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Piek MW, de Boer JP, Vriens MR, van Leeuwaarde RS, Stokkel M, Hartemink KJ, van Duijnhoven F, Kessels R, van der Ploeg IMC. Retrospective Analyses of 18FDG-PET/CT Thyroid Incidentaloma in Adults: Incidence, Treatment, and Outcome in a Tertiary Cancer Referral Center. Thyroid 2021; 31:1715-1722. [PMID: 34340567 DOI: 10.1089/thy.2021.0226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: A thyroid incidentaloma (TI) is an unexpected, asymptomatic thyroid lesion discovered during the investigation of an unrelated condition. The aim of the present study is to examine the incidence of 18Fluorodeoxyglucose (FDG)-positron emission tomography (PET) TI, the associated management strategies and the outcomes in a tertiary cancer referral center. Methods: This study involves a retrospective cohort study of 1003 patients with TI found on 18FDG-PET/CT scans performed between January 2010 and January 2020 for a nonthyroidal malignancy. The Kaplan-Meier method was used for survival analyses in patients concerning an underlying malignancy, with a prevalence of 5% or higher in this cohort. Logistic- and cox regression analyses were performed to analyze predictors of thyroid malignancy and mortality. A propensity score weighted method was used to control for baseline differences between the intervention (additional TI diagnostics) and control (no TI diagnostics) group. Results: FDG-positive TI occurred in 1.9% (1003/52,693) of the oncologic 18FDG-PET/CT scans performed in our center. Thyroid surgery was performed in 47 patients (6%) and a thyroid malignancy was detected in 31 of them, which is 66% of those who had an operation and 4% of all patients. During the follow-up (median 6 years), 334 deaths (42%) related to different types of cancer (38%) or other causes (4%) were observed. One patient died from medullary thyroid cancer. In multivariate analysis adjusted for age, gender and the type- and stage of nonthyroidal malignancy, were independent predictors of survival (P < .05). Conclusions: The incidence of TI in this tertiary cancer referral center was comparable to current literature. Further thyroid workup was performed in less than half of the patients, and only a minority of patients underwent thyroid surgery. Since only one patient died from thyroid cancer, the strategy to withhold from thyroid diagnostics and treatment seems valid for most TI. Active thyroid treatment might benefit a subgroup of patients in whom the primary nonthyroidal malignancy is successfully treated or presumably stable. A wait-and-see policy with ultrasound follow-up could be an alternative strategy. These considerations should be part of the shared decision making in cancer patients with a TI.
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Affiliation(s)
- Marceline W Piek
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jan Paul de Boer
- Department of Internal Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Menno R Vriens
- Department of Surgery and University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Rachel S van Leeuwaarde
- Department of Internal Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Internal Medicine, University Medical Centre of Utrecht, Utrecht, The Netherlands
| | - Marcel Stokkel
- Department of Nuclear Medicine, and Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Koen J Hartemink
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rob Kessels
- Department of Biometrics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Scappaticcio L, Piccardo A, Treglia G, Poller DN, Trimboli P. The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis. Endocrine 2021; 73:540-549. [PMID: 33761104 PMCID: PMC8325664 DOI: 10.1007/s12020-021-02683-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE 18F-FDG thyroid incidentaloma (TI) occurs in ~2% of PET/CT examinations with a cancer prevalence of up to 35-40%. Guidelines recommend fine-needle aspiration cytology (FNA) if a focal 18F-FDG TI corresponds to a sonographic nodule >1 cm. The aim of this systematic review and meta-analysis was to provide evidence-based data on the diagnostic distribution of 18F-FDG TIs in the six Bethesda systems for reporting thyroid cytopathology (BETHESDA) subcategories. METHODS Original studies reporting 18F-FDG TIs and cytologically classified according to BETHESDA were included. Six separate meta-analyses were performed to obtain the pooled prevalence (95% confidence interval, 95% CI) of 18F-FDG TIs in the six BETHESDA subcategories. RESULTS Fifteen studies were finally included. Nine studies were from Asian/Eastern and six from Western countries. FNA data according to BETHESDA was available in 2304 cases. The pooled prevalence of 18F-FDG TIs according to BETHESDA was BETHESDA I 10% (6-14), BETHESDA II 45% (37-53), BETHESDA III 8% (3-13), BETHESDA IV 8% (5-12), BETHESDA V 6% (4-9), BETHESDA VI 19% (13-25). A significantly different prevalence was found in the BETHESDA IV between Asian/Eastern (2%) and Western (19%) studies. CONCLUSION Two-thirds of focal 18F-FDG TIs undergoing FNA have either malignant (BETHESDA VI) or benign (BETHESDA II) cytology while a minority will have indeterminate (BETHESDA III or IV) FNA results. Significant differences between Asian/Eastern and Western studies are also present in the prevalence of indeterminate FNA results.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, University of Campania 'L. Vanvitelli'', Naples, Italy.
| | | | - Giorgio Treglia
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - David N Poller
- Departments of Cytology & Pathology, Queen Alexandra Hospital, Portsmouth, UK
- UCL Cancer Institute, 72 Huntley St., Bloomsbury, London, WC1E 6DD, UK
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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de Leijer JF, Metman MJH, van der Hoorn A, Brouwers AH, Kruijff S, van Hemel BM, Links TP, Westerlaan HE. Focal Thyroid Incidentalomas on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration. Front Endocrinol (Lausanne) 2021; 12:723394. [PMID: 34744999 PMCID: PMC8564374 DOI: 10.3389/fendo.2021.723394] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The rising demand for 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) has led to an increase of thyroid incidentalomas. Current guidelines are restricted in giving options to tailor diagnostics and to suit the individual patient. OBJECTIVES We aimed at exploring the extent of potential overdiagnostics by performing a systematic review and meta-analysis of the literature on the prevalence, the risk of malignancy (ROM) and the risk of inconclusive FNAC (ROIF) of focal thyroid incidentalomas (FTI) on 18F-FDG PET/CT. DATA SOURCES A literature search in MEDLINE, Embase and Web of Science was performed to identify relevant studies. STUDY SELECTION Studies providing information on the prevalence and/or ROM of FTI on 18F-FDG PET/CT in patients with no prior history of thyroid disease were selected by two authors independently. Sixty-one studies met the inclusion criteria. DATA ANALYSIS A random effects meta-analysis on prevalence, ROM and ROIF with 95% confidence intervals (CIs) was performed. Heterogeneity and publication bias were tested. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. DATA SYNTHESIS Fifty studies were suitable for prevalence analysis. In total, 12,943 FTI were identified in 640,616 patients. The pooled prevalence was 2.22% (95% CI = 1.90% - 2.54%, I2 = 99%). 5151 FTI had cyto- or histopathology results available. The pooled ROM was 30.8% (95% CI = 28.1% - 33.4%, I2 = 57%). 1308 (83%) of malignant nodules were papillary thyroid carcinoma (PTC). The pooled ROIF was 20.8% (95% CI = 13.7% - 27.9%, I2 = 92%). LIMITATIONS The main limitations were the low to moderate methodological quality of the studies and the moderate to high heterogeneity of the results. CONCLUSION FTI are a common finding on 18F-FDG PET/CTs. Nodules are malignant in approximately one third of the cases, with the majority being PTC. Cytology results are non-diagnostic or indeterminate in one fifth of FNACs. These findings reveal the potential risk of overdiagnostics of FTI and emphasize that the workup of FTI should be performed within the context of the patient's disease and that guidelines should adopt this patient tailored approach.
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Affiliation(s)
- J. F. de Leijer
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M. J. H. Metman
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. van der Hoorn
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - S. Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - B. M. van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - T. P. Links
- Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - H. E. Westerlaan
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: H. E. Westerlaan,
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Abstract
Thyroid incidentalomas are frequently reported on 18F-FDG PET/CT scan. High risk of malignancy is thought to be associated with increased metabolic activity and high standardized uptake value. Likewise, thyroid nodules with focal FDG avidity have a higher potential to be malignant. However, some benign nodules such as follicular and Hurthle cell adenomas can also present with focal hypermetabolic activity. We report a case of a 59-year-old lady diagnosed with gastric carcinoma, who had a hypermetabolic thyroid nodule on FDG PET/CT scan. Despite the complex texture of the nodule and intense focal avidity, the histopathology was consistent with Hurtle cell adenoma.
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Affiliation(s)
- Aamna Hassan
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Department of Nuclear Medicine, Lahore, Pakistan
| | - Saima Riaz
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Department of Nuclear Medicine, Lahore, Pakistan
| | - Amna Asif
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Department of Pathology, Lahore, Pakistan
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Shi H, Yuan Z, Yuan Z, Yang C, Zhang J, Shou Y, Zhang W, Ping Z, Gao X, Liu S. Diagnostic Value of Volume-Based Fluorine-18-Fluorodeoxyglucose PET/CT Parameters for Characterizing Thyroid Incidentaloma. Korean J Radiol 2018. [PMID: 29520193 PMCID: PMC5840064 DOI: 10.3348/kjr.2018.19.2.342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective To assess clinical value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for differentiation of malignant from benign focal thyroid incidentaloma. Materials and Methods This retrospective study included 99 patients with focal thyroid incidentaloma of 5216 non-thyroid cancer patients that had undergone PET/CT. PET/CT semi-quantitative parameters, volume-based functional parameters, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of thyroid incidentaloma were assessed. Receiver-operating characteristic (ROC) analysis was conducted and areas under the curve (AUC) were compared by Hanley and McNeil test to evaluate usefulness of maximum standardized uptake value (SUVmax), MTV and TLG, as markers for differentiating malignant from benign thyroid incidentalomas. Results Of 99 thyroid incidentalomas, 64 (64.6%) were malignant and 35 (35.4%) were benign. Malignant thyroid incidentalomas were larger (1.8 cm vs. 1.3 cm, p = 0.006), and had higher SUVmax (11.3 vs. 4.8, p < 0.001), MTV (all p < 0.001) and TLG (all p < 0.001) than benign. TLG 4.0 had the highest performance for differentiation of malignant from benign thyroid incidentaloma in all semi-quantitative parameters with AUC 0.895 by ROC curve analysis. AUC (TLG 4.0) was significantly larger than AUC (SUVmean), AUC (MTV 2.5), AUC (MTV 3.0), AUC (MTV 3.5), AUC (TLG 2.5), and AUC (TLG 3.0), respectively (all, p < 0.05). There was no statistical difference between AUC (TLG 4.0) and AUC (SUVmax) (p > 0.05). A threshold TLG 4.0 of 2.475 had 81.3% sensitivity and 94.3% specificity for identifying malignant thyroid incidentalomas. Conclusion Volume-based PET/CT parameters could potentially have clinical value in differential diagnosis of thyroid incidentaloma along with SUVmax.
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Affiliation(s)
- Huazheng Shi
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China.,Department of Radiology, affiliated Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Zuguo Yuan
- Department of Chemoradiotherapy, Yinzhou People's Hospital, Ningbo 315100, China
| | - Zheng Yuan
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Chunshan Yang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Jian Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Yi Shou
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Wenrui Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Zhaofu Ping
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Shiyuan Liu
- Department of Radiology, affiliated Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
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Cansu GB, Yılmaz N, Toru S, Sarı R, Gökhan Ocak G, Arıcı C, Altunbaş HA, Balcı MK. Evaluation of Incidental Thyroid Nodules in Cancer Patients. J Natl Med Assoc 2017; 109:299-306. [PMID: 29173938 DOI: 10.1016/j.jnma.2017.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Frequency of thyroid cancer in incidental thyroid nodules identified by imaging techniques in cancer patients is higher than that in the normal population. In the retrospective study, we have both investigated the incidence of thyroid cancer in incidentally identified nodules and compared the imaging techniques to determine whether there is any difference between them in detection of malign nodules. METHODS A total of 7319 patients who underwent thyroid fine-needle aspiration biopsy (FNAB) were included in the study. The data of 174 patients who had previously been diagnosed with a hematologic or solid malignancy prior to the FNAB procedure and had incidentally identified thyroid nodules were evaluated retrospectively. RESULTS Eighty-six (49.5%) of the incidental nodules were identified with ultrasonography (USG), 62 (35.6%) with positron emission tomography (PET) or PET/computed tomography (PET/CT), and 26 (14.9%) with CT. As a result of thyroidectomy, papillary carcinoma was identified in 8 (4.6%) patients, and metastasis to the thyroid of a primary cancer was found in 3 (1.7%) patients. While the papillary carcinoma proportion in the nodules identified by USG was 3.4%, PET/CT was 8.9%. A cut-off maximal standardized uptake value of 11.6 in PET/CT indicated malignancy achieving a sensitivity of 83.3% and a specificity of 91.1%. CONCLUSION Whether the nodule in the incidental thyroid nodules of cancer patients is identified using USG or PET/CT, the risk of thyroid cancer is similar. However, cancer risk is higher in the event of a higher focal uptake in the nodules identified by PET/CT.
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Affiliation(s)
- Güven Barış Cansu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yunusemre State Hospital, Eskişehir, Turkey.
| | - Nusret Yılmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Serap Toru
- Department of Pathology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ramazan Sarı
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Güzide Gökhan Ocak
- Department of Pathology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Cumhur Arıcı
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hasan Ali Altunbaş
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mustafa Kemal Balcı
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
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Pak K, Shin S, Kim SJ, Kim K, Kim BS, Kim SJ, Jeon YK, Kim SS, Kim BH, Kim IJ. Risk of Malignancy in Thyroid Incidentaloma is Not Increased in Overweight or Obese Patients, but in Young Patients. Nutr Cancer 2017; 69:580-584. [PMID: 28353353 DOI: 10.1080/01635581.2017.1299877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Thyroid incidentaloma is defined as an unsuspected, asymptomatic thyroid lesion that is discovered on an imaging study or during an operation unrelated to the thyroid gland. We aim to evaluate the relationship between overweight or obese and risk of malignancy in patients with thyroid incidentaloma detected by F18-flurodeoxyglucose positron emission tomography/computed tomography and factors to predict risk of malignancy in thyroid incidentaloma. From January 2010 to December 2013, a total of 238 patients were eligible for this study. Using the Bethesda system for reporting thyroid cytopathology, categories I-III were defined as a nonmalignancy and categories V-VI were defined as a malignancy. When patients with body mass index (BMI) of less than 23 and 23 or more were divided into two groups of normal and overweight or obese, risk of malignancy of thyroid incidentaloma was not significantly different between two groups (P = 0.1812). In logistic regression analysis, age was the only variable that showed a significant association with malignancy of thyroid incidentaloma (odds ratio 0.9608, P = 0.0021). However, none of sex, height, weight, and BMI was predictor of malignancy of thyroid incidentaloma. We demonstrated that being overweight or obese did not increase rate of malignancy in patients with thyroid incidentaloma.
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Affiliation(s)
- Kyoungjune Pak
- a Department of Nuclear Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Seunghyeon Shin
- a Department of Nuclear Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - So Jung Kim
- a Department of Nuclear Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Keunyoung Kim
- a Department of Nuclear Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Bum Soo Kim
- b Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology , Pusan National University Yangsan Hospital , Yangsan , Korea
| | - Seong Jang Kim
- b Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology , Pusan National University Yangsan Hospital , Yangsan , Korea
| | - Yun Kyung Jeon
- c Department of Internal Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Sang Soo Kim
- c Department of Internal Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Bo Hyun Kim
- c Department of Internal Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - In-Joo Kim
- a Department of Nuclear Medicine and Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
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The incidence of thyroid cancer in focal hypermetabolic thyroid lesions: an 18F-FDG PET/CT study in more than 6000 patients. Nucl Med Commun 2017; 37:1290-1296. [PMID: 27612034 DOI: 10.1097/mnm.0000000000000592] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clinical significance of incidental thyroid abnormalities discovered in fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) (FDG PET/CT) studies remains controversial. The aim of this large retrospective study was to (a) determine the prevalence of focal F-FDG thyroid uptake on whole-body F-FDG PET/CT studies carried out for nonthyroid cancers and (b) to test whether intense focal F-FDG thyroid uptake is associated with malignancy. MATERIALS AND METHODS A total of 11 921 F-FDG PET/CT studies in 6216 patients carried out at our institution between January 2012 and December 2014 were analyzed. We retrospectively reviewed the medical records of these patients. Eight hundred and forty-five/6216 (13.6%) patients had a thyroid incidentaloma on the basis of the clinical F-FDG PET/CT report. One hundred and sixty/845 (18.9%) of these underwent ultrasound and 98 (61.3%) of these underwent a fine-needle aspiration (FNA). Twenty-six of these 98 (26.5%) patients underwent thyroidectomy. Thyroid lesion and background standardized uptake value (SUVs) for each patient were measured upon review of the F-FDG PET/CT study. We measured maximum standardized uptake value (SUVmax), thyroid to background TL/TBG, thyroid to bloodpool TL/BP and thyroid to liver TL/L ratios in benign and malignant lesions. Receiver operating curves were calculated to determine optimal cut-off values between malignant and benign lesions. RESULTS Twenty-one of the 98 patients who underwent FNA biopsy or thyroidectomy had malignant disease (21.4%). Malignant lesions had significantly higher thyroid lesion SUVmax, TL/TBG, TL/BP, and TL/L than benign nodules. The receiver operating curves derived cut-off ratio TL/TBG of more than 2.0 differentiated benign from malignant lesions best with a specificity and sensitivity of 0.76 and 0.88, respectively. CONCLUSION The incidence of malignancy in biopsied focal hypermetabolic thyroid lesions is 21.4%. Lesions on F-FDG PET/CT studies, with a ratio TL/TBG more than 2.0, warrant further work-up with ultrasound and FNA to exclude malignancy.
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Fluorine-18 fluorodeoxyglucose avid thyroid incidentalomas on PET/CT scan in cancer patients. Nucl Med Commun 2016; 37:1069-73. [DOI: 10.1097/mnm.0000000000000557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yalcin MM, Altinova AE, Ozkan C, Toruner F, Akturk M, Akdemir O, Emiroglu T, Gokce D, Poyraz A, Taneri F, Yetkin I. THYROID MALIGNANCY RISK OF INCIDENTAL THYROID NODULES IN PATIENTS WITH NON-THYROID CANCER. ACTA ENDOCRINOLOGICA-BUCHAREST 2016; 12:185-190. [PMID: 31149085 DOI: 10.4183/aeb.2016.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Thyroid incidentaloma is a common disorder in endocrinology practice. Current literature regarding the risk of thyroid cancer in incidentalomas found in patients with non-thyroid cancer is limited. Objective The aim of the present study was to investigate the frequency of thyroid malignancy in thyroid incidentalomas detected in patients with non-thyroid cancer. Design Case control study. Subjects and Methods The database of 287 thyroid nodules from 161 patients with a history of non-thyroid cancer followed between 2008 and 2014 were retrospectively evaluated. Results From 287 thyroid nodules, 69.7 % had a benign final cytology. Thyroid cancer detected in one nodule while follicular neoplasia detected in 4 nodules, atypia of unknown significance (AUS) detected in 10 nodules, Hurthle cell neoplasia detected in 5 nodules and suspicious for malignancy detected in 6 nodules according to fine needle aspiration biopsy results. Metastasis of the non-thyroid cancer to the thyroid gland was detected in 4 nodules. Twenty seven nodules from 15 patients were removed with surgery. There were 3 malignant nodules found after surgery (1 papillary, 1 follicular and 1 medullary cancer). In addition to these three thyroid cancers, two patients with benign nodules had co-incidental thyroid cancer detected after surgery. Finally, 11.1 % of thyroid nodules which underwent thyroid surgery had malignant histopathology except for co-incidental and metastatic cancers. Conclusions The frequency of thyroid malignancy seems not to be substantially increased in incidental thyroid nodules detected in patients with non-thyroid cancer when these patients were evaluated in nodule-based approach.
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Affiliation(s)
- M M Yalcin
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - A E Altinova
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - C Ozkan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - F Toruner
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - M Akturk
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - O Akdemir
- Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - T Emiroglu
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - D Gokce
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - A Poyraz
- Gazi University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - F Taneri
- Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - I Yetkin
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Dearman C, Hill EJ, Franklin JM, Sadler GP, Wang LM, Silva MA, Sharma RA. Management of a thyroid "incidentaloma" in a patient with cancer: a case report. Int Med Case Rep J 2015; 8:247-9. [PMID: 26508893 PMCID: PMC4610890 DOI: 10.2147/imcrj.s92857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The routine use of 18F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography scans for staging and assessment of treatment response for cancer has resulted in a large number of thyroid abnormalities being detected as incidental findings (“incidentalomas”). Since most PET/CT scans are performed in the setting of a known nonthyroid malignancy, the need for “incidentalomas” to be further investigated and managed depends on the stage, prognosis, and current treatment plan for the known malignancy. We present a case describing the management of an incidental F-fluorodeoxyglucose-avid thyroid nodule detected in a patient with known metastatic colorectal cancer. On the basis of this case, we discuss the management of incidental PET-detected thyroid nodules in patients with metastatic cancer. Thyroid “incidentalomas” must be seen in the context of the prognosis and treatment plan for the known malignancy.
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Affiliation(s)
- Charles Dearman
- Department of Oncology, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Esme J Hill
- Department of Oncology, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Jamie M Franklin
- Department of Oncology, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Greg P Sadler
- Department of Endocrine Surgery, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Lai Mun Wang
- Department of Histopathology and Hepatobiliary Surgery, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Michael A Silva
- Department of Histopathology and Hepatobiliary Surgery, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Ricky A Sharma
- CRUK-MRC Oxford Institute for Radiation Oncology, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
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Agrawal K, Weaver J, Ul-Hassan F, Jeannon JP, Simo R, Carroll P, Hubbard JG, Chandra A, Mohan HK. Incidence and Significance of Incidental Focal Thyroid Uptake on (18)F-FDG PET Study in a Large Patient Cohort: Retrospective Single-Centre Experience in the United Kingdom. Eur Thyroid J 2015; 4:115-22. [PMID: 26279997 PMCID: PMC4521059 DOI: 10.1159/000431319] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/11/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the prevalence and pathological nature of incidental focal thyroid uptake on (18)F-FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) PET (positron emission tomography) and examine the role of the maximum standardised uptake value (SUVmax) to differentiate benign from malignant thyroid pathology. MATERIAL AND METHODS (18)F-FDG PET reports were retrospectively reviewed. Incidental focal tracer uptake in the thyroid was noted in 147 patients (0.5%). Patients with known primary thyroid malignancy were excluded. The final diagnosis was made following ultrasonography of the neck, fine-needle aspiration cytology (FNAC) or histopathology of the surgically resected specimen where surgery was indicated. A Mann-Whitney U test was used to compare the SUVmax of benign and malignant thyroid pathology. Receiver operating characteristic (ROC) analysis was performed to identify an SUVmax cutoff in differentiating benign from malignant pathology. RESULTS A final diagnosis was achieved in 47/147 (32%) of the patients. The diagnoses included benign lesions in 36 patients and malignancy in 9 patients. In 2 patients, FNAC demonstrated indeterminate follicular lesions; however, surgical excision was not performed. There was a highly significant difference in the mean SUVmax of malignant focal thyroid uptake (15.7 ± 5.9) compared to that of benign lesions (7.1 ± 6.8) with a p value of 0.000123. An SUVmax of 9.1 achieved a sensitivity of 81.6%, specificity of 100% and area under the curve of 0.915 in the ROC analysis differentiating benign from malignant disease. CONCLUSION The malignancy potential of incidental focal thyroid uptake remains high and warrants prompt and appropriate follow-up by the clinician. The SUVmax may aid in further characterisation of the lesion and its management.
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Affiliation(s)
- Kanhaiyalal Agrawal
- Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- *Dr. Kanhaiyalal Agrawal, MBBS, MD, Department of Nuclear Medicine, Guy's Hospital, Great Maze Pond, London SE19RT (UK), E-Mail
| | - James Weaver
- Departments of King's College London, London, UK
| | - Fahim Ul-Hassan
- Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Departments of Clinical PET Centre, King's College London, UK
| | - Jean-Pierre Jeannon
- Departments of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ricard Simo
- Departments of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Carroll
- Departments of Consultant Endocrinologist, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Johnathan G. Hubbard
- Departments of Consultant Endocrine Surgeon, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ashish Chandra
- Departments of Histopathology/Cytology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hosahalli Krishnamurthy Mohan
- Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Departments of Clinical PET Centre, King's College London, UK
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14
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Ciarallo A, Marcus C, Taghipour M, Subramaniam RM. Value of Fluorodeoxyglucose PET/Computed Tomography Patient Management and Outcomes in Thyroid Cancer. PET Clin 2015; 10:265-78. [DOI: 10.1016/j.cpet.2014.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Thyroid incidentalomas on PET imaging – Evaluation of management and clinical outcomes. Surgeon 2015; 13:116-20. [DOI: 10.1016/j.surge.2014.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/22/2014] [Accepted: 06/23/2014] [Indexed: 01/31/2023]
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16
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Chun AR, Jo HM, Lee SH, Chun HW, Park JM, Kim KJ, Jung CH, Mok JO, Kang SK, Kim CH, Kim BY. Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography. Endocrinol Metab (Seoul) 2015; 30:71-7. [PMID: 25325277 PMCID: PMC4384680 DOI: 10.3803/enm.2015.30.1.71] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 06/03/2014] [Accepted: 07/07/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Thyroid incidentalomas detected by 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUVmax) in 18F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy. METHODS A total of 2,584 subjects underwent 18F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects. RESULTS Of the 2,584 subjects who underwent 18F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUVmax was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001). CONCLUSION Thyroid incidentalomas found on 18F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUVmax tended to be malignant.
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Affiliation(s)
- A Reum Chun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hye Min Jo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seoung Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hong Woo Chun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jung Mi Park
- Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kyu Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chan Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Oh Mok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Koo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chul Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bo Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
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Abstract
OBJECTIVE Thyroid cancer is the most common endocrine cancer. This review evaluates the established use of (18)F-FDG PET/CT in papillary, follicular, Hürthle cell, anaplastic, and medullary thyroid cancers. The significance of incidental diffuse and focal thyroid FDG uptake is discussed. The evolving value of non-FDG radiotracers, including (124)I, (18)F-dihydroxyphenylalanine, and (68)Ga somatostatin analogs, is summarized. CONCLUSION PET/CT is a valuable imaging test, in the appropriate clinical context, for the management of thyroid cancers.
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18
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Marques P, Ratão P, Salgado L, Bugalho MJ. Thyroid Carcinoma Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography Among Individuals Without Prior Evidence of Thyroid Disease: Relevance and Clinicopathologic Features. Endocr Pract 2014; 20:1129-36. [PMID: 24936549 DOI: 10.4158/ep14042.or] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The expanding use of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has contributed to an increasing number of thyroid incidentalomas. The present study aimed to estimate the prevalence of 18F-FDG-PET thyroid incidentalomas and evaluate the clinicopathologic features of thyroid malignancies detected by 18F-FDG-PET. METHODS We reviewed all 18F-FDG-PET exams performed at the Portuguese Institute of Oncology, Lisbon, between 2007 and 2012 (n = 9,374). The inclusion criteria were focal thyroid uptake and absence of known thyroid disease. RESULTS Focal thyroid uptake was observed in 60 out of 9,374 18F-FDG-PET exams (prevalence of 0.64%). Fine-needle aspiration cytology (FNAC) was performed in 23 patients and reported as malignant in 14 cases (56.5% primary thyroid carcinoma; 4.3% secondary malignancy), as benign in 7 cases (30.5%) and as follicular lesion of undetermined significance in 2 cases (8.7%). Fourteen patients had surgery. A final histologic diagnosis of papillary thyroid carcinoma was established in 12 cases (52.2%). Three were multifocal (25.0%); 8 had extrathyroidal extension (66.7%); 5 had angioinvasion (41.7%); 3 had lymph nodes metastases (25.0%) and 2 showed lung metastases (16.7%). Overall, 91.7% were classified as intermediate or high risk. All patients had radioiodine therapy. At the last observation (mean follow-up was 29.9 months), persistent or recurrent disease was identified in 4 patients (33.3%) and none died from thyroid malignancy. CONCLUSIONS Thyroid carcinomas disclosed by 18F-FDG-PET are associated with aggressive histological criteria likely to carry a worse prognosis.
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Affiliation(s)
- Pedro Marques
- Department of Endocrinology, Instituto Portuguěs de Oncologia de Lisboa
| | - Pedro Ratão
- Department of Nuclear Medicine Department, Instituto Portuguěs de Oncologia de Lisboa
| | - Lucília Salgado
- Department of Nuclear Medicine Department, Instituto Portuguěs de Oncologia de Lisboa
| | - Maria João Bugalho
- Department of Endocrinology, Instituto Portuguěs de Oncologia de Lisboa University Clinic of Endocrinology, Faculdade de Ciěncias Médicas, Universidade Nova de Lisboa
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