was more sensitive and has higher negative predictive value for detecting ipsilateral level IV and level VI LNs than neck CT. Other analyzed factors were not related to accuracies of both modalities. Conclusion CE PET/CT was more sensitive and reliable than neck CT for preoperative LN staging in patients with thyroid cancer.
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Affiliation(s)
- Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, Korea
| | - Jung-Min Ha
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, Korea
| | - Yeon-Hee Han
- Department of Nuclear Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Yunjung Choi
- Department of Nuclear Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ki Hwan Hong
- Department of Otolaryngology-Head and Neck Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Jun-Hee Park
- Department of Otolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Sung Hoon Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Mi Park
- Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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King DL, Stack BC, Spring PM, Walker R, Bodenner DL. Incidence of Thyroid Carcinoma in Fluorodeoxyglucose Positron Emission Tomography-Positive Thyroid Incidentalomas. Otolaryngol Head Neck Surg 2016; 137:400-4. [PMID: 17765765 DOI: 10.1016/j.otohns.2007.02.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 02/26/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE: Fluorodeoxyglucose (FDG) whole body positron emission tomography (PET) scan may show clinically occult second lesions. Such lesions in the thyroid are increasingly common. There are several recent reports of a high probability of malignancy in these lesions ranging from 14% to 63%. STUDY DESIGN AND SETTING: This is a retrospective review of 15,711 PET scans at a multi-disciplinary thyroid clinic at a tertiary care university medical center. Twenty-two patients were referred with thyroid PET “incidentalomas.” The review included 18 FDG-PET scans, ultrasound guided fine needle aspiration biopsies, and thyroid surgery pathology. Aspiration cytology or pathology were the main outcome measures. RESULTS: Three patients had malignancy of the PET-positive thyroid lesions. Papillary thyroid micro carcinomas were detected in four of the specimens that showed a benign pathology of the dominant nodule. CONCLUSION: Our experience shows a 14% malignancy rate for the dominant (imaged) nodule and a total malignancy rate of 32% when the incidental micro carcinomas are included. Both of these rates are significantly lower than results published previously.
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Affiliation(s)
- Deanne L King
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Beech P, Lavender I, Jong I, Soo G, Ramdave S, Chong A, Nandurkar D. Ultrasound stratification of the FDG-avid thyroid nodule. Clin Radiol 2016; 71:164-9. [DOI: 10.1016/j.crad.2015.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 10/01/2015] [Accepted: 10/21/2015] [Indexed: 01/01/2023]
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Buyukdereli G, Aktar Y, Kara E, Uguz A, Sonmez H. Role of 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Cytologically Indeterminate Thyroid Nodules. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e21186. [PMID: 27110335 PMCID: PMC4837297 DOI: 10.5812/iranjradiol.21186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 04/06/2015] [Accepted: 04/21/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid nodules with indeterminate fine-needle aspiration biopsy (FNAB) results remain a diagnostic dilemma, because 70 - 85% of these nodules have been found to be benign after thyroid surgery. OBJECTIVES The purpose of this study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the preoperative diagnosis of cytologically indeterminate nodules. PATIENTS AND METHODS Forty-six patients were included in this study. These individuals had undergone FDG PET/CTs for the preoperative evaluation of thyroid nodules with indeterminate FNAB results. The results of the preoperative PET/CT scans were compared with the postoperative pathological results and statistically analyzed. RESULTS Of the 46 patients included in our study, the histopathology of the surgical specimens revealed thyroid cancer in 17 individuals (37%, 17/46). The PET/CT scan showed a positive result in 27 patients. Of these, 16 patients (59.3%) were found to have thyroid carcinomas. In addition, the PET/CT scan was considered to be negative in 19 patients, 18 (94.7%) of whom had benign lesions. For the detection of malignant lesions, the values for the sensitivity and specificity, and the positive predictive and negative predictive values were 94%, 62%, 59%, and 95%, respectively. CONCLUSION The FDG PET/CT showed a high sensitivity and a high negative predictive value for identifying malignancies in thyroid nodules with indeterminate FNAB results. Therefore, the FDG PET/CT may be a helpful tool in the clinical management of these nodules. When an FDG positive lesion is detected, further examination is recommended.
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Affiliation(s)
- Gulgun Buyukdereli
- Department of Nuclear Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Yasemin Aktar
- Department of Nuclear Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ertan Kara
- Department of Public Health, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Aysun Uguz
- Department of Pathology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Husnu Sonmez
- Department of General Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
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ŞENCAN EREN M, ÖZDOĞAN Ö, GEDİK A, CEYLAN M, GÜRAY DURAK M, SEÇİL M, KOÇDOR MA, ÇÖMLEKÇİ A, DURAK H. The incidence of 18F-FDG PET/CT thyroid incidentalomas andthe prevalence of malignancy: a prospective study. Turk J Med Sci 2016; 46:840-7. [DOI: 10.3906/sag-1503-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/09/2015] [Indexed: 11/03/2022] Open
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Kim TH, Ji YB, Song CM, Kim JY, Choi YY, Park JS, Tae K. SUVmax of 18F-FDG PET/CT in the differential diagnosis of benign and malignant thyroid nodules according to tumor volume. World J Surg Oncol 2015; 13:217. [PMID: 26179774 PMCID: PMC4504214 DOI: 10.1186/s12957-015-0635-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate whether the maximum standardized uptake value (SUVmax) measured on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could be used as the primary means of differential diagnosis of thyroid nodules when tumor volume is assessed. METHODS We studied 192 patients who underwent preoperative 18F-FDG PET/CT followed by thyroidectomy. We evaluated the correlation between the volume of thyroid nodules, 18F-FDG uptake on visual analysis, and the mean SUVmax measured on 18F-FDG PET/CT. RESULTS When stratified by tumor volume, the mean SUVmax was higher in malignant than in benign nodules in nodules≥1 cm3 (p<0.001). However, it did not differ between benign and malignant nodules smaller than 1 cm3. At a cut-off value of SUVmax of 6, the respective sensitivities of 18F-FDG PET/CT, ultrasonography, and fine needle aspiration cytology were 60.8, 96.4, and 99.1%, and the respective specificities were 95.9, 98.2, and 96.8%. CONCLUSIONS 18F-FDG PET/CT is limited as a primary modality in the differential diagnosis of benign and malignant thyroid nodules because of its low sensitivity.
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Affiliation(s)
- Tae Heon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea.
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea.
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea.
| | - Ji Young Kim
- Department of Nuclear Medicine, College of Medicine, Hanyang University, Seoul, Korea.
| | - Yun Young Choi
- Department of Nuclear Medicine, College of Medicine, Hanyang University, Seoul, Korea.
| | - Jeong Seon Park
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Korea.
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Korea.
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Hurtado-López LM, Fernández-Ramírez F, Martínez-Peñafiel E, Ruiz JDC, González NEH. Molecular Analysis by Gene Expression of Mitochondrial ATPase Subunits in Papillary Thyroid Cancer: Is ATP5E Transcript a Possible Early Tumor Marker? Med Sci Monit 2015; 21:1745-51. [PMID: 26079849 PMCID: PMC4482184 DOI: 10.12659/msm.893597] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/02/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cancer development involves an "injury" to the respiratory machinery (Warburg effect) due to decreased or impaired mitochondrial function. This circumstance results in a down regulation of some of the ATPase subunits of the malignant tissue. The objective of this work was to assess and compare the relative expression of mRNA of mitochondrial ATPase subunits between samples of thyroid cancer and benign nodules. MATERIAL AND METHODS Samples from 31 patients who had an operation for PTC at the General Hospital of Mexico were snap-frozen and stored at -70°C. Thirty-five patients who had an operation for benign tumors were also included in the study. mRNA expression levels of alpha, beta, gamma, and epsilon subunits of F1 and "c12" of subunit Fo were determined by real-time RT-PCR (by duplicate), in order to determine if abnormal expression of these genes could partially explain the Warburg effect in papillary thyroid cancer (PTC). RESULTS ATP5E transcript alteration (down-expression) was highly associated to PTC diagnosis OR=11.76 (95% confidence interval, 1.245-237.98; p=0.04). CONCLUSIONS Relative down-expression of ATP5E transcript was highly associated with PTC diagnosis. This transcript alteration may be used as a tumoral marker in papillary thyroid cancer.
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Affiliation(s)
- Luis Mauricio Hurtado-López
- Thyroid Clinic, Hospital General de Mexico, Instituto Politecnico Nacional, Mexico, Mexico
- Molecular Oncology, Escuela Superior de Medicina, Instituto Politecnico Nacional, Mexico, Mexico
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The usefulness of standardized uptake value in differentiation between benign and malignant thyroid lesions detected incidentally in 18F-FDG PET/CT examination. PLoS One 2014; 9:e109612. [PMID: 25296297 PMCID: PMC4190406 DOI: 10.1371/journal.pone.0109612] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 09/01/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction In the last decade, (18)F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET and PET/CT) has become one of the major diagnostic tools used in oncology. A significant number of patients who undergo this procedure, due to non-thyroidal reasons, present incidental uptake of (18F-FDG) in the thyroid. The aim of the study was to compare the SUVmax (standardized uptake value) of thyroid focal lesions, which were incidentally found on PET/CT, in relation to the results of thyroid fine-needle aspiration biopsy (FNAB) and/or histopathological evaluation. Materials and Methods Patients referred for PET/CT examination, due to non-thyroidal illness, presented focal 18F-FDG uptake in the thyroid and were advised to undergo ultrasonography (US), hormonal evaluation, FNAB and/or total thyroidectomy at our institution. Results 6614 PET/CT examinations performed in 5520 patients were analyzed. Of the 122 patients with focal thyroid 18F-FDG activity, 82 patients (67.2%) underwent further thyroid evaluation using FNAB. Benign lesions were diagnosed in 46 patients, malignant - in 19 patients (confirmed by post-surgical histopathology), while 17 patients had inconclusive results of cytological assessment. Mean SUVmax of benign lesions was 3.2±2.8 (median = 2.4), while the mean SUVmax value for malignant lesions was 7.1±8.2 (median = 3.5). The risk of malignancy was 16.7% for lesions with a SUVmax under 3, 43.8% for lesions with a SUVmax between 3 and 6, and 54.6% for lesions with a SUVmax over 6. In the group of malignant lesions, a positive correlation between the lesion’s diameter and SUVmax was observed (p = 0.03, r = 0.57). Conclusions Subjects with incidental focal uptake of 18F-FDG in thyroid are at a high risk of thyroid malignancy. A high value of SUVmax further increases the risk of malignancy, indicating the necessity for further cytological or histological evaluation. However, as SUVmax correlated with the diameter of malignant lesions, small lesions with focal uptake of 18F-FDG should be interpreted cautiously.
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Hwang SO, Lee SW, Kang JK, Choi HH, Kim WW, Park HY, Jung JH. Clinical value of visually identifiable 18F-fluorodeoxyglucose uptake in primary papillary thyroid microcarcinoma. Otolaryngol Head Neck Surg 2014; 151:415-20. [PMID: 24903453 DOI: 10.1177/0194599814537224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study evaluates the relationship between visually identifiable (18)F-fluorodeoxyglucose (FDG) uptake in primary papillary thyroid microcarcinoma (PTMC) and tumor aggressiveness. STUDY DESIGN Historical cohort study. SETTING Tertiary care center. METHODS Clinicopathological factors and PET/CT findings of 219 PTMC surgical patients who underwent preoperative (18)F-FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. RESULTS (18)F-FDG uptake was observed in the tumors of 124 (56.6%) patients. Tumor size (odds ratio [OR] = 1.774; 95% confidence interval [CI], 1.416-2.223; P < .0001) and Hashimoto thyroiditis (OR = 2.815; CI, 1.237-6.404; P = .014) independently predicted (18)F-FDG uptake. Tumor size (OR = 1.495; CI, 1.217-1.835; P < .0001) and BRAF(V600E) mutation (OR = 3.320; CI, 1.056-10.432; P = .040) independently predicted extrathyroidal invasion. Multiplicity (OR = 2.375; CI, 1.278-4.415; P = .006) independently predicted central lymph node metastasis. CONCLUSION (18)F-FDG uptake in PTMC depends on tumor size and Hashimoto thyroiditis. Therefore, preoperative PET/CT for PTMC may not help in evaluating tumor aggressiveness.
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Affiliation(s)
- Seung Ook Hwang
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jin Koo Kang
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyang Hee Choi
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Kim MH, Ko SH, Bae JS, Lee SH, Jung CK, Lim DJ, Baek KH, Kim SH, Lee JM, Kang MI, Cha BY. Non-FDG-avid primary papillary thyroid carcinoma may not differ from FDG-avid papillary thyroid carcinoma. Thyroid 2013; 23:1452-60. [PMID: 23688271 DOI: 10.1089/thy.2013.0051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND FDG (2-[(18)F]Fluoro-2-D-deoxyglucose-positron emission tomography (PET)/computed tomography (CT), which can detect a change in glucose metabolism in cancer cells, has been introduced as a diagnostic and prognostic tool in papillary thyroid carcinoma (PTC). However, differences in the clinicopathological and biological characteristics between primary PTCs with FDG uptake and those without FDG uptake are not well established. METHODS A total of 188 patients with PTC who had preoperative PET/CT scans were enrolled to compare the differences of clinicopathological parameters between FDG-avid (F-PTC; n = 150) and non-FDG-avid tumors (FN-PTC; n = 38). Immunohistochemical staining for glucose transporter (GLUT)-1 and hypoxia-inducible factor-1 alpha (HIF-1α) was performed. RESULTS FN-PTCs were smaller; had a lower incidence of lymphatic invasion, vascular invasion, multifocality, and central lymph node metastasis; and had a lower maximum standardized uptake value than F-PTCs. After exclusion of high-risk patients for recurrence, FN-PTCs remained smaller (p < 0.001) and had less lymphatic invasion (p = 0.061). Among tumors larger than the spatial resolution of the PET/CT scan, macrocalcification was more frequent in FN-PTC than in F-PTC (p = 0.043). While FN-PTC and F-PTC showed no difference in GLUT-1 expression (50% vs. 75%, p = 0.363), FN-PTC showed lower HIF-1α immunoreactivity than F-PTC (25.0% vs. 75.0%, p = 0.032). CONCLUSION Tumor size and macrocalcification are clinicopathological differences between FN-PTC and F-PTC. Biologically, HIF-1α may be responsible for increased FDG uptake in PTC.
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Affiliation(s)
- Min-Hee Kim
- 1 Department of Internal Medicine (Division of Endocrinology and Metabolism), The Catholic University of Korea , College of Medicine, Seoul, Korea
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Combined 99mTc-methoxyisobutylisonitrile scintigraphy and fine-needle aspiration cytology offers an accurate and potentially cost-effective investigative strategy for the assessment of solitary or dominant thyroid nodules. Eur J Nucl Med Mol Imaging 2013; 41:105-15. [DOI: 10.1007/s00259-013-2546-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
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Wang N, Zhai H, Lu Y. Is fluorine-18 fluorodeoxyglucose positron emission tomography useful for the thyroid nodules with indeterminate fine needle aspiration biopsy? A meta-analysis of the literature. J Otolaryngol Head Neck Surg 2013; 42:38. [PMID: 24228840 PMCID: PMC3765697 DOI: 10.1186/1916-0216-42-38] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 05/25/2013] [Indexed: 12/29/2022] Open
Abstract
Background The indeterminate fine needle aspiration biopsy (FNAB) results present a clinical dilemma for physicians. The aim of this study was to evaluate the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography (18 F-FDG PET) in the detection of these indeterminate lesions. Methods Seven studies (involving a total of 267 patients) published before November 2012 were reviewed. Systematic methods were used to identify, select, and evaluate the methodological quality of the studies as well as to summarize the overall findings of sensitivity and specificity. Results A total number of 70 patients were confirmed to have malignant lesions, with a cancer prevalence of 26.2% (70/267; ranging from 19.6% to 40.0% in these studies). The pooled sensitivity and specificity of PET or PET/CT for the detection of cancer was 89.0% (95% CI: 79.0% ~ 95.0%) and 55.0% (95% CI: 48.0% ~ 62.0%), respectively. There was no evidence of threshold effects or publication bias. The area [±standard error (±SE)] under the symmetrical sROC curve was 0.7207 ± 0.1041. Although SUVmax was higher in malignant lesions (P < 0.01), there was still a great overlap. The best cut-off value of SUVmax for differentiation was 2.05; but with a high sensitivity of 89.8% and low specificity of 42.0%. Conclusion F-FDG PET or PET/CT showed a high sensitivity in detecting thyroid cancers in patients with indeterminate FNAB results. Further examination was strongly recommended when an FDG-avid lesion was detected.
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Affiliation(s)
- Ningjian Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, No, 639, Zhizaoju Road, Shanghai 200011, China.
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Bertagna F, Treglia G, Piccardo A, Giovannini E, Bosio G, Biasiotto G, Bahij EK, Maroldi R, Giubbini R. F18-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value. Endocrine 2013. [PMID: 23179777 DOI: 10.1007/s12020-012-9837-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Thyroid incidental uptake is defined as a thyroid uptake incidentally and newly detected by imaging techniques performed for an unrelated purpose and especially for non-thyroid diseases. Aim of the study was to establish the prevalence and pathological nature of focal thyroid incidentalomas detected at F18-FDG-PET/CT in patients studied for oncological purposes and not for thyroid disease. Secondary end point was to establish a possible maximum standardised uptake value cut-off over which a malignant lesion should be suspected. We have retrospectively evaluated 49519 patients who underwent F18-FDG-PET/CT for oncologic purposes in three Nuclear Medicine Centres (N.1 = 11278, N.2 = 31076, N.3 = 7165). A focal incidental thyroid uptake was diagnosed in 729 (1.5 %) patients (287-39.4 % male and 442-60.6 % female; average age: 65.26). Of 729 thyroid incidentalomas 211 (28.9 %) underwent further investigation to determine the nature of the nodule; 124/211 (58.8 %) incidentalomas were benign, 72/211 (34.1 %) malignant, 4/211 (1.9 %) non-diagnostic at cytological examination in the absence of surgery and histological evaluation and 11/211 (5.2 %) were indeterminate at cytological examination. A centre-based receiver operating curve (ROC) analysis of the patients with a definitive diagnosis was performed to identify a SUVmax cut-off useful in differentiating benign from malignant incidentalomas. In the centre N.1 it was 4.8 (sensitivity = 95.7 %, specificity = 46.4 %, area under the curve = 0.758); 5.3 in the centre N.2 (sensitivity = 76.3 %, specificity = 72.5 %, area under the curve = 0.815); 7 in the centre N.3 (sensitivity = 57.1 %, specificity = 79.3 %, area under the curve = 0.627). F18-FDG-PET/CT thyroid incidentalomas are a relevant diagnostic reality which requires further investigations and clinical management especially considering that, despite mainly benign, approximately one third of focal thyroid uptakes are malignant.
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Affiliation(s)
- Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
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Abstract
Thyroid cancer includes several neoplasms originating from the thyroid gland-from indolent and curable histologies of differentiated thyroid carcinoma to aggressive anaplastic thyroid carcinoma. Differentiation of thyroid nodules is problematic on CT and MR imaging unless there is evidence of extrathyroidal extension. Evaluation of regional lymph nodes is often performed clinically or with ultrasound. The retropharyngeal and mediastinal lymph nodes are better evaluated by CT and MR imaging. Nuclear scintigraphy is useful for staging and treatment of distant metastasis in differentiated thyroid carcinoma. PET may have a role in aggressive cancers. Accurate staging affects surgical management and subsequent therapy.
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Affiliation(s)
- Amit M Saindane
- Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA 30322, USA.
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Could 18F-FDG-PET/CT avoid unnecessary thyroidectomies in patients with cytological diagnosis of follicular neoplasm? Langenbecks Arch Surg 2013; 398:709-16. [DOI: 10.1007/s00423-013-1070-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 02/19/2013] [Indexed: 11/25/2022]
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Kao YH, Lim SS, Ong SC, Padhy AK. Thyroid Incidentalomas on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography: Incidence, Malignancy Risk, and Comparison of Standardized Uptake Values. Can Assoc Radiol J 2012; 63:289-93. [DOI: 10.1016/j.carj.2011.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 04/15/2011] [Accepted: 04/24/2011] [Indexed: 11/16/2022] Open
Abstract
Introduction To determine the incidence of fluorine-18-fluorodeoxyglucose (FDG) avid thyroid incidentalomas detected on positron emission tomography (PET) with integrated computed tomography (CT), and correlate the FDG–PET-CT findings to cytology. Methods A total of 942 FDG–PET-CT reports were retrospectively reviewed. Patients with FDG-avid thyroid incidentalomas were further reviewed for correlative cytology. Results The incidence of FDG-avid thyroid incidentalomas is 2.2%. Thyroid malignancies were identified in 3 of 6 patients who underwent cytologic correlation, with a positive predictive value of 50% (95% confidence interval, 14%-86%). The mean maximum standardized uptake values of benign and malignant FDG-avid thyroid incidentalomas were 5.6 and 6.6, respectively. Conclusion A FDG-avid thyroid incidentaloma may predict underlying malignancy. Cytologic assessment should be considered for FDG-avid thyroid incidentalomas.
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Affiliation(s)
- Yung H. Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Siew S. Lim
- Division of Family Medicine, Singhealth Polyclinics, Singapore
| | - Seng C. Ong
- Nuclear Medicine and PET Centre, Mount Elizabeth Hospital, Singapore
| | - Ajit K. Padhy
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
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Singh S, Singh A, Khanna AK. Thyroid incidentaloma. Indian J Surg Oncol 2012; 3:173-81. [PMID: 23997505 PMCID: PMC3444577 DOI: 10.1007/s13193-011-0098-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 10/24/2011] [Indexed: 11/28/2022] Open
Abstract
Because of emerging investigation modalities many of the thyroid lesions are picked up and that poses a big dilemma about management of such lesions. Majority of these lesions especially in iodine-deficient regions, are not significant and may be only followed up without any active treatment but, sometimes the small lesions may be microcarcinoma. This article discusses about the reliability of clinical examination of neck for detection of such lesions, the controversy of such lesion being benign or malignant, and how to evaluate these lesions and the recommendation as per American Thyroid Association guidelines.
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Affiliation(s)
- Seema Singh
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Anutosh Singh
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - A. K. Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
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Soelberg KK, Bonnema SJ, Brix TH, Hegedüs L. Risk of malignancy in thyroid incidentalomas detected by 18F-fluorodeoxyglucose positron emission tomography: a systematic review. Thyroid 2012; 22:918-25. [PMID: 22827552 DOI: 10.1089/thy.2012.0005] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The expanding use of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) has led to the identification of increasing numbers of patients with an incidentaloma in the thyroid gland. We aimed to review the proportion of incidental thyroid cancers found by (18)F-FDG PET or PET/computed tomography imaging. METHODS Studies evaluating thyroid carcinomas discovered incidentally in patients or healthy volunteers by (18)F-FDG PET were systematically searched in the PubMed database from 2000 to 2011. The main exclusion criteria were known thyroid disease, lack of assigned diagnoses, investigation of diffuse uptake only, or investigation of patients with head and neck cancer, or cancer in the upper part of the thorax. RESULTS Twenty-two studies met our criteria comprising a total of 125,754 subjects. Of these, 1994 (1.6%) had unexpected focal hypermetabolic activity, while 999 of 48,644 individuals (2.1%) had an unexpected diffuse hypermetabolic activity in the thyroid gland. A diagnosis was assigned in 1051 of the 1994 patients with a focal uptake, 366 of whom (34.8%) had thyroid malignancy. Likewise, a diagnosis was assigned in 168 of 999 patients with a diffuse uptake, 7 of whom (4.4%) had thyroid malignancy. In the eight studies reporting individual maximum standardized uptake values (SUV(max)), the mean SUV(max) was 4.8 (standard deviation [SD] 3.1) and 6.9 (SD 4.7) in benign and malignant lesions, respectively (p<0.001). CONCLUSIONS Incidentally found thyroid nodules, using (18)F-FDG PET, are at high risk of harboring malignancy if uptake is focal. SUV are significantly higher in malignant than in benign nodules. The pronounced inhomogeneity and other shortcomings of the studies are discussed.
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Follicular neoplasm involving one lobe of thyroid: is hemithyroidectomy the adequate initial procedure? Ir J Med Sci 2012; 182:37-40. [DOI: 10.1007/s11845-012-0822-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/29/2012] [Indexed: 01/21/2023]
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Kanzaki R, Higashiyama M, Oda K, Okami J, Maeda J, Takenaka A, Tomita Y, Kodama K. Surgical management of primary intrathoracic goiters. Gen Thorac Cardiovasc Surg 2012; 60:171-4. [PMID: 22419189 DOI: 10.1007/s11748-011-0801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 02/28/2011] [Indexed: 10/28/2022]
Abstract
Intrathoracic goiters account for 3.1%-5.8% of all mediastinal masses. Primary intrathoracic goiters, which receive their blood supply from mediastinal vessels and disconnect at the cervical thyroid, are even rarer. This report presents two cases of surgical resection of benign and malignant primary intrathoracic goiters. Usefulness of a whole-body (18)F-fluorine-2-fluoro-D: -glucose positron emission tomography/computed tomography study and intraoperative fine-needle aspiration cytology in the management of primary intrathoracic goiters is discussed.
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Affiliation(s)
- Ryu Kanzaki
- Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.
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Boeckmann J, Bartel T, Siegel E, Bodenner D, Stack BC. Can the pathology of a thyroid nodule be determined by positron emission tomography uptake? Otolaryngol Head Neck Surg 2012; 146:906-12. [PMID: 22307576 DOI: 10.1177/0194599811435770] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine if standardized uptake values (SUV) on positron emission tomography (PET) are predictive of thyroid pathology and the significance of serial SUV measurements of thyroid nodules over time. STUDY DESIGN Case series with chart review. SETTING Academic health center. SUBJECTS In total, 23,384 PET and PET/computed tomography (CT) scans were performed between December 2001 and April 2011. METHODS Patients with incidental thyroid uptake were identified. SUV(max), age, sex, size of thyroid lesion, indication for PET scan, and cytology/pathology were collected. RESULTS Incidental thyroid uptake was noted in 1309 PET scans (5.60%), focal uptake in 690 (2.95%), and diffuse uptake in 619 (2.65%). Complete data were available for 359 PET scans from 103 patients. Malignancy was identified in 28 patients (27%). Twenty-five of the 28 lesions (89%) were primary thyroid malignancies. A significant difference between malignant SUV(max) and benign SUV(max) was found (mean ± SD, 7.04 ± 7.88 for malignancies vs 3.85 ± 3.06 for benign tumors, P = .0292). Receiver operating characteristics curves were constructed on patients with PET data within 3 months of diagnosis and indicated that a SUV(max) of 4.2 differentiated maximally between benign and malignant lesions. Serial SUV uptake had no significant change over time. CONCLUSION All thyroid nodules with focal uptake on (18)F-fluorodeoxyglucose-PET/CT should be considered at higher risk of malignancy than those discovered incidentally by other imaging modalities. Higher SUV(max) values are more indicative of malignant lesions. All lesions should be evaluated with ultrasonography ± fine-needle aspiration if no clinical contraindications exist. Size of the primary nodule does not influence SUV(max) uptake.
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Affiliation(s)
- Jacob Boeckmann
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Deandreis D, Al Ghuzlan A, Auperin A, Vielh P, Caillou B, Chami L, Lumbroso J, Travagli JP, Hartl D, Baudin E, Schlumberger M, Leboulleux S. Is (18)F-fluorodeoxyglucose-PET/CT useful for the presurgical characterization of thyroid nodules with indeterminate fine needle aspiration cytology? Thyroid 2012; 22:165-72. [PMID: 22257371 DOI: 10.1089/thy.2011.0255] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid nodules found incidentally on (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) have been shown to be malignant in 30%-50% of cases. The American Thyroid Association recommends performing fine needle aspiration cytology (FNAC) for thyroid nodules showing FDG uptake. On the other hand, the role of FDG-PET in characterizing thyroid nodules with indeterminate cytology before surgery is not clear. The goal of this study was to evaluate the role of FDG-PET/computed tomography (CT) in predicting malignancy of thyroid nodules with indeterminate FNAC and to correlate FDG uptake with pathological and ultrasonographic (US) features. METHODS Between November 2006 and October 2009, 55 patients (42 women, mean age: 50 years) planned for surgery for 56 thyroid nodules with indeterminate FNAC were prospectively included and considered for analysis. All patients underwent presurgical FDG-PET/CT (Siemens Biograph, mean FDG injected activity: 165 MBq) and neck US. Pathology of the corresponding surgical specimen was the gold standard for statistical analysis. RESULTS At pathology 34 nodules were benign, 10 were malignant (7 papillary and 3 follicular carcinomas), and 12 were tumors of uncertain malignant potential (TUMP). The median size of the thyroid nodules was 21 mm (range: 10-57). Sensitivity, specificity, positive (PPV), and negative predictive (NPV) values of FDG-PET in detecting cancer/TUMP were 77%, 62%, 57%, and 81%, respectively. In multivariate analysis, cellular atypia was the only factor predictive of FDG uptake (p<0.001). Hurthle cells and poorly differentiated components were independent predictive factors of high (≥5) SUV Max (p=0.02 and p=0.02). Sensitivity, specificity, PPV, and NPV of US in detecting cancer/TUMP were 82%, 47%, 50%, and 80%, respectively. In multivariate analysis, hypervascularization was correlated with malignancy/TUMP (p=0.007) and cystic features were correlated with benignity (p=0.03). CONCLUSION Adding FDG-PET findings to neck US provided no diagnostic benefit. The sensitivity and specificity of FDG-PET in the presurgical evaluation of indeterminate thyroid nodules are too low to recommend FDG-PET routinely.
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Affiliation(s)
- Desiree Deandreis
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, Villejuif, France.
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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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Lang BHH. The Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Prognostication, Diagnosis, and Management of Thyroid Carcinoma. J Thyroid Res 2011; 2012:198313. [PMID: 22007340 PMCID: PMC3189566 DOI: 10.1155/2012/198313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022] Open
Abstract
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) plays an increasingly important role in the prognostication, diagnosis, and management of thyroid carcinoma. For patients diagnosed with primary or persistent/recurrent thyroid carcinoma, a finding of FDG-PET positivity implies a more aggressive tumor biology and a distinct mutational profile, both of which carry prognostic significance. Therefore, FDG-PET positivity may be a useful potential risk factor for preoperative risk stratification in primary thyroid carcinoma. This information may help in the planning of subsequent treatment strategy such as the extent of thyroidectomy, prophylactic central neck dissection, and radioiodine ablation. FDG-PET scan has also been found to be a useful adjunct in characterizing indeterminate thyroid nodules on fine needle aspiration cytology. However, larger-sized prospective studies are required to validate this finding. FDG-PET or FDG-PET/CT scan has become the imaging of choice in patients with a negative whole-body radioiodine scan, but with an abnormally raised thyroglobulin level after total thyroidectomy and radioiodine ablation.
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Affiliation(s)
- Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
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Giovanella L, Suriano S, Maffioli M, Ceriani L. 18FDG-positron emission tomography/computed tomography (PET/CT) scanning in thyroid nodules with nondiagnostic cytology. Clin Endocrinol (Oxf) 2011; 74:644-8. [PMID: 21470288 DOI: 10.1111/j.1365-2265.2011.04005.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the role of positron emission tomography/computed tomography (PET/CT) scans with (18) FDG ((18)FDG-PET/CT) in the evaluation of thyroid nodules with nondiagnostic cytology. SUBJECTS AND METHODS Eighty-eight patients with a single euthyroid nodule and repeatedly nondiagnostic ultrasound-guided fine-needle cytology (US-FNC) were enrolled in the present study. Nodules concentrating (18)FDG were considered positive (i.e. suspicious for malignancy). Histological findings were obtained after surgery in all patients. RESULTS None of 41 patients with negative (18)FDG-PET/CT scan had a final histological diagnosis of malignancy (i.e. no false-negative results). Twenty-nine patients with final histological diagnosis of thyroid cancer had positive (18)FDG-PET/CT scan. Eighteen patients with final histological diagnosis of benign lesions (including four with follicular adenomas) also had positive (18)FDG-PET/CT scans. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 100%, 69%, 79%, 62% and 100%, respectively. CONCLUSIONS A negative (18)FDG-PET/CT scan accurately excludes malignancy in thyroid nodules with non-diagnostic US-FNC procedures. Histology is still necessary to distinguish benign from malignant disease in (18)FDG-PET/CT-positive nodules, but unnecessary surgery could have been reduced from 88 to 41 cases (46%) in our series.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Utility of ¹¹C-choline imaging as a supplement to F-18 FDG PET imaging for detection of thyroid carcinoma. Clin Nucl Med 2011; 36:91-5. [PMID: 21220968 DOI: 10.1097/rlu.0b013e318203bb55] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We present 4 patients with thyroid carcinoma who underwent ¹¹C-choline PET/CT for the detection of their primary tumor and its metastases. Previous F-18 FDG PET had shown no abnormal tracer uptake in the lesions in 3 patients and only mild uptake in 1 patient. MATERIALS AND METHODS Four patients aged between 24 and 59 years (2 newly diagnosed and 2 with recurrence) underwent whole-body F-18 FDG PET/CT. The patients then underwent regional ¹¹C-choline PET/CT imaging on a separate day. RESULTS All of the lesions in 4 patients were ¹¹C-choline avid except for a few small lung metastases. The SUVmax of the lesions was 7.94 ± 4.93. ¹¹C-choline imaging detected 3 primary tumors in 4 patients, 1 tumor in the tracheal wall in 1 patient, 7 cervical lymph nodes metastases in 3 patients, and several lung metastases in 1 patient. CONCLUSIONS ¹¹C-choline PET/CT may be a promising supplement to F-18 FDG PET/CT in the detection of thyroid carcinoma and its metastases.
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Nishimori H, Tabah R, Hickeson M, How J. Incidental thyroid "PETomas": clinical significance and novel description of the self-resolving variant of focal FDG-PET thyroid uptake. Can J Surg 2011; 54:83-8. [PMID: 21251421 PMCID: PMC3116704 DOI: 10.1503/cjs.023209] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Recent series of incidental thyroid activity on fluorodeoxyglucose positron emission tomography (FDG-PET) in patients evaluated for nonthyroidal malignancy, which we refer to as a "PEToma," have suggested that such lesions are associated with a significant incidence of primary thyroid cancer. METHODS We retrospectively reviewed 6457 FDG-PET scans performed on 4726 patients from May 2004 to March 2007. We reviewed the cases of patients whose PET or computed tomography (CT) radiology reports described PET uptake within the thyroid to identify incidence and malignant potential of PETomas and evaluate their clinical and histopathologic features. RESULTS We found that 160 patients (3.4%) had incidental, abnormal FDG uptake in the thyroid gland, 103 of whom had focal uptake (the PEToma group). Of these patients, 50 (48%) underwent further investigations, including ultrasonography in 48, fine-needle aspiration cytology in 38 and computed tomography in 3. Ten patients underwent surgery, and papillary thyroid cancer was identified in 9. The remaining 53 patients with PETomas underwent no further investigation. Interestingly, 5 patients who had focal uptake within the thyroid showed either spontaneous resolution on repeat FDG-PET (self-resolving) or no focal lesion on subsequent ultrasonography (false-positive). CONCLUSION The incidence of papillary thyroid cancer in the present series is similar to that in the literature. Although some patients will show self-resolving or false-positive focal thyroid uptake on FDG-PET, we believe that, if the patient's clinical status permits, the evaluation of patients with incidental thyroid PEToma should include ultrasonographic confirmation and fine-needle aspiration cytology.
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Affiliation(s)
- Hidefumi Nishimori
- Division of Surgical Oncology, McGill University Health Centre, Montréal, Que
| | - Roger Tabah
- Division of Surgical Oncology, McGill University Health Centre, Montréal, Que
| | - Marc Hickeson
- Division of Diagnostic Radiology, McGill University Health Centre, Montréal, Que
| | - Jacques How
- Division of Endocrinology, McGill University Health Centre, Montréal, Que
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Vriens D, de Wilt JHW, van der Wilt GJ, Netea-Maier RT, Oyen WJG, de Geus-Oei LF. The role of [18
F]-2-fluoro-2-deoxy-d-glucose-positron emission tomography in thyroid nodules with indeterminate fine-needle aspiration biopsy. Cancer 2011; 117:4582-94. [DOI: 10.1002/cncr.26085] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/01/2011] [Accepted: 02/11/2011] [Indexed: 01/04/2023]
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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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Law TT, Lang BHH. Incidental thyroid carcinoma by FDG-PET/CT: a study of clinicopathological characteristics. Ann Surg Oncol 2011; 18:472-8. [PMID: 20740320 PMCID: PMC3032177 DOI: 10.1245/s10434-010-1287-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND The rising incidence of incidental thyroid carcinoma (ITC) detected during fluoro-2-deoxy-D: -glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scanning poses a challenge to clinicians. The present study aims to critically evaluate the clinicopathological characteristics of ITC detected by FDG-PET/CT. METHODS Among the 557 patients managed at our institution, 40 (7.2%) patients were identified as having ITC. Of these, 22 patients had their tumor detected by FDG-PET/CT (PET group) and 11 by ultrasonography (USG group). Additional bedside ultrasonography ± fine-needle aspiration (FNA) was done in all patients at their clinic visit. The clinicopathological characteristics were compared between the PET and USG groups. RESULTS The PET group had significantly more patients with history of nonthyroidal malignancy (P < 0.001). Papillary carcinoma was the most common histological type in both groups. Despite having similar histological and prognostic features including tumor size, tumor multifocality, capsular invasion, extrathyroidal extension, and lymph node metastases, tumor bilaterality (or presence of contralateral tumor focus) was significantly more frequent in the PET than the USG group (P = 0.04). The tumors were also more advanced by the tumor-node-metastasis (TNM) staging system in the PET group (P = 0.021). None of the contralateral tumor foci were evident preoperatively. One patient in the USG group developed metastatic thyroid carcinoma in neck lymph nodes 28 months after thyroid resection. CONCLUSION ITC by FDG-PET/CT had higher incidence of tumor bilaterality than those detected by ultrasonography. Total thyroidectomy should be considered for ITC detected by FDG-PET/CT even for tumor size <10 mm.
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Affiliation(s)
- T. T. Law
- Division of Endocrine Surgery, Department of Surgery, University of Hong Kong, Hong Kong SAR, China
| | - Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, University of Hong Kong, Hong Kong SAR, China
- Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
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Choi JW, Yoon YH, Yoon YH, Kim SM, Koo BS. Characteristics of Primary Papillary Thyroid Carcinoma with False-Negative Findings on Initial 18F-FDG PET/CT. Ann Surg Oncol 2010; 18:1306-11. [DOI: 10.1245/s10434-010-1469-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Indexed: 11/18/2022]
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D'Souza MM, Marwaha RK, Sharma R, Jaimini A, Thomas S, Singh D, Jain M, Bhalla PJS, Tripathi M, Tiwari A, Mishra A, Mondal A, Tripathi RP. Prospective evaluation of solitary thyroid nodule on 18F-FDG PET/CT and high-resolution ultrasonography. Ann Nucl Med 2010; 24:345-55. [PMID: 20373060 DOI: 10.1007/s12149-010-0357-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Accepted: 02/09/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The utility of 18F-FDG PET/CT in the assessment of thyroid nodules is unclear as there are several conflicting reports on the usefulness of SUV as an indicator to distinguish benign from malignant thyroid lesions. This study incorporated an additional parameter, namely dual time point imaging, to determine the diagnostic accuracy of PET/CT imaging. The performance of 18F-FDG PET/CT was compared to that of high-resolution ultrasound which is routinely used for the evaluation of thyroid nodules. METHODS Two hundred patients with incidentally detected solitary thyroid nodules were included in the study. Each patient underwent ultrasound and PET/CT evaluation within 7 days of each other, reported by an experienced radiologist and nuclear medicine specialist, respectively, in a blinded manner. The PET/CT criteria employed were maximum SUV (SUV(max)) at 60 min and change in SUV(max) at delayed (120 min) imaging. Final diagnosis was based on pathological evaluation and follow-up. RESULTS Of the 200 patients, 26 had malignant and 174 had benign nodules. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of ultrasound were 80.8, 81.6, 39.6, 96.6 and 81.5%, respectively. Using SUV(max) at 60 min as the diagnostic criterion, the above indices were 80.8, 84.5, 43.8, 96.7 and 84%, respectively, for PET/CT. The SUV(max) of malignant thyroid lesions was significantly higher than benign lesions (16.2 +/- 10.6 vs. 4.5 +/- 3.1, respectively; p = 0.0001). Incorporation of percentage change in SUV(max) at delayed imaging as the diagnostic criterion yielded a slightly improved sensitivity, specificity, PPV, NPV and accuracy of 84.6, 85.6, 46.8, 97.4 and 85.5%, respectively. There was a significant difference in percentage change in SUV(max) between malignant and benign thyroid lesions (14.9 +/- 11.4 vs. -1.6 +/- 13.7, respectively; p = 0.0001). However, there was no statistically significant difference (95% confidence interval) between the diagnostic performance of PET/CT and ultrasound. CONCLUSIONS Routine use of 18F-FDG PET/CT with SUV(max) at 60 min as the sole diagnostic criterion does not appear to have a significant advantage over high-resolution ultrasound in the evaluation of thyroid nodules. Incorporation of dual time point imaging enhances image interpretation, and yields a higher diagnostic performance, yet it is not statistically significant. Bearing in mind the cost, limited availability and radiation exposure, routine use of 18F-FDG PET/CT for distinguishing benign from malignant thyroid nodules cannot be recommended.
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Affiliation(s)
- Maria Mathew D'Souza
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, 110054, India.
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Abstract
The thyroid specialist frequently evaluates thyroid nodules because they may represent malignancy. Nodules are typically found on physical examination or incidentally when other imaging studies are performed. Malignant or symptomatic nodules that compress nearby structures warrant surgical excision. Yet, the majority of thyroid nodules are asymptomatic and benign, so the thyroid surgeon must rely on diagnostic studies to determine when surgery is indicated. Ultrasound is the preferred imaging modality for thyroid nodules, and the ultrasound guided fine-needle aspiration biopsy (FNAB) is the preferred method of tissue sampling. Nodules 1 cm or larger or nodules with suspicious sonographic appearance warrant cytologic analysis to better quantify the risk for malignancy. Molecular biomarkers are a powerful adjunct to cytology. Detecting malignancy preoperatively allows total thyroidectomy in a single operation without the need for frozen section or a second operation for completion of a thyroidectomy if malignancy is found during the initial thyroid lobectomy.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Biomarkers, Tumor/genetics
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- DNA Mutational Analysis
- Diagnosis, Differential
- Diagnostic Imaging
- Frozen Sections
- Humans
- Sensitivity and Specificity
- Thyroid Gland/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnosis
- Thyroid Nodule/genetics
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Thyroidectomy
- Ultrasonography, Interventional
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Affiliation(s)
- Steven R Bomeli
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh, PA, USA
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47
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Ohba K, Nishizawa S, Matsushita A, Inubushi M, Nagayama K, Iwaki H, Matsunaga H, Suzuki S, Sasaki S, Oki Y, Okada H, Nakamura H. High incidence of thyroid cancer in focal thyroid incidentaloma detected by 18F-fluorodeoxyglucose [corrected] positron emission tomography in relatively young healthy subjects: results of 3-year follow-up. Endocr J 2010; 57:395-401. [PMID: 20160400 DOI: 10.1507/endocrj.k10e-008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
As 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is becoming a common imaging modality, the number of thyroid incidentalomas identified by FDG-PET (PET incidentaloma) is increasing. The purpose of this study was to elucidate the risk of cancer in focal thyroid PET incidentaloma in healthy subjects of relatively younger age as well as the usefulness of repeated FDG-PET. The study was conducted with an observation period of three years. A total of 1,501 healthy volunteers (mean age, 43.5+/-9.7 years) underwent the first FDG-PET from August 2003 to July 2004. When focal thyroid PET incidentaloma was found, further diagnostic examination was conducted. When thyroid cancer was suspected, surgical resection was performed with the patient' s agreement. Patients with PET incidentaloma without surgery were offered annual US and FDG-PET and finally FNAB was performed in the fourth year. Focal thyroid PET incidentaloma was observed in 20 subjects. The final diagnoses in 20 subjects were malignant in 11 (ten papillary thyroid carcinoma (PTC) and one thyroid carcinoma showing thymus-like differentiation), indeterminate in one, and benign in eight subjects. Seven patients not treated surgically at the first examination had annual FDG-PET. One patient with PTC showed increasing SUVmax, but another with a benign nodule exhibited a similar increase. Others (one with PTC, one with an indeterminate nodule, and three with benign nodules) exhibited negligible SUVmax changes. When closely examined, focal thyroid PET incidentaloma in relatively young healthy adults has a high probability of malignancy. Repeated FDG-PET to follow up patients with thyroid nodules is ineffective.
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Affiliation(s)
- Kenji Ohba
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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48
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Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167-214. [PMID: 19860577 DOI: 10.1089/thy.2009.0110] [Citation(s) in RCA: 4642] [Impact Index Per Article: 309.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. METHODS Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease. CONCLUSIONS We created evidence-based recommendations in response to our appointment as an independent task force by the American Thyroid Association to assist in the clinical management of patients with thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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49
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Bae JS, Chae BJ, Park WC, Kim JS, Kim SH, Jung SS, Song BJ. Incidental thyroid lesions detected by FDG-PET/CT: prevalence and risk of thyroid cancer. World J Surg Oncol 2009; 7:63. [PMID: 19664272 PMCID: PMC2732624 DOI: 10.1186/1477-7819-7-63] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/10/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incidentally found thyroid lesions are frequently detected in patients undergoing FDG-PET/CT. The aim of this study was to investigate the prevalence of incidentally found thyroid lesions in patients undergoing FDG-PET/CT and determine the risk for thyroid cancer. METHODS FDG-PET/CT was performed on 3,379 patients for evaluation of suspected or known cancer or cancer screening without any history of thyroid cancer between November 2003 and December 2005. Medical records related to the FDG-PET/CT findings including maximum SUV(SUVmax) and pattern of FDG uptake, US findings, FNA, histopathology received by operation were reviewed retrospectively. RESULTS Two hundred eighty five patients (8.4%) were identified to have FDG uptake on FDG-PET/CT. 99 patients with focal or diffuse FDG uptake underwent further evaluation. The cancer risk of incidentally found thyroid lesions on FDG-PET/CT was 23.2% (22/99) and the cancer risks associated with focal and diffuse FDG uptake were 30.9% and 6.4%. There was a significant difference in the SUVmax between the benign and malignant nodules (3.35 +/- 1.69 vs. 6.64 +/- 4.12; P < 0.001). There was a significant correlation between the SUVmax and the size of the cancer. CONCLUSION The results of this study suggest that incidentally found thyroid lesions by FDG-PET/CT, especially a focal FDG uptake and a high SUV, have a high risk of thyroid malignancy. Further diagnostic work-up is needed in these cases.
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Affiliation(s)
- Ja Seong Bae
- Department of Surgery, The Catholic University of Korea, Seoul, Korea.
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50
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Abstract
PURPOSE OF REVIEW To provide an update on potential predictors of thyroid malignancy and how their use may alter clinical management. RECENT FINDINGS As thyroid nodules become more prevalent clinicians are increasingly impelled to identify the optimal predictor(s) of thyroid malignancy, with the goal of guiding management based on assessed risk. The gold standard evaluation for thyroid nodules is ultrasound-guided fine-needle aspiration biopsy. Fine-needle aspiration biopsy is not perfect and adjuncts which complement its predictive value are being investigated from several innovative perspectives. These include large tumor size (> or =4 cm), which appears to be an independent predictor of thyroid malignancy; 18F-fluorodeoxyglucose positron emission tomography, which appears to facilitate exclusion of malignancy in cytologically indeterminate thyroid nodules; and peripheral blood and fine-needle aspiration biopsy analysis of molecular markers, which may help to identify malignant thyroid nodules with greater specificity. SUMMARY Fine-needle aspiration biopsy of large thyroid nodules has a high false-negative rate and should be considered for diagnostic lobectomy. Nodule size appears to be an independent factor predicting malignancy and indeterminate lesions at least 4 cm should be considered for initial total thyroidectomy. Nuclear imaging may aid exclusion of malignancy in thyroid nodules and molecular markers have great promise in predicting thyroid malignancy with higher specificity.
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