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Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography.

Chun AR, Jo HM, Lee SH, Chun HW, Park JM, Kim KJ, Jung CH, Mok JO, Kang SK, Kim CH, Kim BY - Endocrinol Metab (Seoul) (2014)

Bottom Line: Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection.Median SUVmax was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).Thyroid incidentalomas found on 18F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

ABSTRACT

Background: Thyroid incidentalomas detected by 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUVmax) in 18F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy.

Methods: A total of 2,584 subjects underwent 18F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects.

Results: Of the 2,584 subjects who underwent 18F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUVmax was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).

Conclusion: Thyroid incidentalomas found on 18F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUVmax tended to be malignant.

No MeSH data available.


Related in: MedlinePlus

A 60-year-old man with underlying sigmoid colon cancer. (A) A focal fluorodeoxyglucose-avid lesion with calcification was incidentally detected in the right lobe of the thyroid (posterior-anterior view). (B) Fusion axial positron emission tomography/computed tomography image showing a hypermetabolic lesion and calcification in the right lobe of the thyroid gland (maximal standardized uptake value=2.6).
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Figure 2: A 60-year-old man with underlying sigmoid colon cancer. (A) A focal fluorodeoxyglucose-avid lesion with calcification was incidentally detected in the right lobe of the thyroid (posterior-anterior view). (B) Fusion axial positron emission tomography/computed tomography image showing a hypermetabolic lesion and calcification in the right lobe of the thyroid gland (maximal standardized uptake value=2.6).

Mentions: Of the 2,584 subjects who underwent 18F-FDG PET/CT (319 for cancer screening, 2,265 for metastatic evaluation), 52 (2.0%) were identified as having focal FDG uptake in the thyroid (Fig. 2). Among these 52 patients, further evaluation was not performed on 16 subjects because of refusal of additional workup, loss to clinical follow-up, or extensive disease of another underlying primary malignancy. These cases were excluded. Finally, 36 patients (12 males and 24 females; mean age, 63.4±10.9 years; range, 40 to 80 years; 28 patients with suspected or known cancer, eight healthy subjects who underwent 18F-FDG PET/CT for cancer screening) who underwent FNAC for further diagnostic evaluastion were included in the analysis. All subjects who underwent further histologic evaluation, except for one, also had a thyroid US scan and had their tumor size determined by measurement of the longest diameter.


Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography.

Chun AR, Jo HM, Lee SH, Chun HW, Park JM, Kim KJ, Jung CH, Mok JO, Kang SK, Kim CH, Kim BY - Endocrinol Metab (Seoul) (2014)

A 60-year-old man with underlying sigmoid colon cancer. (A) A focal fluorodeoxyglucose-avid lesion with calcification was incidentally detected in the right lobe of the thyroid (posterior-anterior view). (B) Fusion axial positron emission tomography/computed tomography image showing a hypermetabolic lesion and calcification in the right lobe of the thyroid gland (maximal standardized uptake value=2.6).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384680&req=5

Figure 2: A 60-year-old man with underlying sigmoid colon cancer. (A) A focal fluorodeoxyglucose-avid lesion with calcification was incidentally detected in the right lobe of the thyroid (posterior-anterior view). (B) Fusion axial positron emission tomography/computed tomography image showing a hypermetabolic lesion and calcification in the right lobe of the thyroid gland (maximal standardized uptake value=2.6).
Mentions: Of the 2,584 subjects who underwent 18F-FDG PET/CT (319 for cancer screening, 2,265 for metastatic evaluation), 52 (2.0%) were identified as having focal FDG uptake in the thyroid (Fig. 2). Among these 52 patients, further evaluation was not performed on 16 subjects because of refusal of additional workup, loss to clinical follow-up, or extensive disease of another underlying primary malignancy. These cases were excluded. Finally, 36 patients (12 males and 24 females; mean age, 63.4±10.9 years; range, 40 to 80 years; 28 patients with suspected or known cancer, eight healthy subjects who underwent 18F-FDG PET/CT for cancer screening) who underwent FNAC for further diagnostic evaluastion were included in the analysis. All subjects who underwent further histologic evaluation, except for one, also had a thyroid US scan and had their tumor size determined by measurement of the longest diameter.

Bottom Line: Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection.Median SUVmax was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).Thyroid incidentalomas found on 18F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

ABSTRACT

Background: Thyroid incidentalomas detected by 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUVmax) in 18F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy.

Methods: A total of 2,584 subjects underwent 18F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects.

Results: Of the 2,584 subjects who underwent 18F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUVmax was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).

Conclusion: Thyroid incidentalomas found on 18F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUVmax tended to be malignant.

No MeSH data available.


Related in: MedlinePlus