Cohen MS, Arslan N, Dehdashti F, Doherty GM, Lairmore TC, Brunt LM, Moley JF. Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography.
Surgery 2001;
130:941-6. [PMID:
11742321 DOI:
10.1067/msy.2001.118265]
[Citation(s) in RCA: 200] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND
Thyroid tumors often exhibit increased metabolic activity, as evidenced by enhanced glucose uptake on positron emission tomography (PET) with use of (18)F-fluorodeoxyglucose (FDG). The incidence of new thyroid lesions found on routine FDG-PET has not been previously reported.
METHODS
A retrospective review of all patients who underwent FDG-PET imaging at our institution from June 1, 1996, through March 15, 2001, identified patients with a newly diagnosed thyroid lesion. Thyroid incidentaloma was defined as a thyroid lesion seen initially on FDG-PET in a patient without a history of thyroid disease. Available follow-up data were documented.
RESULTS
One hundred and two of 4525 FDG-PET examinations (2.3%) demonstrated thyroid incidentalomas. Eighty-seven of 102 patients had no thyroid histology because of other malignancies. Fifteen patients had thyroid biopsy: 7 (47%) with thyroid cancer, 6 (40%) with nodular hyperplasia, 1 with thyroiditis, and 1 with atypical cells of indeterminate origin. The average standardized uptake values were higher for malignant compared with benign lesions.
CONCLUSIONS
Thyroid incidentaloma identified by FDG-PET occurred with a frequency of 2.3%. Of the thyroid incidentalomas that underwent biopsy, 47% were found to be malignant. Given the risk of malignancy, patients with new thyroid lesions on PET scan should have a tissue diagnosis if it will influence outcome and management. Standardized uptake values may be helpful in predicting benign versus malignant histology.
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