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Zhang D, Wang XN, Jiang L, Yu CX, Chen YN, Yu XJ, Pan MF. Conventional ultrasonography and elastosonography in diagnosis of malignant thyroid nodules: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 13:1082881. [PMID: 36686488 PMCID: PMC9859672 DOI: 10.3389/fendo.2022.1082881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose To evaluate the diagnostic value of conventional ultrasound and elastosonography in malignant thyroid nodules by meta-analysis. Methods The literature included in the Cochrane Library, PubMed, and Embase were searched by using "elastosonography, ultrasonography, thyroid nodules" as the keywords. The clinical studies using elastosonography and conventional ultrasound to diagnose thyroid nodules were selected, and histopathology of thyroid nodules was used as reference standards. The quality evaluation and heterogeneity test were performed on the literature that met the requirements, the combined specificity and sensitivity were pooled, and a comprehensive ROC curve analysis was performed. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was utilized to evaluate the quality of each included study. Meta-DiSc version 1.4, StataSE 12 and Review Manager 5.4 were used. Results A total of nine studies assessed 3066 thyroid nodules (2043 benign and 1023 malignant). The pooled sensitivity, specificity, PLR, NLR, and DOR of conventional ultrasound for the diagnose of malignant thyroid nodules were 0.833 (95% CI 0.809-0.855), 0.818 (95% CI 0.801-0.835), 4.85 (95% CI 4.36-5.39), 0.20 (95% CI 0.17-0.23), and 29.38 (95% CI 23.28-37.08), respectively, with an AUC of 0.9068. Also, the pooled sensitivity, specificity, PLR, NLR, and DOR of elastosonography were 0.774 (95% CI 0.741-0.804), 0.737 (95% CI 0.715-0.758), 3.14(95% CI 2.85-3.47), 0.29 (95% CI 0.25-0.34), and 9.35 (95% CI 7.63-11.46), respectively, with an AUC of 0.8801. Three studies provided data regarding the conventional ultrasound and elastosonography. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.902 (95% CI 0.870-0.928), 0.649 (95% CI 0.616-0.681), 2.72 (95% CI 2.46-3.00), 0.14 (95% CI 0.11-0.19), 25.51 (95%CI 17.11-38.03), and 0.9294. Conclusion The existing evidence shows that elastosonography cannot completely replace conventional ultrasound in the diagnosis of malignant thyroid nodules, and the combination of elastosonography and conventional ultrasound gives a better diagnostic precision. Systematic review registration www.crd.york.ac.uk, identifier PROSPERO CRD42022375808.
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Affiliation(s)
- Dian Zhang
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Xiao-Na Wang
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Li Jiang
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Chun-Xia Yu
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Yue-Nan Chen
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Xue-Juan Yu
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China
| | - Mei-Fang Pan
- Department of Ultrasound, Xiangcheng People's Hospital, Suzhou, Jiangsu, China
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Gökden Y, Özülker F, Özülker T. Prevalence and Clinical Significance of Incidental Focal 18F-FDG Uptake in Colon on PET/CT Imaging. Mol Imaging Radionucl Ther 2022; 31:96-103. [PMID: 35770960 PMCID: PMC9246315 DOI: 10.4274/mirt.galenos.2022.38247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: The present study aimed to identify the prevalence of focal uptake in the colon on 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) studies performed for the evaluation of malignancies other than colon, to detect the rate of malignancy in incidental focal 18F-FDG avid colonic lesions and to investigate if any possible role of maximum standardized uptake value (SUVmax) values in the discrimination of malignant lesions from premalignant and benign ones exist. Methods: We retrospectively reviewed the files of 8,017 patients with known or suspected malignancy, who underwent whole-body 18F-FDG PET/CT at our institution during the period November 2017 to November 2019. Patients showing a single site of focally increased colonic 18F-FDG uptake that was more intense compared to liver uptake on 18F-FDG PET studies and referred to colonoscopy were enrolled in the study. Results: Fifty two patients (83.8%) had at least 1 corresponding lesion on colonoscopy, whereas in 10 patients no lesion was detected. Subsequent histopathological examinations revealed no corresponding lesion in 13 (13.7%), a benign lesion in 18 (18.9%), hyperplastic polyp in 10 (10.5%), low-grade polyp in 16 (16.8%), high-grade polyp in 29 (30.5%) and malignant lesion in 9 (9.5%) of the focal 18F-FDG uptake sites. According to histopathology results, statistically no significant difference was found between the SUVmax measurements of malignant and benign cases (p>0.05) but the average SUVmax measurements of malignant cases were found to be significantly higher than lower + high-grade cases (p<0.05) and hyperplastic polyp cases (p<0.01). Conclusion: In conclusion, any unexpected focal 18F-FDG uptake in 18F-FDG PET/CT studies is suspicious for malignancy and should be clarified by colonoscopy. The intensity of 18F-FDG uptake does not preclude the application of colonoscopy and histopathological verification of the lesion if there is any.
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Affiliation(s)
- Yasemin Gökden
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Internal Medicine, İstanbul, Turkey
| | - Filiz Özülker
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tamer Özülker
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Abstract
Thyroid nodules may be discovered in a variety of settings. Familiarity with their management is important for medical specialists. Workup should start with history and physical examination, proceed to laboratory studies, and then to imaging. Nodules are selected for fine needle aspiration (FNA) biopsy based on imaging criteria. Most nodules can be accurately diagnosed on cytopathology, but some may require additional molecular testing to evaluate risk of malignancy. Patients with malignant lesions require additional investigation before referral to an experienced thyroid surgeon. Those who have benign lesions may require monitoring by periodic ultrasound to identify nodules requiring reevaluation.
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Affiliation(s)
- Elizabeth H Holt
- Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, Yale Medical School, PO Box 208020, New Haven, CT 06520-8020, USA.
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Scappaticcio L, Piccardo A, Treglia G, Poller DN, Trimboli P. The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis. Endocrine 2021; 73:540-549. [PMID: 33761104 PMCID: PMC8325664 DOI: 10.1007/s12020-021-02683-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE 18F-FDG thyroid incidentaloma (TI) occurs in ~2% of PET/CT examinations with a cancer prevalence of up to 35-40%. Guidelines recommend fine-needle aspiration cytology (FNA) if a focal 18F-FDG TI corresponds to a sonographic nodule >1 cm. The aim of this systematic review and meta-analysis was to provide evidence-based data on the diagnostic distribution of 18F-FDG TIs in the six Bethesda systems for reporting thyroid cytopathology (BETHESDA) subcategories. METHODS Original studies reporting 18F-FDG TIs and cytologically classified according to BETHESDA were included. Six separate meta-analyses were performed to obtain the pooled prevalence (95% confidence interval, 95% CI) of 18F-FDG TIs in the six BETHESDA subcategories. RESULTS Fifteen studies were finally included. Nine studies were from Asian/Eastern and six from Western countries. FNA data according to BETHESDA was available in 2304 cases. The pooled prevalence of 18F-FDG TIs according to BETHESDA was BETHESDA I 10% (6-14), BETHESDA II 45% (37-53), BETHESDA III 8% (3-13), BETHESDA IV 8% (5-12), BETHESDA V 6% (4-9), BETHESDA VI 19% (13-25). A significantly different prevalence was found in the BETHESDA IV between Asian/Eastern (2%) and Western (19%) studies. CONCLUSION Two-thirds of focal 18F-FDG TIs undergoing FNA have either malignant (BETHESDA VI) or benign (BETHESDA II) cytology while a minority will have indeterminate (BETHESDA III or IV) FNA results. Significant differences between Asian/Eastern and Western studies are also present in the prevalence of indeterminate FNA results.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, University of Campania 'L. Vanvitelli'', Naples, Italy.
| | | | - Giorgio Treglia
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - David N Poller
- Departments of Cytology & Pathology, Queen Alexandra Hospital, Portsmouth, UK
- UCL Cancer Institute, 72 Huntley St., Bloomsbury, London, WC1E 6DD, UK
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Sharbidre KG, Lockhart ME, Tessler FN. Incidental Thyroid Nodules on Imaging: Relevance and Management. Radiol Clin North Am 2021; 59:525-533. [PMID: 34053603 DOI: 10.1016/j.rcl.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Incidental thyroid nodules (ITNs) are commonly detected on imaging examinations performed for other reasons, particularly computed tomography (CT) (and now PET-CT and even PET-MR imaging), MR imaging, and sonography, primarily a consequence of the increasing sensitivity of these diagnostic modalities. Appropriate management of ITNs is crucial to avoid the cost and medical consequences of unnecessary workups.
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Affiliation(s)
- Kedar G Sharbidre
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT N357, Birmingham, AL 35249, USA.
| | - Mark E Lockhart
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT N344, Birmingham, AL 35249, USA
| | - Franklin N Tessler
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, GSB 409, Birmingham, AL 35249, USA
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de Leijer JF, Metman MJH, van der Hoorn A, Brouwers AH, Kruijff S, van Hemel BM, Links TP, Westerlaan HE. Focal Thyroid Incidentalomas on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration. Front Endocrinol (Lausanne) 2021; 12:723394. [PMID: 34744999 PMCID: PMC8564374 DOI: 10.3389/fendo.2021.723394] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The rising demand for 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) has led to an increase of thyroid incidentalomas. Current guidelines are restricted in giving options to tailor diagnostics and to suit the individual patient. OBJECTIVES We aimed at exploring the extent of potential overdiagnostics by performing a systematic review and meta-analysis of the literature on the prevalence, the risk of malignancy (ROM) and the risk of inconclusive FNAC (ROIF) of focal thyroid incidentalomas (FTI) on 18F-FDG PET/CT. DATA SOURCES A literature search in MEDLINE, Embase and Web of Science was performed to identify relevant studies. STUDY SELECTION Studies providing information on the prevalence and/or ROM of FTI on 18F-FDG PET/CT in patients with no prior history of thyroid disease were selected by two authors independently. Sixty-one studies met the inclusion criteria. DATA ANALYSIS A random effects meta-analysis on prevalence, ROM and ROIF with 95% confidence intervals (CIs) was performed. Heterogeneity and publication bias were tested. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. DATA SYNTHESIS Fifty studies were suitable for prevalence analysis. In total, 12,943 FTI were identified in 640,616 patients. The pooled prevalence was 2.22% (95% CI = 1.90% - 2.54%, I2 = 99%). 5151 FTI had cyto- or histopathology results available. The pooled ROM was 30.8% (95% CI = 28.1% - 33.4%, I2 = 57%). 1308 (83%) of malignant nodules were papillary thyroid carcinoma (PTC). The pooled ROIF was 20.8% (95% CI = 13.7% - 27.9%, I2 = 92%). LIMITATIONS The main limitations were the low to moderate methodological quality of the studies and the moderate to high heterogeneity of the results. CONCLUSION FTI are a common finding on 18F-FDG PET/CTs. Nodules are malignant in approximately one third of the cases, with the majority being PTC. Cytology results are non-diagnostic or indeterminate in one fifth of FNACs. These findings reveal the potential risk of overdiagnostics of FTI and emphasize that the workup of FTI should be performed within the context of the patient's disease and that guidelines should adopt this patient tailored approach.
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Affiliation(s)
- J. F. de Leijer
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M. J. H. Metman
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. van der Hoorn
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - A. H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - S. Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - B. M. van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - T. P. Links
- Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - H. E. Westerlaan
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: H. E. Westerlaan,
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Lee JC, Britten FL, Hartnett GF. Follow-up of incidental findings on positron emission tomography. World J Nucl Med 2020; 19:317-318. [PMID: 33354197 PMCID: PMC7745852 DOI: 10.4103/wjnm.wjnm_41_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Joseph C Lee
- Department of Medical Imaging, The Prince Charles Hospital, Chermside, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - Fiona L Britten
- Faculty of Medicine, University of Queensland, Herston, Australia.,Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Gemma F Hartnett
- Faculty of Medicine, University of Queensland, Herston, Australia.,Department of Medical Oncology, Redcliffe General Hospital, Redcliffe, Queensland, Australia
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