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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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Vriens D, de Koster EJ, de Geus-Oei LF, Oyen WJG. Preoperative stratification of cytologically indeterminate thyroid nodules by [ 18F]FDG-PET: can Orpheus bring back Eurydice? Eur J Nucl Med Mol Imaging 2023; 50:975-979. [PMID: 36658413 DOI: 10.1007/s00259-022-06093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Dennis Vriens
- Department of Radiology, (C2-P-117), Section of Nuclear Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, (C2-P-117), Section of Nuclear Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
- Radiation Science & Technology, Delft University of Technology, Delft, The Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate, Hospital, Arnhem, the Netherlands
- Department of Biomedical Sciences, Department of Nuclear Medicine, Humanitas University, Humanitas Clinical and Research Centre, Milan, Italy
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Giovanella L, Milan L, Piccardo A, Bottoni G, Cuzzocrea M, Paone G, Ceriani L. Radiomics analysis improves 18FDG PET/CT-based risk stratification of cytologically indeterminate thyroid nodules. Endocrine 2022; 75:202-210. [PMID: 34468949 PMCID: PMC8763930 DOI: 10.1007/s12020-021-02856-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/21/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE As ~25% of cytologically indeterminate thyroid nodules harbour malignancy, diagnostic lobectomy is still performed in many cases. 18FDG PET/CT rules out malignancy in visually negative nodules; however, none of the currently available interpretation criteria differentiates malignant from benign 18FDG-avid nodules. We evaluated the ability of PET metrics and radiomics features (RFs) to predict final diagnosis of 18FDG-avid cytologically indeterminate thyroid nodules. METHODS Seventy-eight patients were retrospectively included. After volumetric segmentation of each thyroid lesion, 4 PET metrics and 107 RFs were extracted. A logistic regression was performed including thyroid stimulating hormone, PET metrics, and RFs to assess their predictive performance. A linear combination of the resulting parameters generated a radiomics score (RS) that was matched with cytology classes (Bethesda III and IV) and compared with final diagnosis. RESULTS Two RFs (shape_Sphericity and glcm_Autocorrelation) differentiated malignant from benign lesions. A predictive model integrating RS and cytology classes effectively stratified the risk of malignancy. The prevalence of thyroid cancer increased from 5 to 37% and 79% in accordance with the number (score 0, 1 or 2, respectively) of positive biomarkers. CONCLUSIONS Our multiparametric model may be useful for reducing the number of diagnostic lobectomies with advantages in terms of costs and quality of life for patients.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland.
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Lisa Milan
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Marco Cuzzocrea
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland
| | - Gaetano Paone
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland
| | - Luca Ceriani
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Sepehrizadeh T, Jong I, DeVeer M, Malhotra A. PET/MRI in paediatric disease. Eur J Radiol 2021; 144:109987. [PMID: 34649143 DOI: 10.1016/j.ejrad.2021.109987] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
Nuclear medicine and molecular imaging have a small but growing role in the management of paediatric and neonatal diseases. During the past decade, combined PET/MRI has emerged as a clinically important hybrid imaging modality in paediatric medicine due to diagnostic advantages and reduced radiation exposure compared to alternative techniques. The applications for nuclear medicine, radiopharmaceuticals and combined PET/MRI in paediatric diagnosis is broadly similar to adults, however there are some key differences. There are a variety of clinical applications for PET/MRI imaging in children including, but not limited to, oncology, neurology, cardiovascular, infection and chronic inflammatory diseases, and in renal-urological disorders. In this article, we review the applications of PET/MRI in paediatric and neonatal imaging, its current role, advantages and disadvantages over other hybrid imaging techniques such as PET/CT, and its future applications. Overall, PET/MRI is a powerful imaging technology in diagnostic medicine and paediatric diseases. Higher soft tissue contrasts and lower radiation dose of the MRI makes it the superior technology compared to other conventional techniques such as PET/CT or scintigraphy. However, this relatively new hybrid imaging has also some limitations. MRI based attenuation correction remains a challenge and although methodologies have improved significantly in the last decades, most remain under development.
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Affiliation(s)
| | - Ian Jong
- Department of diagnostic imaging, Monash Health, Melbourne, Australia
| | - Michael DeVeer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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Characteristics of malignant thyroid lesions on [ 18F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT). Eur J Radiol Open 2021; 8:100373. [PMID: 34458507 PMCID: PMC8379667 DOI: 10.1016/j.ejro.2021.100373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the imaging variables that can best differentiate malignant from benign thyroid lesions incidentally found on F-18 FDG PET/CT scans. Methods All F-18 FDG PET/CT studies starting from 2011 to end of 2016 were reviewed for incidental thyroid lesions or metabolic abnormalities. Only patients who were found to have FNAB or histopathology were included. Patients with known thyroid malignancy were excluded. Patients were analyzed for age, sex, SUVmax, non-enhanced CT tissue density in mean Hounsfield units (HU), uptake pattern (focal or diffuse) and gland morphology (MNG or diffuse). A control group of 15 patients with normal thyroid glands were used to assess the tissue density in HU for normal thyroid tissue. Sensitivity, specificity, PPV, NPV and accuracy to detect malignancy were calculated. Pearson Chi-square test was used to compare categorical variables while unpaired T-test and one way ANOVA test were used to compare means of continuous variables. ROC analysis was used to assess the best cut off points for SUVmax and HU. Regression analysis was used to detect the independent predictors for malignant lesions. Results Biopsy was unsatisfactory or indeterminate in 4/48 patients (8%). Only 44 patients (mean age 55.2 ± 14.7; 30 females (68 %)) with unequivocal FNAB or histopathology were included for further analysis. MNG was noted in 17/44 patients (38.6 %). Thyroid malignancy was found in 16/44 (36.4 %), benign thyroid lesions in 28/44 (63.6 %). Thyroid malignancies were 12 papillary, 1 follicular, 1 Hurthle cell neoplasm and 2 lymphoma. Benign lesions were 23 benign follicular or colloid nodules and 5 autoimmune thyroiditis. Focal FDG uptake pattern was more frequently associated with malignant lesions compared to benign lesions (75 % vs. 43 %; p = 0.039). The mean SUVmax and tissue density (HU) were both higher in malignant than benign lesions (8.8 ± 8.3 vs. 3.6 ± 1.9, p = 0.024) and (48.9 ± 12.7 vs. 32.9 ± 17.5, p = 0.003) respectively. The mean HU in the control group with normal thyroid tissue was 90 ± 7.4 significantly higher than in both the benign and malignant lesions (p < 0.001). ROC analysis revealed SUVmax cutoff of >4.7 and HU cutoff of >42 to best differentiate malignant from benign lesions. The sensitivity, specificity, PPV, NPV and accuracy to detect malignancy for SUVmax>4.7 were 68.8 %, 78.6 %, 64.8 %, 81.5 & 75.0 % (p = 0.002), for HU > 42 were 81.3.0 %, 75.0 %, 65.0 %, 87.5 & 77.3 % (p = 0.0003) and for both parameters combined were 87.5 %, 60.7 %, 56.0 %, 89.5 % and accuracy of 70.5 % (p = 0.002) respectively. Only HU > 42 and SUVmax>4.7 were independent predictors for malignancy with odd ratios 8.98 and 4.93 respectively. Conclusion A higher tissue density (HU > 42) and SUVmax>4.7 as well as tendency for focal uptake pattern are the most significant characteristics associated with malignant thyroid lesions occasionally detected on PET/CT.
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Ciappuccini R, Licaj I, Lasne-Cardon A, Babin E, de Raucourt D, Blanchard D, Bastit V, Saguet-Rysanek V, Lequesne J, Peyronnet D, Grellard JM, Clarisse B, Bardet S. 18F-Fluorocholine Positron Emission Tomography/Computed Tomography is a Highly Sensitive but Poorly Specific Tool for Identifying Malignancy in Thyroid Nodules with Indeterminate Cytology: The Chocolate Study. Thyroid 2021; 31:800-809. [PMID: 33183159 PMCID: PMC8110014 DOI: 10.1089/thy.2020.0555] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Refining the risk of malignancy in patients presenting with thyroid nodules with indeterminate cytology (IC) is a critical challenge. We investigated the performances of 18F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) to predict malignancy. Methods: Between May 2016 and March 2019, 107 patients presenting with a thyroid nodule ≥15 mm with IC and eligible for surgery were included in this prospective study. Head-and-neck PET/CT acquisitions were performed 20 and 60 minutes after injection of 1.5 MBq/kg of FCH. PET/CT acquisition was scored positive when maximal standardized uptake value in the IC nodule was higher than in the thyroid background. Pathology was the gold standard for diagnosis. Results: At pathology, 19 (18%) nodules were malignant, 87 were benign, and one was a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Sensitivity, specificity, accuracy, positive-predictive value (PPV), and negative-predictive value (NPV) of FCH PET/CT in detecting cancer or NIFTP were 90%, 50%, 55%, 29%, and 96% at 20 minutes and 85%, 49%, 67%, 28%, and 94% at 60 minutes, respectively. Higher specificity (58% vs. 33%, p = 0.01) was observed in nononcocytic (n = 72) than in oncocytic IC nodules (n = 35). The pre-PET/CT probability of cancer or NIFTP in Bethesda III-IV nodules was 11% and the post-PET/CT probability was 19% in PET-positives and 0% in PET-negatives. In retrospective analysis, 42% of surgeries would have been unnecessary after PET/CT and 81% before (p < 0.001), resulting in a hypothetical 48% reduction (95% confidence interval [32-64]). Conclusions: FCH PET/CT offers high NPV to reliably exclude cancer in PET-negative IC nodules, but suffers from low PPV, particularly in those with oncocytic cytology. ClinicalTrials.gov identifier: NCT02784223.
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Affiliation(s)
- Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
- INSERM 1086 ANTICIPE, Caen University, Caen, France
- Address correspondence to: Renaud Ciappuccini, MD, Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, 3 Avenue Général Harris, Caen, F-14000, France
| | - Idlir Licaj
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Audrey Lasne-Cardon
- Department of Head and Neck Surgery, François Baclesse Cancer Centre, Caen, France
| | - Emmanuel Babin
- INSERM 1086 ANTICIPE, Caen University, Caen, France
- Department of Head and Neck Surgery, University Hospital, Caen, France
| | | | - David Blanchard
- Department of Head and Neck Surgery, Hôpital Saint-Martin, Caen, France
| | - Vianney Bastit
- Department of Head and Neck Surgery, François Baclesse Cancer Centre, Caen, France
| | | | - Justine Lequesne
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Damien Peyronnet
- Department of Nuclear Medicine, University Hospital, Caen, France
| | - Jean-Michel Grellard
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Bénédicte Clarisse
- Department of Clinical Research and François Baclesse Cancer Centre, Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
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Wong KS, Angell TE, Barletta JA, Krane JF. Hürthle cell lesions of the thyroid: Progress made and challenges remaining. Cancer Cytopathol 2020; 129:347-362. [PMID: 33108684 DOI: 10.1002/cncy.22375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022]
Abstract
Hürthle cell-predominant thyroid fine needle aspirations (FNA) are encountered frequently in routine practice, yet they are often challenging to diagnose accurately and are associated with significant interobserver variability. This is largely due to the ubiquity of Hürthle cells in thyroid pathology, ranging from nonneoplastic conditions to aggressive malignancies. Although limitations in cytomorphologic diagnoses likely will remain for the foreseeable future, our knowledge of the molecular pathogenesis of Hürthle cell neoplasia and application of molecular testing to cytologic material have increased dramatically within the past decade. This review provides context behind the challenges in diagnosis of Hürthle cell lesions and summarizes the more recent advances in diagnostic tools.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Trevor E Angell
- Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Aksu A, Karahan Şen NP, Acar E, Çapa Kaya G. Evaluating Focal 18F-FDG Uptake in Thyroid Gland with Radiomics. Nucl Med Mol Imaging 2020; 54:241-248. [PMID: 33088353 DOI: 10.1007/s13139-020-00659-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose The aim of this study was to evaluate the ability of 18F-FDG PET/CT texture analysis to predict the exact pathological outcome of thyroid incidentalomas. Methods 18F-FDG PET/CT images between March 2010 and September 2018 were retrospectively reviewed in patients with focal 18F-FDG uptake in the thyroid gland and who underwent fine needle aspiration biopsy from this area. The focal uptake in the thyroid gland was drawn in 3D with 40% SUVmax threshold. Features were extracted from volume of interest (VOI) using the LIFEx package. The features obtained were compared in benign and malignant groups, and statistically significant variables were evaluated by receiver operating curve (ROC) analysis. The correlation between the variables with area under curve (AUC) value over 0.7 was examined; variables with correlation coefficient less than 0.6 were evaluated with machine learning algorithms. Results Sixty patients (70% train set, 30% test set) were included in the study. In univariate analysis, a statistically significant difference was observed in 6 conventional parameters, 5 first-, and 16 second-order features between benign and malignant groups in train set (p < 0.05). The feature with the highest benign-malignant discriminating power was GLRLMRLNU (AUC:0.827). AUC value of SUVmax was calculated as 0.758. GLRLMRLNU and SUVmax were evaluated to build a model to predict the exact pathology outcome. Random forest algorithm showed the best accuracy and AUC (78.6% and 0.849, respectively). Conclusion In the differentiation of benign-malignant thyroid incidentalomas, GLRLMRLNU and SUVmax combination may be more useful than SUVmax to predict the outcome.
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Affiliation(s)
- Ayşegül Aksu
- Department of Nuclear Medicine, School of Medicine, Dokuz Eylul University, İzmir, Turkey
| | | | - Emine Acar
- Department of Nuclear Medicine, Kent Hospital, İzmir, Turkey.,Department of Translational Oncology, Institute of Health Sciences, Dokuz Eylul University, İzmir, Turkey
| | - Gamze Çapa Kaya
- Department of Nuclear Medicine, School of Medicine, Dokuz Eylul University, İzmir, Turkey
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Imaging and Imaging-Based Management of Pediatric Thyroid Nodules. J Clin Med 2020; 9:jcm9020384. [PMID: 32024056 PMCID: PMC7074552 DOI: 10.3390/jcm9020384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Thyroid nodules are less frequent in children than adults. Childhood thyroid nodules carry specific features, including a higher risk of malignancy than nodules in adults, rendering them unique in terms of management. Subsequently, they should be considered a distinct clinical entity with specific imaging recommendations. Initial evaluation requires a thorough workup, including clinical examination, and a detailed personal and familial history to determine the presence of possible risk factors. Laboratory and radiologic evaluation play an integral part in the diagnostic algorithm, with ultrasonography (US) being the first diagnostic test in all patients. US elastography has been recently introduced as an incremental method, reducing the subjectivity of the clinical diagnosis of nodule firmness associated with increased malignancy risk. However, fine-needle aspiration biopsy (FNAB) remains the mainstay in the diagnostic work-up of thyroid nodules and is documented to be best method for differentiating benign from malignant thyroid nodules. In addition, thyroid scintigraphy provides functional imaging information, which has a role both in the diagnostic management of thyroid nodules and during follow up in malignancies. Finally, despite providing additional information in certain clinical scenarios, 18F-fludeoxyglucose Positron Emission Tomography (18F-FDG-PET), computed tomography (CT), and magnetic resonance imaging (MRI) imaging are not routinely recommended for the evaluation of patients with newly detected thyroid nodules or in all cases of thyroid cancer. The objective of this review is to summarize the concepts in imaging and imaging-based management of nodular thyroid disease in the pediatric population, acknowledging the unique features that this patient group carries and the specific approach it requires.
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11
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Piccardo A, Trimboli P, Foppiani L, Treglia G, Ferrarazzo G, Massollo M, Bottoni G, Giovanella L. PET/CT in thyroid nodule and differentiated thyroid cancer patients. The evidence-based state of the art. Rev Endocr Metab Disord 2019; 20:47-64. [PMID: 30900067 DOI: 10.1007/s11154-019-09491-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A more conservative approach to the clinical management of thyroid nodules and differentiated thyroid cancer has recently been proposed by the 2015 ATA guidelines. In this context, fine-needle aspiration biopsy has been reserved for nodules with particular ultrasound features or dimensions that exclude low-risk thyroid lesions. Accordingly, a less aggressive surgical approach (i.e. lobectomy) has been recommended as the first-choice treatment in nodules with indeterminate cytology or in small cytologically confirmed malignant nodules. At the same time, radioactive remnant ablation has been considered only for DTC patients with concrete risks of disease persistence/relapse after thyroidectomy. In addition, further radioactive iodine therapies (RAI) have been proposed only for patients presenting unresectable and iodine-avid structural relapse. In this complex scenario, which requires attention to each clinical aspect of the patient, the introduction of accurate diagnostic tools is highly warranted. PET/CT is a very sensitive and specific diagnostic procedure that can better characterize the risk of thyroid nodules, identify DTC relapse early and predict the response to RAI. Thus, it seems essential to customize a more conservative approach to thyroid nodules and DTC patients. The aim of this review is to report the principal clinical context in which PET/CT has been used and to evaluate the evidence-based support for each diagnostic indication.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy.
| | - Pierpaolo Trimboli
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
| | - Luca Foppiani
- Department of Internal Medicine, Galliera Hospital, Genoa, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Giulia Ferrarazzo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Luca Giovanella
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
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12
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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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13
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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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Pattison DA, Bozin M, Gorelik A, Hofman MS, Hicks RJ, Skandarajah A. 18F-FDG–Avid Thyroid Incidentalomas: The Importance of Contextual Interpretation. J Nucl Med 2017; 59:749-755. [DOI: 10.2967/jnumed.117.198085] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/11/2017] [Indexed: 11/16/2022] Open
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Pathak KA, Goertzen AL, Nason RW, Klonisch T, Leslie WD. A prospective cohort study to assess the role of FDG-PET in differentiating benign and malignant follicular neoplasms. Ann Med Surg (Lond) 2016; 12:27-31. [PMID: 27872746 PMCID: PMC5109254 DOI: 10.1016/j.amsu.2016.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 12/28/2022] Open
Abstract
Background Follicular and Hürthle cell neoplasms are diagnostic challenges. This prospective study was designed to evaluate the efficacy of [18F]-2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the risk of malignancy in follicular/Hürthle cell neoplasms. Materials and methods Fifty thyroid nodules showing follicular/Hürthle cell neoplasm on prior ultrasonography guided fine needle aspiration cytology (FNAC) were recruited into this study. A FDG-PET/CT scan, performed for neck and superior mediastinum, was reported by a single observer, blinded to the surgical and pathology findings. Receiver operating characteristic (ROC) curve analysis of maximum standardized uptake value (SUVmax) and the area under the curve (AUROC) were used to assess discrimination between benign from malignant nodules. Youden index was used to identify the optimal cut-off SUVmax for diagnosing malignancy. Sensitivity, specificity, predictive values and overall accuracy were used as measures of performance. Results Our study group comprises of 31 benign and 19 malignant thyroid nodules. After excluding all Hürthle cell adenomas, the AUROC for discriminating benign and malignant non-Hürthle cell neoplasms was 0.79 (95% CI, 0.64–0.94; p = 0.001); with SUVmax of 3.25 as the best cut-off for the purpose. PET/CT had sensitivity of 79% (95% CI, 54–93%), specificity of 83% (95% CI, 60–94%), positive predictive value (PPV) of 79% (95% CI, 54–93%), and negative predictive value (NPV) of 83% (95% CI, 60–94%). The overall accuracy was 81%. Conclusions FDG-PET/CT can help in differentiating benign and malignant non-Hürthle cell neoplasms. SUVmax of 3.25 was found to be the best for identifying malignant non-Hürthle cell follicular neoplasms. Earlier meta-analyses have not considered Hürthle cell neoplasm separate from other follicular neoplasm. Hürthle cell neoplasm are known to show high FDG uptake. FDG-PET/CT can help in differentiating benign and malignant non-Hürthle cell thyroid nodules. A cut-off SUVmax of 3.25 enhances the accuracy of FDG-PET/CT in identifying cancers in thyroid nodules.
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Affiliation(s)
- K Alok Pathak
- Division of Surgical Oncology, Cancer Care Manitoba & University of Manitoba, Winnipeg Canada; Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg Canada
| | - Andrew L Goertzen
- Section of Nuclear Medicine, Department of Radiology, University of Manitoba, Winnipeg Canada
| | - Richard W Nason
- Division of Surgical Oncology, Cancer Care Manitoba & University of Manitoba, Winnipeg Canada
| | - Thomas Klonisch
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg Canada
| | - William D Leslie
- Section of Nuclear Medicine, Department of Radiology, University of Manitoba, Winnipeg Canada
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Valderrabano P, Montilla-Soler J, Mifsud M, Leon M, Centeno B, Khazai L, Padhya T, McCaffrey T, Russell J, McIver B, Otto K. Hypermetabolism on (18)F-Fluorodeoxyglucose Positron Emission Tomography Scan Does Not Influence the Interpretation of Thyroid Cytopathology, and Nodules with a SUVmax <2.5 Are Not at Increased Risk for Malignancy. Thyroid 2016; 26:1300-7. [PMID: 27324615 DOI: 10.1089/thy.2015.0654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hypermetabolism of thyroid nodules on (18)F-fluorodeoxyglucose positron emission tomography (PET) is associated with a higher prevalence of malignancy. However, the definition of hypermetabolism and its impact on cytological interpretation are unclear. METHODS Medical records of all patients with thyroid nodules who had undergone cytological evaluation at the Moffitt Cancer Center between October 2008 and May 2014 were retrospectively reviewed. Those with a PET scan performed within one year of the cytology composed the study group, and the rest were used as controls. The distribution of the cytological categories, percentage of resection, and prevalence of malignancy among each Bethesda category was compared between both groups. RESULTS Fifteen percent (436) of all thyroid nodules with cytological evaluation were in the study group. Maximum standardized uptake values (SUVmax) were directly associated with the probability of having a malignant or a follicular neoplasm cytological diagnosis; and inversely associated with the probability of having a benign cytological diagnosis. However, the prevalence of cancer within each Bethesda category was not associated with SUVmax values. It was found that the prevalence of malignant cytology increased to >5% with SUVmax values ≥2.5. SUVmax values were significantly higher in malignant than in benign nodules on histology (mean values 10.8 vs. 5) but with significant overlap between both groups for either the whole cohort or nodules with indeterminate cytology only limiting its use for differential diagnosis. CONCLUSIONS The prevalence of malignancy in thyroid nodules with a SUVmax <2.5 is similar to the general population, and management should not be modified in those patients. The increased prevalence of malignancy among hypermetabolic thyroid nodules (SUVmax ≥2.5) is well characterized by cytology and does not impact the interpretation of cytological categories. Therefore, SUVmax value does not add relevant information once cytology is available.
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Affiliation(s)
- Pablo Valderrabano
- 1 Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
| | - Jaime Montilla-Soler
- 2 Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
| | - Mathew Mifsud
- 3 Department of Otolaryngology-Head and Neck Surgery, University of South Florida , Tampa, Florida
| | - Marino Leon
- 4 Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
| | - Barbara Centeno
- 4 Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
| | - Laila Khazai
- 4 Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
| | - Tapan Padhya
- 3 Department of Otolaryngology-Head and Neck Surgery, University of South Florida , Tampa, Florida
| | - Thomas McCaffrey
- 3 Department of Otolaryngology-Head and Neck Surgery, University of South Florida , Tampa, Florida
| | - Jeffery Russell
- 1 Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
| | - Bryan McIver
- 1 Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
| | - Kristen Otto
- 1 Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, Florida
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FDG-PET characteristics of Hürthle cell and follicular adenomas. Ann Nucl Med 2016; 30:506-9. [PMID: 27221817 DOI: 10.1007/s12149-016-1087-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/17/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Follicular (FN) and Hürthle cell neoplasms (HCN) are considered indeterminate on thyroid fine needle aspiration cytology and are preoperative diagnostic challenges. The role of [(18)F]-2-fluoro-2-deoxy-D-glucose (FDG) in characterizing indeterminate thyroid nodules remains equivocal, because of the increased FDG uptake by some benign thyroid nodules. The objective of this study was to compare the FDG positron emission tomography/computerized tomography (PET/CT) characteristics of follicular (FA) and Hürthle cell adenomas (HCA). METHODS Twenty-nine patients with 31 thyroid nodules underwent FDG-PET/CT scans of the neck and superior mediastinum for indeterminate FN/HCN, and were later found to have benign adenomas on final histopathology. All scans were reported by a single observer, who was blinded to the surgical and pathology findings. Receiver operating characteristic (ROC) curve analysis of maximum standardized uptake value (SUVmax) and the area under the curve (AUROC) were used to assess discrimination between FA and HCA. Youden index was used to identify the optimal cut-off SUVmax. Sensitivity, specificity, predictive values and overall accuracy were used as measures of performance. RESULTS The mean age of our study cohort was 60.7 ± 12.6 years and 77 % of the patients were females. Age of the patients (p = 0.48), their gender (p = 0.52), and the size of thyroid nodules (p = 0.79) were similar for FA and HCA. Increased focal FDG uptake was observed in 100 % of HCA and 52 % of FA (p = 0.02). SUVmax of HCA was significantly higher (p < 0.001) than that of FA. SUVmax of 5 was the best cut-off for discrimination between HCA and FA, with AUROC of 0.90 (95 % CI, 0.79-1.00; p = 0.001). With this cut-off, FDG-PET/CT had sensitivity of identifying HCA of 88 % (95 % CI 47-99 %), specificity of 87 % (95 % CI 65-97 %), positive predictive value of 70 % (95 % CI 35-92 %), and negative predictive value of 95 % (95 % CI 74-99 %). The overall accuracy was 87 %. CONCLUSIONS HCA shows significantly higher focal FDG uptake as compared to FA and should always be considered in the differential diagnosis of FDG-PET positive thyroid nodules.
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Piccardo A, Puntoni M, Treglia G, Foppiani L, Bertagna F, Paparo F, Massollo M, Dib B, Paone G, Arlandini A, Catrambone U, Casazza S, Pastorino A, Cabria M, Giovanella L. Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology. Eur J Endocrinol 2016; 174:693-703. [PMID: 26966173 DOI: 10.1530/eje-15-1199] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the role of (18)F-flurodeoxiglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. PATIENTS AND METHODS We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent (18)F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and (99m)Tc-methoxyisobutylisonitrile scintigraphy ((99m)Tc-MIBI-scan). Histopathology was the standard of reference. We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (NPV) values of (18)F-FDG-PET/CT with those of (99m)Tc-MIBI-scan and MPUS in detecting cancer. Univariate and multivariate analyses evaluated the association between each diagnostic tool and histopathology. RESULTS On histopathology, 69 out of 87 nodules were found to be benign and 18 to be malignant. The SE, SP, AC, PPV and NPV of (18)F-FDG-PET/CT were 94, 58, 66, 37 and 98% respectively. The SE, AC and NPV of (18)F-FDG-PET/CT were significantly higher than those of MPUS and (99m)Tc-MIBI-scan. The association of both positive (18)F-FDG-PET/CT and MPUS (FDG+/MPUS+) showed significantly lower SE (61% vs 94%) and NPV (88% vs 98%) than (18)F-FDG-PET/CT alone, but significantly higher SP (77% vs 58%). On univariate analysis, (18)F-FDG-PET/CT and the combination of FDG+/MPUS+ and of FDG+/MIBI- were all significantly associated with histopathology. On multivariate analysis, only FDG+/MIBI- was significantly associated with histopathology. CONCLUSION The AC of (18)F-FDG-PET /CT in detecting thyroid malignancy is higher than that of (99m)Tc-MIBI-scan and MPUS. A negative (18)F-FDG-PET/CT correctly predicts benign findings on histopathology. The association of FDG+/MPS+ is significantly more specific than (18)F-FDG-PET/CT alone in identifying differentiated thyroid cancer. A positive (18)F-FDG-PET/CT is significantly associated with malignancy when qualitative (99m)Tc-MIBI-scan is rated as negative.
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Affiliation(s)
- A Piccardo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - M Puntoni
- Clinical Trial UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Treglia
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Foppiani
- Internal MedicineGalliera Hospital, Genoa, Italy
| | - F Bertagna
- Department of Nuclear MedicineUniversity of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - F Paparo
- Department of RadiologyGalliera Hospital, Genoa, Italy
| | - M Massollo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - B Dib
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Paone
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - A Arlandini
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - U Catrambone
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - S Casazza
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - A Pastorino
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - M Cabria
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - L Giovanella
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8739] [Impact Index Per Article: 1092.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. 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, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Kim SJ, Chang S. Predictive value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodules according to Bethesda categories of fine needle aspiration biopsy results. Endocrine 2015; 50:681-8. [PMID: 25948075 DOI: 10.1007/s12020-015-0620-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/27/2015] [Indexed: 01/21/2023]
Abstract
The current study was aimed to investigate the clinical value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodule (TN) with inconclusive fine-needle aspiration biopsy (FNAB) results. The current study enrolled 200 patients who showed F-18 FDG incidentaloma and were performed FNAB. The intratumoral heterogeneity of F-18 FDG uptake was represented as the heterogeneity factor (HF), defined as the derivative (dV/dT) of a volume-threshold function for a primary tumor. The diagnostic and predictive values of HF and F-18 FDG PET/CT parameters were evaluated for characterization of inconclusive FNAB results. Among F-18 FDG PET/CT parameters, SUVmax, MTV, and TLG of malignant group were statistically higher than those of Bethesda category of suspicious malignant group. However, HF values were not statistically different between the groups of Bethesda categories (Kruskal-Wallis statistics, 9.924; p = 0.0774). In ROC analysis, when HF > 2.751 was used as cut-off value, the sensitivity and specificity for prediction of malignant TN were 100 % (95 % CI 69.2-100 %) and 60 % (95 % CI 42.1-76.1 %), respectively. The AUC was 0.826 (95 % CI 0.684-0.922) and standard error was 0.0648 (p < 0.0001). In conclusion, the intratumoral heterogeneity of F-18 FDG uptake represented by HF could be a predictor for characterization of TN with inconclusive FNAB results. Additional large population-based prospective studies are needed to validate the diagnostic utility of HF of F-18 FDG PET/CT.
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Affiliation(s)
- Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea.
- Biomedical Research Institute, Pusan National University Hospital, Busan, 602-739, Republic of Korea.
| | - Samuel Chang
- Department of Radiology, University of Colorado School of Medicine, 12401, 17th Ave, Aurora, CO, 80045, USA
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Wakahara S, Konoshita T, Sakai A, Nakaya T, Ichikawa M, Yamamoto K, Imagawa M, Kimura H, Okazawa H, Ishizuka T. Intrathoracic Benign Goiter Imaged by 18F-FDG-PET: A Case Report. Medicine (Baltimore) 2015; 94:e1387. [PMID: 26266396 PMCID: PMC4616668 DOI: 10.1097/md.0000000000001387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 55-year-old woman was referred for a suspicion of mediastinal tumor through plain X-ray photography (X-P). Magnetic resonance imaging (MRI) revealed a 3 cm diameter tumor which seemed to connect to the thyroid and projected into the mediastinum. A fine needle aspiration biopsy was tried but could not reach a conclusive diagnosis. Thereby, fluorine-18-fluorodeoxyglucose positron emission tomography (F-FDG-PET) was performed and a high accumulation was revealed with standardized uptake value (SUV) of 3.8. Thus, the right lobe excision procedure was enforced. The obtained tumor was continuous to the right lobe as expected. Microscopically, the encapsulated tumor consisted of atypical large-sized follicles without malignant characteristics. Thus, histological diagnosis was follicular thyroid adenoma.Thus, follicular adenoma of thyroid could present negative iodine-123-radioisotope (I-RI) uptake and positive F-FDG-PET accumulation.
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Affiliation(s)
- Shigeyuki Wakahara
- From the Third Department of Internal Medicine, University of Fukui Faculty of Medical Sciences, Fukui, Japan (SW, TK, AS, TN, MI, KY, MI, TI); Department of Radiology, University of Fukui Faculty of Medical Sciences, Fukui, Japan (HK); and Biomedical Imaging Research Center, University of Fukui Faculty of Medical Sciences, Fukui, Japan (HO)
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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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Guralnik L, Rozenberg R, Frenkel A, Israel O, Keidar Z. Metabolic PET/CT-Guided Lung Lesion Biopsies: Impact on Diagnostic Accuracy and Rate of Sampling Error. J Nucl Med 2015; 56:518-22. [DOI: 10.2967/jnumed.113.131466] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022] Open
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Nachiappan AC, Metwalli ZA, Hailey BS, Patel RA, Ostrowski ML, Wynne DM. The thyroid: review of imaging features and biopsy techniques with radiologic-pathologic correlation. Radiographics 2015; 34:276-93. [PMID: 24617678 DOI: 10.1148/rg.342135067] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Knowledge of the normal and abnormal imaging appearances of the thyroid gland is essential for appropriate identification and diagnosis of thyroid lesions. Thyroid nodules are often detected incidentally at computed tomography, magnetic resonance imaging, and positron emission tomography; however, ultrasonography (US) is the most commonly used imaging modality for characterization of these nodules. US characteristics that increase the likelihood of malignancy in a thyroid nodule include microcalcifications, solid composition, and central vascularity. Nuclear scintigraphy is commonly used for evaluation of physiologic thyroid function and for identification of metabolically active and inactive nodules. When fine-needle aspiration biopsy (FNAB) of a lesion is indicated based on clinical and radiologic features, appropriate US-guided biopsy technique and careful cytologic analysis are crucial for making the diagnosis. FNAB and core biopsy are the two percutaneous techniques used to obtain a specimen, with the latter technique being indicated following nondiagnostic or indeterminate FNAB. Specimen adequacy and diagnostic accuracy vary due to several factors, including location of aspiration and biopsy technique used. The radiologist must have a basic knowledge of thyroid disease, be familiar with specimen processing, and recognize the cytologic and radiologic appearances of thyroid lesions, all of which will facilitate the management of these lesions. Online supplemental material is available for this article.
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Affiliation(s)
- Arun C Nachiappan
- From the Department of Radiology (A.C.N., Z.A.M., B.S.H., D.M.W.) and Department of Pathology and Immunology (R.A.P., M.L.O.), Baylor College of Medicine, One Baylor Plaza, MS: BCM 360, Houston, TX 77030
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25
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Vriens D, Adang EMM, Netea-Maier RT, Smit JWA, de Wilt JHW, Oyen WJG, de Geus-Oei LF. Cost-effectiveness of FDG-PET/CT for cytologically indeterminate thyroid nodules: a decision analytic approach. J Clin Endocrinol Metab 2014; 99:3263-74. [PMID: 24873995 DOI: 10.1210/jc.2013-3483] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Patients with thyroid nodules of indeterminate cytology undergo diagnostic surgery according to current guidelines. In 75% of patients, the nodule is benign. In these patients, surgery was unnecessary and unbeneficial because complications may occur. Preoperative fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) was found to have a very high negative predictive value (96%) and might therefore avoid futile surgery, complications, and costs. In the United States, two molecular tests of cytology material are routinely used for this purpose. OBJECTIVE Five-year cost-effectiveness for routine implementation of FDG-PET/CT was evaluated in adult patients with indeterminate fine-needle aspiration cytology and compared with surgery in all patients and both molecular tests. DESIGN A Markov decision model was developed to synthesize the evidence on cost-effectiveness about the four alternative strategies. The model was probabilistically analyzed. One-way sensitivity analyses of deterministic input variables likely to influence outcome were performed. SETTING AND SUBJECTS The model was representative for adult patients with cytologically indeterminate thyroid nodules. MAIN OUTCOME MEASURES The discounted incremental net monetary benefit (iNMB), the efficiency decision rule containing outcomes as quality-adjusted life-years and (direct) medical cost, of implementation of FDG-PET/CT is displayed. RESULTS Full implementation of FDG-PET/CT resulted in 40% surgery for benign nodules, compared with 75% in the conventional approach, without a difference in recurrence free and overall survival. The FDG-PET/CT modality is the more efficient technology, with a mean iNMB of €3684 compared with surgery in all. Also, compared with a gene expression classifier test and a molecular marker panel, the mean iNMB of FDG-PET/CT was €1030 and €3851, respectively, and consequently the more efficient alternative. CONCLUSION Full implementation of preoperative FDG-PET/CT in patients with indeterminate thyroid nodules could prevent up to 47% of current unnecessary surgery leading to lower costs and a modest increase of health-related quality of life. Compared with an approach with diagnostic surgery in all patients and both molecular tests, it is the least expensive alternative with similar effectiveness as the gene-expression classifier.
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Affiliation(s)
- D Vriens
- Departments of Radiology and Nuclear Medicine (D.V., W.J.G.O., L.F.d.G.-O.), Health Evidence (E.M.M.A.), Internal Medicine Section of Endocrinology (R.T.N.-M.), Internal Medicine (J.W.A.S.), and Surgery (J.H.W.d.W.), Radboudumc, 6500 HB Nijmegen, The Netherlands
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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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Pak K, Kim SJ, Kim IJ, Kim BH, Kim SS, Jeon YK. The role of 18F-fluorodeoxyglucose positron emission tomography in differentiated thyroid cancer before surgery. Endocr Relat Cancer 2013; 20:R203-13. [PMID: 23722225 DOI: 10.1530/erc-13-0088] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The incidence of thyroid cancer in both men and women is increasing faster than that of any other cancer. Although positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) has received much attention, the use of FDG PET for the management of thyroid cancer is limited primarily to postoperative follow-up. However, it might have a role in selected, more aggressive pathologies, and so patients at a high risk of distant metastasis may benefit from PET before surgery. As less FDG-avid thyroid cancers may lower the diagnostic accuracy of PET in preoperative assessment, an understanding of FDG avidity is important for the evaluation of thyroid cancer. FDG avidity has been shown to be associated with tumor size, lymph node metastasis, and glucose transporter expression and differentiation. As PET is commonly used in clinical practice, the detection of incidentalomas by PET is increasing. However, incidentalomas detected by PET have a high risk of malignancy. Clinicians handling cytologically indeterminate nodules face a dilemma regarding a procedure for a definitive diagnosis, usually lobectomy. With 'nondiagnostic (ND)' fine-needle biopsy (FNA), PET has shown a negative predictive value (NPV) of 100%, which indicates that negative uptake in a ND FNA procedure accurately excludes malignancy. With 'atypia of undetermined significance' or 'follicular neoplasm', the sensitivity and NPV of PET are 84 and 88%. PET does not provide additional information for the preoperative assessment of thyroid cancer. However, factors associated with FDG positivity are related to a poor prognosis; therefore, FDG PET scans before surgery may facilitate the prediction of the prognosis of differentiated thyroid cancer.
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Affiliation(s)
- Kyoungjune Pak
- Department of Nuclear Medicine, Department of Internal Medicine Medical Research Institute, Pusan National University Hospital, Pusan National University, Busan, South Korea
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Rosen JE, Suh H, Giordano NJ, Aamar OM, Rodriguez-Diaz E, Bigio II, Lee SL. Preoperative discrimination of benign from malignant disease in thyroid nodules with indeterminate cytology using elastic light-scattering spectroscopy. IEEE Trans Biomed Eng 2013; 61:2336-40. [PMID: 23771305 DOI: 10.1109/tbme.2013.2267452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Thyroid nodules are common and often require fine needle aspiration biopsy (FNAB) to determine the presence of malignancy to direct therapy. Unfortunately, approximately 15-30% of thyroid nodules evaluated by FNAB are not clearly benign or malignant by cytology alone. These patients require surgery for the purpose of diagnosis alone; most of these nodules ultimately prove to be benign. Elastic light scattering spectroscopy (ESS) that measures the spectral differences between benign and malignant thyroid nodules has shown promise in improving preoperative determination of benign status of thyroid nodules. We describe the results of a large, prospective, blinded study validating the ESS algorithm in patients with thyroid nodules. An ESS system was used to acquire spectra from human thyroid tissue. Spectroscopic results were compared to the histopathology of the biopsy samples. Sensitivity and specificity of the ESS system in the differentiation of benign from malignant thyroid nodules are 74% and 90% respectively, with a negative predictive value of 97%. These data suggest that ESS has the potential for use in real time diagnosis of thyroid nodules as an adjunct to FNAB cytology.
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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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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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Kobayashi K, Bhargava P, Raja S, Nasseri F, Al-Balas HA, Smith DD, George SP, Vij MS. Image-guided biopsy: what the interventional radiologist needs to know about PET/CT. Radiographics 2013; 32:1483-501. [PMID: 22977031 DOI: 10.1148/rg.325115159] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Positron emission tomography (PET)/computed tomography (CT) with fluorine 18 fluorodeoxyglucose (FDG) is increasingly used in evaluation of oncology patients. Because PET/CT can demonstrate malignancy before morphologic changes are evident, application of PET/CT information to image-guided biopsy can facilitate early histologic diagnosis and staging. However, because FDG uptake is not specific to cancer, PET/CT findings may raise questions about whether uptake in a lesion is an indication for biopsy. To properly select patients for image-guided biopsy, interventional radiologists should be familiar with the biologic significance of FDG uptake and various causes of false-positive uptake. PET/CT images may also become a source of confusion in the interpretation of biopsy results. Various causes of false-positive and false-negative FDG uptake need to be considered, especially when there is a discrepancy between biopsy results and PET/CT findings. False-negative FDG uptake can result from cancers that are too small to be observed or not FDG avid. False-positive FDG uptake can be due to underlying inflammation from recent treatment. Conversely, complete resolution of FDG uptake in a treated lesion does not necessarily indicate absence of viable cells. When questions about PET/CT findings arise in the context of image-guided biopsy, discussion with experienced nuclear imaging physicians is essential.
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Affiliation(s)
- Katsuhiro Kobayashi
- Diagnostic and Therapeutic Care Line, Section of Radiology, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA.
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Ohba K, Sasaki S, Oki Y, Nishizawa S, Matsushita A, Yoshino A, Suda T, Nakamura H. Factors associated with fluorine-18-fluorodeoxyglucose uptake in benign thyroid nodules. Endocr J 2013; 60:985-90. [PMID: 23707998 DOI: 10.1507/endocrj.ej13-0155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thyroid nodules that exhibit focal uptake of fluorine-18 ((18)F)-fluorodeoxyglucose (FDG) are relatively frequent. Although the clinical features and associated mechanisms of FDG-avid lesions in both thyroid cancer and cytologically indeterminate nodules have been extensively studied, not much information is available on benign nodules. Therefore, in this retrospective study, the clinical, serological, and sonographic features of 15 benign FDG-avid nodules were compared with those of 17 non-avid lesions. Univariate analysis indicated that the FDG-positive and -negative nodules were similar with regard to age, gender, thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies, tumor size, 4 B-mode sonographic findings (i.e., shape, margin, texture, and echo level), and/or elasticity. The presence of intranodular blood flow and the absence of a cystic component were associated with a greater possibility of positive FDG uptake. Multivariate analysis showed that vascularity was the only independent factor predicting FDG uptake. Across a wide range of tumor types, the extent of FDG uptake is positively correlated with tumor perfusion; this observation is consistent with the results of this study, which shows that FDG uptake in benign thyroid nodules is associated with increased vascularity.
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Affiliation(s)
- Kenji Ohba
- Department of Internal Medicine 2, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan.
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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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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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Wémeau JL, Sadoul JL, d'Herbomez M, Monpeyssen H, Tramalloni J, Leteurtre E, Borson-Chazot F, Caron P, Carnaille B, Léger J, Do C, Klein M, Raingeard I, Desailloud R, Leenhardt L. Guidelines of the French society of endocrinology for the management of thyroid nodules. ANNALES D'ENDOCRINOLOGIE 2011; 72:251-281. [PMID: 21782154 DOI: 10.1016/j.ando.2011.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 01/21/2023]
Abstract
The present document is a follow-up of the clinical practice guidelines of the French Society of Endocrinology, which were established for the use of its members and made available to scientific communities and physicians. Based on a critical analysis of data from the literature, consensuses and guidelines that have already been published internationally, it constitutes an update of the report on the diagnostic management of thyroid nodules that was proposed in France, in 1995, under the auspices of the French National Agency for Medical Evaluation (l'Agence nationale d'évaluation médicale). The current guidelines were deliberated beforehand by a number of physicians that are recognised for their expertise on the subject, coming from the specialities of endocrinology (the French Thyroid Research Group) and surgery (the French Association for Endocrine Surgery), as well as representatives from the fields of biology, ultrasonography, cytology and nuclear medicine. The guidelines were presented and submitted for the opinion of the members of the Society at its annual conference, which was held in Nice from 7-10 October 2009. The amended document was posted on the website of the Society and benefited from additional remarks of its members. The final version that is presented here was not subjected to methodological validation. It does not claim to be universal in its scope and will need to be revised in concert with progress made in technical and developmental concepts. It constitutes a document that the Society deems useful for distribution concerning the management of thyroid nodules, which is current, efficient and cost effective.
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Affiliation(s)
- J-L Wémeau
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France.
| | - J-L Sadoul
- Endocrinologie, hôpital de l'Archet, CHU 06202 Nice cedex, France
| | - M d'Herbomez
- Département de médecine nucléaire, centre de biologie pathologie, centre hospitalier régional, 59037 Lille cedex, France
| | - H Monpeyssen
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - J Tramalloni
- Centre de radiologie, imagerie médicale et échographie thyroïdienne, hôpital Necker, 141, rue de Sèvres, 75015 Paris, France
| | - E Leteurtre
- Inserm U560, service d'anatomie pathologique, CHRU de Lille, Lille, France
| | - F Borson-Chazot
- Hôpital Louis-Pradel, CHU des hospices civils de Lyon, 28, avenue Doyen-Lépine, 69500 Bron, France
| | - P Caron
- CHU Larrey, avenue du Jean-Poulhès, 31400 Toulouse, France
| | - B Carnaille
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - J Léger
- Service d'endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France
| | - C Do
- Hôpital Claude-Huriez, clinique endocrinologique, CHRU, 59037 Lille cedex, France
| | - M Klein
- Service d'endocrinologie, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - I Raingeard
- Service des maladies métaboliques et endrocriennes, hôpital Lapeyronie, 34295 Montpellier cedex 5, France
| | - R Desailloud
- Service d'endocrinologie, diabétologie et nutrition, hôpital Sud, CHU d'Amiens, avenue René-Laënnec, 80054 Amiens, France
| | - L Leenhardt
- Service de médecine nucléaire, hôpital Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Chan DKK, Lang BHH, Law TT. Value of fluorodeoxyglucose positron emission tomography in characterizing clinically-significant thyroid carcinomas. SURGICAL PRACTICE 2011. [DOI: 10.1111/j.1744-1633.2011.00538.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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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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Kim CJ. Vitamin D dependent rickets type I. KOREAN JOURNAL OF PEDIATRICS 2011; 54:51-4. [PMID: 21503197 PMCID: PMC3077501 DOI: 10.3345/kjp.2011.54.2.51] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/31/2011] [Indexed: 01/14/2023]
Abstract
Vitamin D is present in two forms, ergocalciferol (vitamin D2) produced by plants and cholecalciferol (vitamin D3) produced by animal tissues or by the action of ultraviolet light on 7-dehydrocholesterol in human skin. Both forms of vitamin D are biologically inactive pro-hormones that must undergo sequential hydroxylations in the liver and the kidney before they can bind to and activate the vitamin D receptor. The hormonally active form of vitamin D, 1,25-dihydroxyvitamin D3 [1,25(OH)2D], plays an essential role in calcium and phosphate metabolism, bone growth, and cellular differentiation. Renal synthesis of 1,25(OH)2D from its endogenous precursor, 25-hydroxyvitamin D (25OHD), is the rate-limiting and is catalyzed by the 1α-hydroxylase. Vitamin D dependent rickets type I (VDDR-I), also referred to as vitamin D 1α-hydroxylase deficiency or pseudovitamin D deficiency rickets, is an autosomal recessive disorder characterized clinically by hypotonia, muscle weakness, growth failure, hypocalcemic seizures in early infancy, and radiographic findings of rickets. Characteristic laboratory features are hypocalcemia, increased serum concentrations of parathyroid hormone (PTH), and low or undetectable serum concentrations of 1,25(OH)2D despite normal or increased concentrations of 25OHD. Recent advances have showed in the cloning of the human 1α-hydroxylase and revealed mutations in its gene that cause VDDR-I. This review presents the biology of vitamin D, and 1α-hydroxylase mutations with clinical findings.
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Affiliation(s)
- Chan Jong Kim
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
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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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Donghi V, Di Frenna M, di Lascio A, Chiumello G, Weber G. Vitamin D dependent rickets, diagnostic and therapeutic difficulties: two case reports. J Pediatr Endocrinol Metab 2011; 24:801-5. [PMID: 22145480 DOI: 10.1515/jpem.2011.214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are two types of vitamin D dependent rickets (VDDR) that cause rickets in children. Vitamin D dependent rickets type 1 (VDDR-I) is caused by an inborn error of vitamin D metabolism, which interferes with renal conversion of calcidiol (25OHD) to calcitriol (1,25(OH)2D) by the enzyme 1alpha-hydroxylase. Vitamin D dependent rickets type 2 (VDDR-II) is caused by a defect in the vitamin D receptor (VDR). We report cases of two African children affected by VDDR-I and VDDR-II, respectively. Establishing an early diagnosis of these genetic forms of rickets is challenging, especially in developing countries where nutritional rickets (NR) is the most common variety of the disease. A prompt diagnosis is necessary to initiate adequate treatment, resolve biochemical features and prevent complications, such as severe deformities that may require surgical intervention.
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Affiliation(s)
- Valentina Donghi
- Department of Pediatrics, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy
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Abstract
The introduction of PET(-CT) has brought about a major paradigm shift in the management of thyroid carcinoma, especially from the diagnostic standpoint. From the viewpoint of patient management, the areas where it has made significant impact include the following: (1) the detection of disease focus in patients with differentiated thyroid carcinoma with elevated Tg levels and negative radioiodine scan. When localized disease is identified with F-18 FDG-PET-CT, surgery or focused radiotherapy could be utilized to eradicate the tumor; (2) the localization of disease in patients of MTC with elevated serum calcitonin levels; (3) the detection of unsuspected focal F-18 FDG uptake in the thyroid in patients undergoing whole body F-18 FDG PET for a different indication. This would prompt a workup to rule out thyroid carcinoma. The use of I-124 is evolving at this time and has been of great promise with regard to (a) its better efficacy of lesion detection and (b) the ability to provide lesion-specific dosimetry. In addition, F-18 FDG PET appears to be of potential value in patients with thyroid lymphoma in making the initial diagnosis, monitoring therapeutic response, and assessing for residual disease and/or recurrence.
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Affiliation(s)
- Sandip Basu
- Division of Nuclear Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Suh H, A'amar O, Rodriguez-Diaz E, Lee S, Bigio I, Rosen JE. Elastic light-scattering spectroscopy for discrimination of benign from malignant disease in thyroid nodules. Ann Surg Oncol 2010; 18:1300-5. [PMID: 21174158 DOI: 10.1245/s10434-010-1452-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thyroid cancer is the most common endocrine malignancy. The current standard of diagnosis, fine-needle aspiration biopsy, yields approximately 10-25% of indeterminate results leading to twice as many thyroidectomies for further diagnosis. Elastic scattering spectroscopy (ESS) is a new, minimally invasive optical-biopsy technique mediated by fiber-optic probes that is sensitive to cellular and subcellular morphological features. We assessed the diagnostic potential of ESS in the thyroid to differentiate benign from malignant thyroid nodules as determined by histology. METHODS Under an IRB approved protocol, 36 surgical patients (n = 21 benign thyroid nodules, n = 15 malignant tumors) had collection of ESS data from their fresh ex vivo thyroidectomy specimens. Using surgical pathology as our gold standard, spectral analyses were performed using a training set; these data were used to assess the ESS diagnostic potential using the leave-one-out technique. RESULTS Our test set was 75% sensitive and 95% specific in differentiating benign from malignant thyroid lesions, with a positive predictive value (PPV) of 0.92 and a negative predictive value (NPV) of 0.83. CONCLUSIONS The ESS can accurately distinguish benign vs malignant thyroid lesions with high PPV and NPV. With further validation ESS could potentially be used as an in situ real-time diagnostic tool or as an adjunct to conventional cytology.
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Affiliation(s)
- Hyunsuk Suh
- Department of Surgery, Boston University, Boston, MA, USA
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Traugott AL, Dehdashti F, Trinkaus K, Cohen M, Fialkowski E, Quayle F, Hussain H, Davila R, Ylagan L, Moley JF. Exclusion of malignancy in thyroid nodules with indeterminate fine-needle aspiration cytology after negative 18F-fluorodeoxyglucose positron emission tomography: interim analysis. World J Surg 2010; 34:1247-53. [PMID: 20140435 DOI: 10.1007/s00268-010-0398-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In all, 20% of fine-needle aspiration (FNA) biopsies of thyroid nodules have an indeterminate diagnosis; of these, 80% are found to be benign after thyroidectomy. Some previous reports indicate that positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) imaging may predict malignancy status. We now report results on the first 51 patients in the largest prospective study of FDG-PET in patients with an indeterminate thyroid nodule FNA. METHODS Eligible patients had a dominant thyroid nodule that was palpable or >or=1 cm in greatest dimension as seen by ultrasonography, and indeterminate histology of the FNA biopsy specimen. Participants underwent preoperative neck FDG-PET alone or FDG-PET with computed tomography (FDG-PET/CT). Images were evaluated qualitatively and semiquantitatively using the maximum standardized uptake value (SUV(max)). Final diagnosis was determined by histopathologic analysis after thyroidectomy. Descriptive statistical analysis was performed. RESULTS A total of 51 patients underwent preoperative FDG-PET or FDG-PET/CT. Studies without focally increased uptake localized to the lesion were considered negative. For all lesions (10 malignant, 41 benign), the sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) were 80%, 61%, 33%, and 93%, respectively. Postoperatively, two malignant and six benign lesions were found to be <1 cm by pathology examination; one lesion was not measured. When these lesions were excluded, the sensitivity, specificity, PPV, and NPV were 100%, 59%, 36%, and 100%, respectively. CONCLUSIONS Based on these preliminary data, FDG-PET may have a role in excluding malignancy in thyroid nodules with an indeterminate FNA biopsy. This finding justifies ongoing accrual to our target population of 125 participants.
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Affiliation(s)
- Amber L Traugott
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
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Risk stratification and prediction of cancer of focal thyroid fluorodeoxyglucose uptake during cancer evaluation. Ann Nucl Med 2010; 24:721-8. [DOI: 10.1007/s12149-010-0414-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 08/13/2010] [Indexed: 11/27/2022]
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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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Lee SK, Rho BH. Follicular thyroid adenoma with eggshell calcification presenting as an intensely hypermetabolic lesion on 18F-FDG PET/CT. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:107-110. [PMID: 19655340 DOI: 10.1002/jcu.20615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report herein a case of follicular thyroid adenoma with an eggshell calcification presenting as an intensely hypermetabolic lesion on combined (18)F-fluorodeoxyglucose whole-body PET and CT ((18)F-FDG PET/CT) performed for staging work-up in a 68-year-old woman who had undergone distal gastrectomy with Billroth II anastomosis for early gastric carcinoma. The mass was intensely hypermetabolic (SUV(max) = 21.3 g/mL) on combined (18)F-FDG PET/CT, hypoechoic with an interrupted eggshell calcification on gray-scale ultrasonography (US), and showed intranodular vascularity on power Doppler US. Follicular adenoma should be considered in the differential diagnosis of a mass with an eggshell calcification on US and intense hypermetabolism on (18)F-FDG PET/CT.
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Affiliation(s)
- Sang Kwon Lee
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu 700-712, South Korea
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