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Lee J, Lee J, Song BI. A Machine Learning-Based Radiomics Model for the Differential Diagnosis of Benign and Malignant Thyroid Nodules in F-18 FDG PET/CT: External Validation in the Different Scanner. Cancers (Basel) 2025; 17:331. [PMID: 39858111 PMCID: PMC11763534 DOI: 10.3390/cancers17020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 01/10/2025] [Accepted: 01/16/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND/OBJECTIVES Accurate diagnosis is essential to avoid unnecessary procedures for thyroid incidentalomas (TIs). Advances in radiomics and machine learning applied to medical imaging offer promise for assessing thyroid nodules. This study utilized radiomics analysis on F-18 FDG PET/CT to improve preoperative differential diagnosis of TIs. METHODS A total of 152 patient cases were retrospectively analyzed and split into training and validation sets (7:3) using stratification and randomization. RESULTS The least absolute shrinkage and selection operator (LASSO) algorithm identified nine radiomics features from 960 candidates to construct a radiomics signature predictive of malignancy. Performance of the radiomics score was evaluated using receiver operating characteristic (ROC) analysis and area under the curve (AUC). In the training set, the radiomics score achieved an AUC of 0.794 (95% CI: 0.703-0.885, p < 0.001). Validation was performed on internal and external datasets, yielding AUCs of 0.702 (95% CI: 0.547-0.858, p = 0.011) and 0.668 (95% CI: 0.500-0.838, p = 0.043), respectively. CONCLUSIONS These results demonstrate that the selected nine radiomics features effectively differentiate malignant thyroid nodules. Overall, the radiomics model shows potential as a valuable predictive tool for thyroid cancer in patients with TIs, supporting improved preoperative decision-making.
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Affiliation(s)
- Junchae Lee
- Keimyung University School of Medicine, Daegu 42601, Republic of Korea;
| | - Jinny Lee
- Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea;
| | - Bong-Il Song
- Keimyung University School of Medicine, Daegu 42601, Republic of Korea;
- Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea;
- Department of Medical Information, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
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Abraham PJ, Lindeman BM. Management of Incidental Thyroid Nodules. Surg Clin North Am 2024; 104:711-723. [PMID: 38944493 DOI: 10.1016/j.suc.2024.02.002] [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: 07/01/2024]
Abstract
Thyroid nodules are widely prevalent, and often discovered incidentally. Malignancy rates are low for incidental thyroid nodules, and overall outcomes are favorable regardless of diagnosis. Patients with thyroid nodules should be evaluated with TSH levels followed by ultrasound of the thyroid and cervical lymph nodes. It is important to recognize sonographic features suspicious for thyroid malignancy and obtain biopsies when indicated according to major society guidelines. The Bethesda System for Reporting Thyroid Cytopathology along with molecular testing can help guide management decisions regarding thyroid nodules. Surgical resection and other emerging technologies are safe and effective for the treatment of thyroid nodules needing intervention.
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Affiliation(s)
- Peter J Abraham
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue S, Boshell Diabetes Building, Birmingham, AL 35233, USA
| | - Brenessa M Lindeman
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue S, Boshell Diabetes Building, Birmingham, AL 35233, USA.
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Ren T, Lavender I, Coombs P, Nandurkar D. Sonographic risk stratification of FDG-avid thyroid nodules using the Thyroid Imaging Reporting and Data System. J Med Imaging Radiat Oncol 2024; 68:516-522. [PMID: 38803292 DOI: 10.1111/1754-9485.13712] [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] [Received: 09/30/2023] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The increasing usage of positron emission tomography/computed tomography (PET/CT) for detection and monitoring of malignancy has led to an increase in incidental detection of thyroid nodules. Nodules that demonstrate increased avidity for 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) have been shown to carry a high incidence of malignancy and warrant further investigation. At present, there has been limited research on the risk stratification of FDG-avid thyroid incidentalomas. Thus, this study aims to evaluate the efficacy of the ACR TIRADS classification in the risk stratification of such nodules. METHODS Data were collected retrospectively for FDG-avid thyroid incidentalomas over a 10-year period. Nodules were characterised using the TIRADS classification and, subsequently, underwent fine-needle aspirate cytology. Cytological findings were classified using the Bethesda reporting system. Non-diagnostic samples (Bethesda class I) were excluded. The remaining samples were divided into two groups: benign (Bethesda class II) or suspicious for malignancy/malignant (Bethesda class III or above). RESULTS Thirty-six percent of low-risk nodules and 45% of high-risk nodules were malignant, respectively (P = 0.516). The sensitivity and specificity of TIRADS for detection of malignant nodules were 56% and 54%, respectively. There were no malignant TIRADS 1 or 2 nodules. The absence of any suspicious sonographic features had a 1.0 negative predictive value. CONCLUSIONS FDG-avid nodules classified as TIRADS 1 or 2 or have no suspicious ultrasound features have a 0% incidence of malignancy and thus may not require further assessment with fine-needle aspirate cytology (FNA) when detected incidentally. FDG-avid nodules that are TIRADS 3 or above should undergo FNA regardless of size due to the high risk of malignancy and poor sensitivity of the TIRADS classification system.
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Affiliation(s)
- Tianchi Ren
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Ilona Lavender
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Peter Coombs
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Dee Nandurkar
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
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van Doesburg JR, Kalff MC, Voeten DM, Engelsman AF, Jol S, van Berge Henegouwen MI, Daams F, Gisbertz SS. Thyroid Incidentalomas: Incidence and Oncological Implication in Patients with Esophageal Cancer. Dig Surg 2023; 40:216-224. [PMID: 37678197 DOI: 10.1159/000534027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Thyroid incidentalomas are often encountered during imaging performed for the workup of esophageal cancer. Their oncological significance is unknown. This study aimed to establish incidence and etiology of thyroid incidentalomas found during the diagnostic workup of esophageal cancer. METHODS All esophageal cancer patients referred to or diagnosed at the Amsterdam UMC between January 2012 and December 2016 were included. Radiology and multidisciplinary team meeting reports were reviewed for presence of thyroid incidentalomas. When present, the fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) or CT was reassessed by a radiologist. Primary outcome was the incidence and etiology of thyroid incidentalomas. RESULTS In total, 1,110 esophageal cancer patients were included. Median age was 66 years, most were male (77.2%) and had an adenocarcinoma (69.4%). For 115 patients (10.4%), a thyroid incidentaloma was reported. Two thyroidal lesions proved malignant. One was an esophageal cancer metastasis (0.9%) and one was a primary thyroid carcinoma (0.9%). Only the primary thyroid carcinoma resulted in treatment alteration. The other malignant thyroid incidentaloma was in the context of disseminated esophageal disease and ineligible for curative treatment. CONCLUSION In this study, thyroid incidentalomas were only very rarely oncologically significant. Further etiological examination should only be considered in accordance with the TI-RADS classification system and when clinical consequences are to be expected.
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Affiliation(s)
- Jasmijn R van Doesburg
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marianne C Kalff
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Daan M Voeten
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anton F Engelsman
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Saskia Jol
- Department of Radiology, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Escalante DA, Anderson KG. Workup and Management of Thyroid Nodules. Surg Clin North Am 2022; 102:285-307. [DOI: 10.1016/j.suc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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: 0.5] [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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Mihailovic J, Killeen RP, Duignan JA. PET/CT Variants and Pitfalls in Head and Neck Cancers Including Thyroid Cancer. Semin Nucl Med 2021; 51:419-440. [PMID: 33947603 DOI: 10.1053/j.semnuclmed.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PET/CT imaging is a dual-modality diagnostic technology that merges metabolic and structural imaging. There are several currently available radiotracers, but 18F-FDG is the most commonly utilized due to its widespread availability. 18F-FDG PET/CT is a cornerstone of head and neck squamous cell carcinoma imaging. 68Ga-DOTA-TOC is another widely used radiotracer. It allows for whole-body imaging of cellular somatostatin receptors, commonly expressed by neuroendocrine tumors and is the standard of reference for the characterization and staging of neuroendocrine tumors. The normal biodistribution of these PET radiotracers as well as the technical aspects of image acquisition and inadequate patient preparation affect the quality of PET/CT imaging. In addition, normal variants, artifacts and incidental findings may impede accurate image interpretation and can potentially lead to misdiagnosis. In order to correctly interpret PET/CT imaging, it is necessary to have a comprehensive knowledge of the normal anatomy of the head and neck and to be cognizant of potential imaging pitfalls. The interpreter must be familiar with benign conditions which may accumulate radiotracer potentially mimicking neoplastic processes and also be aware of malignancies which can demonstrate low radiotracer uptake. Appropriate use of structural imaging with either CT, MR or ultrasound can serve a complimentary role in several head and neck pathologies including local tumor staging, detection of bone marrow involvement or perineural spread, and classification of thyroid nodules. It is important to be aware of the role of these complementary modalities to maximize diagnostic accuracy and patient outcomes. The purpose of this article is to outline the basic principles of PET/CT imaging, with a focus on 18F-FDG PET/CT and 68Ga-DOTA PET/CT. Basic physiology, variant imaging appearances and potential pitfalls of image interpretation are presented within the context of common use cases of PET technology in patients with head and neck cancers and other pathologies, benign and malignant.
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Affiliation(s)
- Jasna Mihailovic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Centre of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.
| | - Ronan P Killeen
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John A Duignan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Park KW, Shin JH, Hahn SY, Kim JH, Lim Y, Choi JY. The role of histogram analysis of grayscale sonograms to differentiate thyroid nodules identified by 18F-FDG PET-CT. Medicine (Baltimore) 2020; 99:e23252. [PMID: 33235082 PMCID: PMC7710223 DOI: 10.1097/md.0000000000023252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The role of histogram based on ultrasound (US) images for thyroid nodules found in fluorine-18 fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET-CT) is unknown. We aimed to assess whether histogram analysis using gray scale US could differentiate thyroid nodules detected by PET-CT.In this study, 71 thyroid nodules ≥1 cm were identified in 71 patients by conducting 18F-FDG PET-CT, from January 2010 to June 2013. Subsequently, either grayscale US-guided fine needle aspirations or core needle biopsies were performed on each patient. Each grayscale US feature was categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS). Histogram parameters (skewness, kurtosis, intensity, uniformity, and entropy) were extracted from the grayscale US images followed by statistical analysis using the Chi-Squared or Mann-Whitney U tests.The 71 nodules comprised 30 (42.3%) benign nodules, 30 (42.3%) primary thyroid malignancies, and 11 (15.4%) metastatic lesions. Tumor size, US findings, and histogram parameters were significantly different between the benign and malignant thyroid nodules (P = .011, P = .000, and P < .02, respectively). A comparison showed that parallel orientation and an absence of calcifications were found more frequently in metastatic thyroid nodules than in primary thyroid malignancies (P = .04, P < .000, respectively). However, histogram parameters and K-TIRADS were not significantly different between primary thyroid malignancies and metastatic lesions.There is a limit to replacing cytopathological confirmation with texture analysis for the differentiation of thyroid nodules detected by PET-CT. Therefore, cytopathological confirmation of nodules appearing malignant on US images cannot be avoided for an ultimate diagnosis of metastasis.
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Affiliation(s)
- Ko Woon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yaeji Lim
- Department of Applied Statistics, Chung-Ang University, 221, Heukseok-dong, Dongjak-gu
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of
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Roddy S, Biggans T, Raofi AK, Kanodia A, Sudarshan T, Guntur Ramkumar P. Prevalence of incidental thyroid malignancy on routine 18F-fluorodeoxyglucose PET-CT in a large teaching hospital. Eur J Hybrid Imaging 2020; 4:21. [PMID: 34191154 PMCID: PMC8218029 DOI: 10.1186/s41824-020-00089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To quantify incidental thyroid pathology including malignancy on routine 18F-FDG PET-CT scans To compare standardised uptake values (SUVmax) in thyroid malignancy subtypes Methods and materials This is a retrospective study of all 18F-FDG PET-CT scans (n = 6179) performed in a teaching hospital between June 2010 and May 2019. RIS database search of reports for the word “thyroid” was performed. Studies with evidence of thyroid uptake were included. Patient age and gender, primary indication for PET scan (malignant or non-malignant), thyroid result on PET (diffuse or focal tracer uptake, SUVmax), ultrasound and FNAC results were recorded. Results Incidental abnormal thyroid tracer uptake as a proportion of all 18F-FDG PET-CT scans was 4.37% (n = 270). Out of region patients (n = 87) whose records could not be obtained were excluded leaving a study group of n = 183. Ninety-four in this group had focal uptake, and 89 had diffuse uptake. Fifty-five patients in the focal group had undergone further investigations. Of these, 30 were thought to be benign on USS alone, and 25 patients underwent USS/FNAC. Thirteen (24%) malignancies were identified (5 papillary, 6 follicular, 1 poorly differentiated thyroid cancer, 1 metastatic malignancy). Mean SUVmax for papillary carcinoma was noted to be 8.2 g/ml, and follicular carcinoma was 12.6 g/ml. Conclusion Incidental abnormal thyroid 18F-FDG PET-CT uptake in PET-CT scans of 4.37% is in keeping with the known limited literature. Rather similar number of patients was noted in the focal and diffuse tracer uptake categories in the final study group. Around quarter of the focal lesions were identified to be malignant, implying focal lesions should always be further investigated.
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Affiliation(s)
- Shea Roddy
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Thomas Biggans
- Department of Nuclear Medicine, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Ahmad K Raofi
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Avinash Kanodia
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Thiru Sudarshan
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK.,Department of Nuclear Medicine, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK
| | - Prasad Guntur Ramkumar
- Department of Radiology, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK. .,Department of Nuclear Medicine, Ninewells Hospital, James Arrott Drive, Dundee, DD2 1SY, Scotland, UK.
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Nambron R, Rosenthal R, Bahl D. Diagnosis and Evaluation of Thyroid Nodules-the Clinician's Perspective. Radiol Clin North Am 2020; 58:1009-1018. [PMID: 33040844 DOI: 10.1016/j.rcl.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thyroid nodules are a common clinical problem encountered in an endocrine practice. More and more thyroid nodules are now being detected on unrelated imaging studies, leading to an increased diagnosis of low-risk thyroid cancers. There is therefore a greater emphasis on risk assessment based on clinical and sonographic features to avoid morbidity secondary to unnecessary therapy. Molecular diagnostics are also being widely used to further characterize indeterminate nodules. The American Thyroid Association and American College of Radiology-Thyroid Imaging Reporting and Data System guidelines are the most commonly used in clinical practice for risk assessment.
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Affiliation(s)
- Rajasree Nambron
- University of Alabama at Birmingham, UAB Multispecialty Clinic, 2119 East South Boulevard, Montgomery, AL 36116, USA
| | - Richard Rosenthal
- University of Alabama at Birmingham, The Kirklin Clinic of UAB Hospital, 2000 6th Avenue South, Birmingham, AL 35233, USA
| | - Deepti Bahl
- University of Alabama at Birmingham, 510 20th Street South, FOT 702, Birmingham, AL 35294-3407, USA.
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Loo CH, Khoo ACH, Tan WC, Khor YH, Tang JJ, Tang MM, Chan LC. The findings of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography scan in patients with hidradenitis suppurativa in Malaysia: A multicenter study. World J Nucl Med 2020; 20:32-37. [PMID: 33850487 PMCID: PMC8034800 DOI: 10.4103/wjnm.wjnm_33_20] [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] [Received: 04/05/2020] [Revised: 05/27/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is known to have association with systemic diseases with chronic inflammation such as psoriasis. We aim to describe the concomitant systemic inflammation in patients with HS using 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET/CT) scan. This was a case–control study conducted in three tertiary hospitals in Northern Malaysia from January to December 2017, involving HS patients aged 18 years and above. Thirty-two HS patients with age- and sex-matched controls were recruited with a mean age of 31.4 years (range: 18–56). Numerous cutaneous inflammatory foci were detected on FDG-PET/CT scan in clinically unapparent sites (27/32, 84.4%). Approximately 90.6%, 93.8%, and 50.0% of the patients had significantly higher cutaneous uptake over nasal, mandibular, and scalp regions, respectively (P < 0.0001). PET/CT scan did not detect any systemic inflammation unlike those found in psoriasis. Three (9.4%) patients had thyroid nodules with high uptake (maximum standard uptake values ranging from 2.9 to 11.3). Two of them were confirmed to have papillary thyroid carcinoma, while the third patient has inconclusive finding. 18F-FDG PET/CT scan may be useful to map disease burden of HS. Nonlesional inflammatory foci on the skin of the nose, mandibular, and scalp are probably significant. The association of thyroid carcinoma in HS warrants further evaluation.
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Affiliation(s)
- Chai Har Loo
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.,Department of Dermatology, Hospital Pulau Pinang, Malaysia
| | | | | | - Yek Huan Khor
- Department of Dermatology, Hospital Pulau Pinang, Malaysia
| | - Jyh Jong Tang
- Department of Dermatology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - Min Moon Tang
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Lee Chin Chan
- Department of Dermatology, Hospital Pulau Pinang, Malaysia
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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: 1.0] [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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Abstract
The incidence of thyroid cancer worldwide has increased significantly over the past 3 decades, due predominantly to an increase in papillary thyroid cancer. Although most of these cancers are small and localized, population-based studies have documented a significant increase in thyroid cancers of all sizes and stages, in addition to incidence-based mortality for papillary thyroid cancer. This suggests that the increasing incidence of thyroid cancer is due in large part to increasing surveillance and overdiagnosis, but that there also appears to be a true increase in new cases of thyroid cancer.
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Affiliation(s)
- Carolyn Dacey Seib
- Department of Surgery, University of California, San Francisco, 1600 Divisadero Street, 4th Floor, Box 1674, San Francisco, CA 94143, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Suite S320, Box 0104, San Francisco, CA 94143, USA; Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Suite S320, Box 0104, San Francisco, CA 94143, USA.
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Tatlıdil S, Akgün A. FDG PET/BT görüntülemede tiroid bezinde rastlantısal saptanan fokal artmış FDG tutulumunun klinik önemi. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.417340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Kumar AA, Datta G, Singh H, Mukherjee PB, Vangal S. Clinical significance of thyroid incidentalomas detected on fluorodeoxyglucose positron emission tomography scan (PETomas): An Indian experience. World J Nucl Med 2019; 18:273-282. [PMID: 31516371 PMCID: PMC6714148 DOI: 10.4103/wjnm.wjnm_46_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Thyroid incidentalomas (TIs) are being frequently detected on positron emission tomography (PET) scan. The risk of malignancy in these focal hot spots is substantially high as compared to incidentalomas detected on ultrasonography (USG)/magnetic resonance imaging/computed tomography (CT). Majority of the studies on the prevalence of TIs in PET and the risk of malignancy in them are retrospective and have had varied results. Very few prospective studies are available and very few Indian studies have been done on the subject. Hence, this study was undertaken to evaluate the clinical significance of TIs detected on fluorodeoxyglucose (FDG)-PET scan. The study included all patients undergoing FDG-PET scan for nonthyroid illness from October 2015 to October 2016. Twenty-three consecutive patients detected to have focal TI (FTI) were prospectively evaluated with detailed history and clinical examination, serum thyroid-stimulating hormone, total T4 and total T3 levels, USG neck, fine-needle aspiration cytology (FNAC), and surgery when indicated. The prevalence of FTI was 2.26%. Out of the 23 FTI cases, 19 patients agreed to undergo further evaluation and malignancy was detected in 5 patients (all papillary carcinomas) making a risk of malignancy of 26.3%. There was no significant correlation between CT attenuation characteristics and size of benign and malignant PETomas or between the maximum standardized uptake value (SUVmax) of benign and malignant PETomas. Hence, the risk of malignancy in thyroid PETomas is substantially high and warrants USG-guided FNAC and further work-up. Their SUVmaxvalues, size, and CT attenuation characteristics do not contribute in differentiating benign from malignant lesions.
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Affiliation(s)
- Avs Anil Kumar
- Department of Nuclear Medicine, Command Hospital, C/O Armed Forces Medical College, Pune, Maharashtra, India
| | - Gaurav Datta
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - Harkirat Singh
- Department of Nuclear Medicine, Command Hospital, C/O Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Shashindran Vangal
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India
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16
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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: 0.7] [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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Abstract
Thyroid incidentalomas are frequently reported on 18F-FDG PET/CT scan. High risk of malignancy is thought to be associated with increased metabolic activity and high standardized uptake value. Likewise, thyroid nodules with focal FDG avidity have a higher potential to be malignant. However, some benign nodules such as follicular and Hurthle cell adenomas can also present with focal hypermetabolic activity. We report a case of a 59-year-old lady diagnosed with gastric carcinoma, who had a hypermetabolic thyroid nodule on FDG PET/CT scan. Despite the complex texture of the nodule and intense focal avidity, the histopathology was consistent with Hurtle cell adenoma.
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Affiliation(s)
- Aamna Hassan
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Department of Nuclear Medicine, Lahore, Pakistan
| | - Saima Riaz
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Department of Nuclear Medicine, Lahore, Pakistan
| | - Amna Asif
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Department of Pathology, Lahore, Pakistan
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Chung SR, Choi YJ, Suh CH, Kim HJ, Lee JJ, Kim WG, Sung TY, Lee YM, Song DE, Lee JH, Baek JH. Thyroid Incidentalomas Detected on 18F-Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography: Malignant Risk Stratification and Management Plan. Thyroid 2018; 28:762-768. [PMID: 29759033 DOI: 10.1089/thy.2017.0560] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aims of this study were to stratify the risk of malignancy in thyroid incidentalomas detected on 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) using ultrasound features according to guidelines for thyroid nodules and to develop a subsequent management plan. METHODS From a historical cohort of 96,942 consecutive patients who underwent 18F-FDG PET/CT between October 2008 and September 2015, 1342 patients with 1364 nodules underwent ultrasound evaluation for focal uptake in thyroid gland, with a final diagnosis made for 877 patients with 907 nodules, which were included in this study. Ultrasound images were retrospectively reviewed, and they were stratified according to the American Thyroid Association and Korean Thyroid Image Reporting and Data System guidelines. The calculated malignancy risks were compared with the estimated risks suggested by the guidelines. RESULTS The overall malignancy risk of thyroid incidentalomas detected on 18F-FDG PET/CT was 54.7%. When stratified according to the American Thyroid Association guidelines, the malignancy risks of thyroid incidentalomas with high and intermediate suspicion (93.2% and 45.2%, respectively) were higher than those indicated in the guidelines. The malignancy risks of thyroid incidentalomas with low and very low suspicion (8.1% and 0%, respectively) were within the guideline ranges. These findings were also noted when thyroid incidentalomas were stratified according to the Korean Thyroid Image Reporting and Data System, and in a subgroup of nodules >1 cm. CONCLUSIONS Ultrasound examinations can be used to stratify the malignancy risk of thyroid incidentalomas detected on 18F-FDG PET/CT. The risk of malignancy did not increase in thyroid incidentalomas with low and very low suspicion, indicating that only selective biopsies may be needed in these categories of thyroid incidentalomas.
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Affiliation(s)
- Sae Rom Chung
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Chong Hyun Suh
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
- 2 Department of Radiology, Namwon Medical Center , Namwon-Si, Republic of Korea
| | - Hwa Jung Kim
- 3 Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Jong Jin Lee
- 4 Department of Nuclear Medicine, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Won Gu Kim
- 5 Department of Endocrinology and Metabolism, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Tae Yon Sung
- 6 Department of Surgery, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Yu-Mi Lee
- 6 Department of Surgery, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Dong Eun Song
- 7 Department of Pathology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine , Asan Medical Center, Seoul, Korea
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Fama F, Sindoni A, Cicciu M, Polito F, Piquard A, Saint-Marc O, Gioffre-Florio M, Benvenga S. Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:139-148. [PMID: 29641730 PMCID: PMC10118985 DOI: 10.20945/2359-3997000000017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Incidental thyroid cancers (ITCs) are often microcarcinomas; among them, the most frequent histotype is the papillary one. The purpose of this study was to evaluate the rate of papillary thyroid cancer (PTC) in patients thyroidectomized for benign multinodular goiter. SUBJECT AND METHODS We retrospectively evaluated the histological incidence of PTC in 207 consecutive patients who, in a 1-year period, underwent thyroidectomy for benign multinodular goiter. All patients came from an iodine-deficient area (Orleans, France) with three nuclear power stations located in the neighboring areas of the county town. RESULTS Overall, 25 thyroids (12.1%) harbored 37 PTC, of which 31 were microcarcinomas. In these 25 PTC patients, mean age was 55 ± 10 years (range 30-75), female:male ratio 20:5 (4:1). In 10 patients (40% of 25 and 4.8% of 207), PTCs were bilateral, and in 7 (2 with microPTCs) the thyroid capsule was infiltrated. These 7 patients underwent central and lateral cervical lymph node dissections, which revealed lymph node metastases in one and two cases, respectively. Radioiodine treatment was performed in 7 cases. Neither mortality nor transient and permanent nerve injuries were observed. Four (16%) transient hypocalcaemias occurred as early complications. At last follow-up visit (mean length of follow-up 17.2 ± 3.4 months), all patients were doing well and free of any clinical local recurrence or distant metastases. CONCLUSION With a 12% risk that multinodular goiter harbors preoperatively unsuspected PTCs, which can have already infiltrated the capsule and that can be accompanied by PTC foci contralaterally, an adequate surgical approach has to be considered.
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Affiliation(s)
- Fausto Fama
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Alessandro Sindoni
- Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University Hospital of Messina, Messina, Italy
| | - Marco Cicciu
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Francesca Polito
- Department of Clinical & Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Arnaud Piquard
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, Orléans, France
| | - Olivier Saint-Marc
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, Orléans, France
| | - Maria Gioffre-Florio
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital of Messina, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical & Experimental Medicine, University Hospital of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University Hospital of Messina, Messina, Italy.,Interdepartmental Program on Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital of Messina, Messina, Italy
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20
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Shi H, Yuan Z, Yuan Z, Yang C, Zhang J, Shou Y, Zhang W, Ping Z, Gao X, Liu S. Diagnostic Value of Volume-Based Fluorine-18-Fluorodeoxyglucose PET/CT Parameters for Characterizing Thyroid Incidentaloma. Korean J Radiol 2018. [PMID: 29520193 PMCID: PMC5840064 DOI: 10.3348/kjr.2018.19.2.342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective To assess clinical value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for differentiation of malignant from benign focal thyroid incidentaloma. Materials and Methods This retrospective study included 99 patients with focal thyroid incidentaloma of 5216 non-thyroid cancer patients that had undergone PET/CT. PET/CT semi-quantitative parameters, volume-based functional parameters, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of thyroid incidentaloma were assessed. Receiver-operating characteristic (ROC) analysis was conducted and areas under the curve (AUC) were compared by Hanley and McNeil test to evaluate usefulness of maximum standardized uptake value (SUVmax), MTV and TLG, as markers for differentiating malignant from benign thyroid incidentalomas. Results Of 99 thyroid incidentalomas, 64 (64.6%) were malignant and 35 (35.4%) were benign. Malignant thyroid incidentalomas were larger (1.8 cm vs. 1.3 cm, p = 0.006), and had higher SUVmax (11.3 vs. 4.8, p < 0.001), MTV (all p < 0.001) and TLG (all p < 0.001) than benign. TLG 4.0 had the highest performance for differentiation of malignant from benign thyroid incidentaloma in all semi-quantitative parameters with AUC 0.895 by ROC curve analysis. AUC (TLG 4.0) was significantly larger than AUC (SUVmean), AUC (MTV 2.5), AUC (MTV 3.0), AUC (MTV 3.5), AUC (TLG 2.5), and AUC (TLG 3.0), respectively (all, p < 0.05). There was no statistical difference between AUC (TLG 4.0) and AUC (SUVmax) (p > 0.05). A threshold TLG 4.0 of 2.475 had 81.3% sensitivity and 94.3% specificity for identifying malignant thyroid incidentalomas. Conclusion Volume-based PET/CT parameters could potentially have clinical value in differential diagnosis of thyroid incidentaloma along with SUVmax.
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Affiliation(s)
- Huazheng Shi
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China.,Department of Radiology, affiliated Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Zuguo Yuan
- Department of Chemoradiotherapy, Yinzhou People's Hospital, Ningbo 315100, China
| | - Zheng Yuan
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Chunshan Yang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Jian Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Yi Shou
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Wenrui Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Zhaofu Ping
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Shiyuan Liu
- Department of Radiology, affiliated Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
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Treglia G, Bertagna F, Sadeghi R, Verburg FA, Ceriani L, Giovanella L. Focal thyroid incidental uptake detected by 18F-fluorodeoxyglucose positron emission tomography. Nuklearmedizin 2017; 52:130-6. [DOI: 10.3413/nukmed-0568-13-03] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/08/2013] [Indexed: 01/08/2023]
Abstract
SummaryAim: To perform a meta-analysis of published data on the prevalence and risk of malignancy of focal thyroid incidental uptake (FTIs) detected by Fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/CT. Methods: A comprehensive literature search of studies published up to and including December 2012 was performed. Pooled prevalence and malignancy risk of FTIs were calculated, including a sub-analysis for the geographic areas of origin of the studies. Results: 34 studies including 215 057 patients were selected. Pooled prevalence of FTIs was 1.92% (95% confidence interval [95%CI]: 1.87–1.99%). Overall, 1522 FTIs underwent histopathology evaluation. Pooled risk of malignancy was 36.2% (95%CI: 33.8–38.6%), without significant differences among various geographic areas. Conclusions: FTIs are observed in about 2% of 18F-FDG-PET or PET/CT scans and carry a significant risk of malignancy. Therefore, further investigation is warranted whenever FTIs are detected by 18F-FDG-PET or PET/CT.
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Clinical significance of patterns of increased [ 18F]-FDG uptake in the thyroid gland: a pictorial review. Jpn J Radiol 2017; 36:181-193. [PMID: 29280068 DOI: 10.1007/s11604-017-0715-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
In the diagnosis and staging of oncologic patients, [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) is well recognized as an important functional imaging modality. FDG-PET also has been used for cancer screening in healthy individuals. In general, the normal thyroid gland shows absent or low uptake on FDG-PET, which is often identified as an incidental finding on PET. Today, thyroid FDG uptake can be seen in three patterns: diffuse; focal; and diffuse-plus-focal. Diffuse thyroid uptake is mainly considered an indicator of chronic thyroiditis. Focal thyroid uptake has been associated with malignancy (range 25-50%). Diffuse-plus-focal uptake is not well recognized and might also indicate a risk of malignancy. Understanding the patterns of thyroid FDG uptake is thus important for nuclear medicine physicians or radiologists when giving recommendations to the referring physician. In this pictorial review, we show the clinical significance of different patterns of thyroid uptake on FDG-PET [PET/computed tomography (CT)], including ultrasonography (US) findings.
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Cansu GB, Yılmaz N, Toru S, Sarı R, Gökhan Ocak G, Arıcı C, Altunbaş HA, Balcı MK. Evaluation of Incidental Thyroid Nodules in Cancer Patients. J Natl Med Assoc 2017; 109:299-306. [PMID: 29173938 DOI: 10.1016/j.jnma.2017.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Frequency of thyroid cancer in incidental thyroid nodules identified by imaging techniques in cancer patients is higher than that in the normal population. In the retrospective study, we have both investigated the incidence of thyroid cancer in incidentally identified nodules and compared the imaging techniques to determine whether there is any difference between them in detection of malign nodules. METHODS A total of 7319 patients who underwent thyroid fine-needle aspiration biopsy (FNAB) were included in the study. The data of 174 patients who had previously been diagnosed with a hematologic or solid malignancy prior to the FNAB procedure and had incidentally identified thyroid nodules were evaluated retrospectively. RESULTS Eighty-six (49.5%) of the incidental nodules were identified with ultrasonography (USG), 62 (35.6%) with positron emission tomography (PET) or PET/computed tomography (PET/CT), and 26 (14.9%) with CT. As a result of thyroidectomy, papillary carcinoma was identified in 8 (4.6%) patients, and metastasis to the thyroid of a primary cancer was found in 3 (1.7%) patients. While the papillary carcinoma proportion in the nodules identified by USG was 3.4%, PET/CT was 8.9%. A cut-off maximal standardized uptake value of 11.6 in PET/CT indicated malignancy achieving a sensitivity of 83.3% and a specificity of 91.1%. CONCLUSION Whether the nodule in the incidental thyroid nodules of cancer patients is identified using USG or PET/CT, the risk of thyroid cancer is similar. However, cancer risk is higher in the event of a higher focal uptake in the nodules identified by PET/CT.
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Affiliation(s)
- Güven Barış Cansu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yunusemre State Hospital, Eskişehir, Turkey.
| | - Nusret Yılmaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Serap Toru
- Department of Pathology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ramazan Sarı
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Güzide Gökhan Ocak
- Department of Pathology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Cumhur Arıcı
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hasan Ali Altunbaş
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mustafa Kemal Balcı
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
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Farrá JC, Picado O, Liu S, Ouyang W, Teo R, Franco AM, Lew JI. Clinically significant cancer rates in incidentally discovered thyroid nodules by routine imaging. J Surg Res 2017; 219:341-346. [DOI: 10.1016/j.jss.2017.06.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/23/2017] [Accepted: 06/16/2017] [Indexed: 12/19/2022]
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Sollini M, Cozzi L, Pepe G, Antunovic L, Lania A, Di Tommaso L, Magnoni P, Erba PA, Kirienko M. [ 18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results. Eur J Hybrid Imaging 2017; 1:3. [PMID: 29782578 PMCID: PMC5954705 DOI: 10.1186/s41824-017-0009-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023] Open
Abstract
Background significance of incidental thyroid 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake on positron emission tomography/computed tomography (PET/CT) scans remains controversial. We aimed to evaluate the ability of [18F]FDG-PET/CT texture analysis to predict final diagnosis in thyroid incidentaloma. Methods We retrospectively evaluated medical records of all patients who performed a [18F]FDG-PET/CT from January 2012 to October 2016. Those patients who presented a thyroid incidentaloma described in the medical records and performed a fine needle aspiration in our institution were considered for the analysis. Cytological and/or histological results were used as reference standard to define the final diagnosis. In case of negative cytology, the nodule was considered benign. In case of non-diagnostic or inconclusive results ultrasound, follow-up and further cytology/histology were used as final diagnosis. For suspected or positive cytological result, histology was used as reference standard. PET images were segmented using a General Electric AW workstation running PET VCAR software (GE Healthcare, Waukesha, WI, USA) settled with a threshold of 40% SUVmax. LifeX software (http://www.lifexsoft.org) was used to perform texture analysis. Statistical analysis was performed with R package (https://www.r-project.org). Results We identified 55 patients with incidental thyroid [18F]FDG uptake. Five patients were excluded from the analysis because a final diagnosis was not available. Thirty-two out of 50 patients had benign nodules while in 18/50 cases a malignancy (primary thyroid cancer = 15, metastases = 3) was diagnosed. Conventional PET parameters and histogram-based features were calculated for all 50 patients, while other matrices-based features were available for 28/50 patients. SUVmax and skewness resulted significantly different in benign and malignant nodules (p = 0.01 and = 0.02, respectively). Using ROC analysis, seven features were identified as potential predictors. Among all the textural features tested, skewness showed the best area under the curve (= 0.66). SUV-based parameters resulted in the highest specificity while MTV, TLG, skewness and kurtosis, as well as correlationGLCM resulted better in sensitivity. Conclusions [18F]FDG-PET/CT texture analysis seems to be a promising approach to stratify the patients with thyroid incidentaloma identified on PET scans, with respect to the risk of the diagnosis of a malignant thyroid nodule and thus, could refine the selection of the patients to be referred for cytology.
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Affiliation(s)
- M Sollini
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
| | - L Cozzi
- 2Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy.,1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
| | - G Pepe
- 3Nuclear Medicine, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - L Antunovic
- 3Nuclear Medicine, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - A Lania
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy.,4Endocrinology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - L Di Tommaso
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy.,5Pathology, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - P Magnoni
- 6Ultrasound Service, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - P A Erba
- 7Regional Center of Nuclear Medicine, University of Pisa, via Roma 55, 56025 Pisa, Italy
| | - M Kirienko
- 1Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 20090 Pieve Emanuele (Milan), Italy
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Algin E, Uner A, Akdemir UO, Gumusay O, Kapucu O, Ozet A. The assessment of incidental thyroid lesions on 18F-fluorodeoxyglucose positron emission tomography/computed tomogrophy: A single centre experience. JOURNAL OF ONCOLOGICAL SCIENCES 2017. [DOI: 10.1016/j.jons.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Li Y, Cui M, Azar N, Nakamoto D, Michael CW. Cytological evaluation by fine needle aspiration biopsy of incidental focal increased fluorodeoxyglucose uptake in thyroid on positron emission tomography scan. Diagn Cytopathol 2017; 45:501-506. [PMID: 28261999 DOI: 10.1002/dc.23695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/23/2017] [Accepted: 02/15/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND With the increased use of whole body fluorodeoxyglucose positron emission tomography (PET) scan for staging/restaging or primary diagnosis of neoplasia, thyroid incidentalomas have become more common. The limited reports of PET-positive thyroid incidentalomas showed incidence of malignancy ranging from 14 to 66%, and there is discrepancy in terms of the diagnostic significance of the standard uptake value (SUV) value. METHODS This is a retrospective study of 20 PET incidentalomas which had cytological evaluation from October 2009 to February 2015 at a tertiary care university medical center, M:F = 8:12. RESULTS Of the 20 cases, 14 (70%) had a cytological diagnosis of atypia or suspicious for neoplasia. Eleven of those (55%) underwent surgical resection with final diagnosis of PTC in 8 cases, follicular carcinoma in one case (5%), follicular adenoma in one case (5%), and Hurthle cell adenoma in one case (5%). There was good correlation between cytological and histological diagnosis. For two cases with cytological diagnosis of suspicious for follicular neoplasm, no further histological diagnosis was obtained. One patient had direct cytological diagnosis of PTC also did not undergo surgical resection/diagnosis due to the advanced primary pancreatic adenocarcinoma. The remaining 6 (30%) cases had a cytological diagnosis of benign follicular nodule. Furthermore, no significant difference between malignant SUV and benign SUV was observed. CONCLUSIONS Malignancy was identified in 50% of the PET-positive incidentalomas in our series. PTC constitutes the major malignant diagnosis. No diagnostic value of SUV was observed to differentiate malignant from benign lesions. Diagn. Cytopathol. 2017;45:501-506. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yanchun Li
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Min Cui
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Dean Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Claire W Michael
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Clinical significance of thyroid incidentalomas identified by 18F-FDG PET/CT: correlation of ultrasonograpy findings with cytology results. Nucl Med Commun 2017; 37:715-20. [PMID: 26963467 DOI: 10.1097/mnm.0000000000000495] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM The aim of this study was to investigate the clinical importance of incidental focal or diffuse fluorine-18 fluorodeoxyglucose (F-FDG) uptake in the thyroid gland on positron emission tomography (PET)/computed tomography (CT) and to evaluate the additive value of thyroid ultrasonography (US) in defining the malignancy potential of thyroid incidentalomas. PATIENTS AND METHODS A total of 1450 patients, who had undergone a PET/CT scan for staging or restaging of various malignancies, were screened retrospectively and 52 (3.6%) patients with focal or diffuse F-FDG uptake in the thyroid gland on PET/CT were enrolled in the study. None of the patients had any history of thyroid diseases. Thyroid US with elastography for a thyroid nodule was performed for all the patients cross-sectionally. Thyroid fine-needle aspiration biopsy (FNAB) was also applied at the same time as the thyroid US to 34 patients with a nodule(s) 10 mm or more in diameter or less than 10 mm, but with malignancy potential ultrasonographically. The cytology results were compared with the thyroid US and F-FDG PET/CT findings. RESULTS Although 39 patients had focal (group 1) F-FDG uptake in the thyroid gland, the remaining 13 patients had diffuse (group 2) uptake. In group 1, FNAB was performed in 32 patients. In 10 of 32 (31%) patients, FNAB results were concordant with malignant cytology (seven primary thyroid malignancy and three metastasis to thyroid). In group 2, in one of two patients who had undergone FNAB, malignant cytology (metastasis to thyroid) was detected. Although the difference between the maximum standardized uptake value (SUVmax) of malignant and benign nodules was statistically significant (10.2±8.9 vs. 5.6±3.0, P=0.013), the difference between the nodule sizes was not statistically significant (20.0±7.3 vs. 16.7±7.4, P=0.923). The presence of suspicious US findings and a high elastography score (≥4) were also statistically significant (P<0.001 and P=0.035, respectively). In the receiver-operator characteristic analysis, a 5.3 cut-off SUVmax was calculated with 82% sensitivity and 65% specificity for predicting malignant cytology. CONCLUSION Focal F-FDG uptake was associated with a higher prevalence of malignant thyroid nodule compared with diffuse F-FDG uptake. In particular, if a focal thyroid incidentaloma with high SUVmax (>5.5), suspicious US findings, and a high elastography score (≥4) is detected, a pathological diagnosis, either by histology or by cytology examination, should be made, especially when the patient has a long life expectancy.
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Nayak P, Soe K, Natwa M, Sachak T, Jin M, Lehman NL, Nabhan F. Incidental hypermetabolic PET positive lesions in thyroid and pituitary glands in a patient with lung cancer: A case of two uncommon findings in a single patient. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2016. [DOI: 10.1016/j.jecr.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nicosia L, Alessi S, Proh M, Grosso E, Ansarin M, Vingiani A, Pisa E, De Fiori E. Solitary thyroid metastasis from colon cancer: a rare case report. Ecancermedicalscience 2016; 10:696. [PMID: 28101139 PMCID: PMC5215259 DOI: 10.3332/ecancer.2016.696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Indexed: 11/06/2022] Open
Abstract
Malignant metastases to the thyroid are rare and are even rarer from a colorectal primary. As these metastases are often asymptomatic, they are usually discovered incidentally on imaging performed as follow-up for the primary tumour. In this report, we present a case of metastatic sigmoid adenocarcinoma to the thyroid diagnosed and treated at our institution.
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Affiliation(s)
- L Nicosia
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - S Alessi
- Divisione di Radiologia, Istituto Europeo di Oncologia, Milano, Italy
| | - M Proh
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale Istituto Europeo di Oncologia, Milano, Italy
| | - E Grosso
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale Istituto Europeo di Oncologia, Milano, Italy
| | - M Ansarin
- Divisione di Otorinolaringoiatria e Chirurgia Cervico Facciale Istituto Europeo di Oncologia, Milano, Italy
| | - A Vingiani
- Divisione di Anatomia Patologica, Istituto Europeo di Oncologia, Milano, Italy
| | - E Pisa
- Divisione di Anatomia Patologica, Istituto Europeo di Oncologia, Milano, Italy
| | - E De Fiori
- Divisione di Radiologia, Istituto Europeo di Oncologia, Milano, Italy
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Affiliation(s)
- Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, University of California, 1600 Divisadero Street, San Francisco, California, 94121, USA
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King DL, Stack BC, Spring PM, Walker R, Bodenner DL. Incidence of Thyroid Carcinoma in Fluorodeoxyglucose Positron Emission Tomography-Positive Thyroid Incidentalomas. Otolaryngol Head Neck Surg 2016; 137:400-4. [PMID: 17765765 DOI: 10.1016/j.otohns.2007.02.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 02/26/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE: Fluorodeoxyglucose (FDG) whole body positron emission tomography (PET) scan may show clinically occult second lesions. Such lesions in the thyroid are increasingly common. There are several recent reports of a high probability of malignancy in these lesions ranging from 14% to 63%. STUDY DESIGN AND SETTING: This is a retrospective review of 15,711 PET scans at a multi-disciplinary thyroid clinic at a tertiary care university medical center. Twenty-two patients were referred with thyroid PET “incidentalomas.” The review included 18 FDG-PET scans, ultrasound guided fine needle aspiration biopsies, and thyroid surgery pathology. Aspiration cytology or pathology were the main outcome measures. RESULTS: Three patients had malignancy of the PET-positive thyroid lesions. Papillary thyroid micro carcinomas were detected in four of the specimens that showed a benign pathology of the dominant nodule. CONCLUSION: Our experience shows a 14% malignancy rate for the dominant (imaged) nodule and a total malignancy rate of 32% when the incidental micro carcinomas are included. Both of these rates are significantly lower than results published previously.
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Affiliation(s)
- Deanne L King
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Starker LF, Prieto PA, Liles JS, Tran Cao HS, Grubbs EG, Lee JE, Perrier ND, Graham PH. Endocrine incidentalomas. Curr Probl Surg 2016; 53:219-46. [DOI: 10.1067/j.cpsurg.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/22/2016] [Indexed: 12/21/2022]
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Beech P, Lavender I, Jong I, Soo G, Ramdave S, Chong A, Nandurkar D. Ultrasound stratification of the FDG-avid thyroid nodule. Clin Radiol 2016; 71:164-9. [DOI: 10.1016/j.crad.2015.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 10/01/2015] [Accepted: 10/21/2015] [Indexed: 01/01/2023]
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Yalcin MM, Altinova AE, Ozkan C, Toruner F, Akturk M, Akdemir O, Emiroglu T, Gokce D, Poyraz A, Taneri F, Yetkin I. THYROID MALIGNANCY RISK OF INCIDENTAL THYROID NODULES IN PATIENTS WITH NON-THYROID CANCER. ACTA ENDOCRINOLOGICA-BUCHAREST 2016; 12:185-190. [PMID: 31149085 DOI: 10.4183/aeb.2016.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Thyroid incidentaloma is a common disorder in endocrinology practice. Current literature regarding the risk of thyroid cancer in incidentalomas found in patients with non-thyroid cancer is limited. Objective The aim of the present study was to investigate the frequency of thyroid malignancy in thyroid incidentalomas detected in patients with non-thyroid cancer. Design Case control study. Subjects and Methods The database of 287 thyroid nodules from 161 patients with a history of non-thyroid cancer followed between 2008 and 2014 were retrospectively evaluated. Results From 287 thyroid nodules, 69.7 % had a benign final cytology. Thyroid cancer detected in one nodule while follicular neoplasia detected in 4 nodules, atypia of unknown significance (AUS) detected in 10 nodules, Hurthle cell neoplasia detected in 5 nodules and suspicious for malignancy detected in 6 nodules according to fine needle aspiration biopsy results. Metastasis of the non-thyroid cancer to the thyroid gland was detected in 4 nodules. Twenty seven nodules from 15 patients were removed with surgery. There were 3 malignant nodules found after surgery (1 papillary, 1 follicular and 1 medullary cancer). In addition to these three thyroid cancers, two patients with benign nodules had co-incidental thyroid cancer detected after surgery. Finally, 11.1 % of thyroid nodules which underwent thyroid surgery had malignant histopathology except for co-incidental and metastatic cancers. Conclusions The frequency of thyroid malignancy seems not to be substantially increased in incidental thyroid nodules detected in patients with non-thyroid cancer when these patients were evaluated in nodule-based approach.
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Affiliation(s)
- M M Yalcin
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - A E Altinova
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - C Ozkan
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - F Toruner
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - M Akturk
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - O Akdemir
- Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - T Emiroglu
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - D Gokce
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - A Poyraz
- Gazi University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - F Taneri
- Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - I Yetkin
- Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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ŞENCAN EREN M, ÖZDOĞAN Ö, GEDİK A, CEYLAN M, GÜRAY DURAK M, SEÇİL M, KOÇDOR MA, ÇÖMLEKÇİ A, DURAK H. The incidence of 18F-FDG PET/CT thyroid incidentalomas andthe prevalence of malignancy: a prospective study. Turk J Med Sci 2016; 46:840-7. [DOI: 10.3906/sag-1503-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/09/2015] [Indexed: 11/03/2022] Open
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Tallini G, de Biase D, Durante C, Acquaviva G, Bisceglia M, Bruno R, Bacchi Reggiani ML, Casadei GP, Costante G, Cremonini N, Lamartina L, Meringolo D, Nardi F, Pession A, Rhoden KJ, Ronga G, Torlontano M, Verrienti A, Visani M, Filetti S. BRAF V600E and risk stratification of thyroid microcarcinoma: a multicenter pathological and clinical study. Mod Pathol 2015; 28:1343-1359. [PMID: 26271724 DOI: 10.1038/modpathol.2015.92] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 02/08/2023]
Abstract
Studies from single institutions have analyzed BRAF in papillary microcarcinomas, sometimes with contradictory results. Most of them have provided limited integration of histological and clinical data. To obtain a comprehensive picture of BRAF V600E-mutated microcarcinomas and to evaluate the role of BRAF testing in risk stratification we performed a retrospective multicenter analysis integrating microscopical, pathological, and clinical information. Three hundred and sixty-five samples from 300 patients treated at six medical institutions covering different geographical regions of Italy were analyzed with central review of all cases. BRAF V600E statistical analysis was conducted on 298 microcarcinomas from 264 patients after exclusion of those that did not meet the required criteria. BRAF V600E was identified in 145/298 tumors (49%) including the following subtypes: 35/37 (95%, P<0.0001) tall cell and 72/114 (64%, P<0.0001) classic; conversely 94/129 follicular variant papillary microcarcinomas (73%, P<0.0001) were BRAF wild type. BRAF V600E-mutated microcarcinomas were characterized by markedly infiltrative contours (P<0.0001) with elongated strings of neoplastic cells departing from the tumor, and by intraglandular tumor spread (P<0.0001), typically within 5 mm of the tumor border. Multivariate analysis correlated BRAF V600E with specific microscopic features (nuclear grooves, optically clear nuclei, tall cells within the tumor, and tumor fibrosis), aggressive growth pattern (infiltrative tumor border, extension into extrathyroidal tissues, and intraglandular tumor spread), higher American Thyroid Association recurrence risk group, and non-incidental tumor discovery. The following showed the strongest link to BRAF V600E: tall cell subtype, many neoplastic cells with nuclear grooves or with optically clear nuclei, infiltrative growth, intraglandular tumor spread, and a tumor discovery that was non-incidental. BRAF V600E-mutated microcarcinomas represent a distinct biological subtype. The mutation is associated with conventional clinico-pathological features considered to be adverse prognostic factors for papillary microcarcinoma, for which it could be regarded as a surrogate marker. BRAF analysis may be useful to identify tumors (BRAF wild type) that have negligible clinical risk.
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Affiliation(s)
- Giovanni Tallini
- Department of Medicine (DIMES), Anatomic Pathology Unit, Bellaria Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Dario de Biase
- Department of Medicine (DIMES), Anatomic Pathology Unit, Bellaria Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Cosimo Durante
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | - Giorgia Acquaviva
- Department of Medicine (DIMES), Anatomic Pathology Unit, Bellaria Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Michele Bisceglia
- Anatomic Pathology Unit, School of Biomedical Sciences, Etromapmacs Pole, Lesina, Italy
| | - Rocco Bruno
- Endocrinology Unit, Tinchi-Pisticci Hospital, Matera, Italy
| | | | | | - Giuseppe Costante
- Department of Health Science, University Magna Grecia di Catanzaro, Catanzaro, Italy
| | - Nadia Cremonini
- Endocrinology Unit, AUSL Bologna-Maggiore Hospital, Bologna, Italy
| | - Livia Lamartina
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | | | - Francesco Nardi
- Department of Experimental Medicine, Anatomic Pathology Unit, University 'Sapienza', Rome, Italy
| | - Annalisa Pession
- Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - Kerry J Rhoden
- Department of Medicine (DIMEC), Medical Genetics Unit, University of Bologna, Bologna, Italy
| | - Giuseppe Ronga
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | - Massimo Torlontano
- Department of Medical Science, Ospedale Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | - Antonella Verrienti
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | - Michela Visani
- Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - Sebastiano Filetti
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
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Sager S, Vatankulu B, Erdogan E, Mut S, Teksoz S, Ozturk T, Sonmezoglu K, Kanmaz B. Comparison of F-18 FDG-PET/CT and Tc-99m MIBI in the preoperative evaluation of cold thyroid nodules in the same patient group. Endocrine 2015; 50:138-45. [PMID: 25795290 DOI: 10.1007/s12020-015-0580-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/14/2015] [Indexed: 11/29/2022]
Abstract
Recent studies have reported that standardized uptake values of FDG-PET imaging might predict malignant thyroid nodules and can be used in the preoperative evaluation of thyroid lesions. The aim of our study was to evaluate FDG-PET imaging in patients with cold thyroid nodules and to compare the imaging findings with Tc-99m MIBI scans and with post-op histopathology results. Twenty-three patients (18F, 5M) with 24 nodules that were suspicious in ultrasound and cold in Tc-99m pertechnetate scan, were included in the study. Each nodule underwent sonographically guided fine-needle aspiration biopsy. FDG-PET and MIBI scans were performed with an interval of 3-5 days. All patients underwent thyroidectomy and their FDG-PET, and MIBI thyroid scan results were compared with post-thyroidectomy pathology results. Post-op histopathology results found 7 malignant and 17 benign nodules. Six of the seven malignant nodules had increased uptake, which were positive for malignancy in both PET and MIBI scans. Each imaging method used different radiopharmaceuticals but showed one false-negative result in two different patients. FDG-PET produced false positives in eight nodules and MIBI scans found false positives in four nodules. FDG-PET imaging and MIBI scan showed the same sensitivity in malignant nodule evaluation, but their specificity differed. As a result, we suggest that FDG-PET imaging is not superior to MIBI scanning in differentiating malignant from benign thyroid nodules. MIBI imaging should be the first choice in the preoperative evaluation of patients with cold thyroid nodules as an adjunct procedure to FNAB because of its low cost and availability. This imaging technique can be used routinely in patients who are reluctant to undergo FNAB.
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Affiliation(s)
- Sait Sager
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Fatih, Istanbul, Turkey,
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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: 0.5] [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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Mariño MA. Incidentalomas: concept, relevance and challenges for medical practice. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2015. [DOI: 10.5712/rbmfc10(35)1053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Incidentaloma (which has not been included as a MeSH term neither in other medical databases or Bioportal) is a neologism used to describe an incidentally discovered mass (or abnormality) in asymptomatic persons. Incidentaloma, or incidental finding, is extremely common now and in most cases harmless, but sometimes it is not possible to exclude the possibility of real damage and in very few cases, some people can get benefit from its discovery. Therefore, most of incidentalomas represent overdiagnosis originated by the massive use of high-resolution diagnostic procedures. In many cases, incidentaloma causes anxiety, consume time and resources, and can even cause further damage to patients’ health as a result of procedures performed in the post-finding follow-up. Thus, it is important to recognize the problem to try to avoid it if possible, and learn strategies to deal with it once we stumbled upon an incidentaloma.
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Zandieh S, Pokieser W, Knoll P, Sonneck-Koenne C, Kudlacek M, Mirzaei S. Oncocytic adenomas of thyroid-mimicking benign or metastatic disease on 18F-FDG-PET scan. Acta Radiol 2015; 56:709-13. [PMID: 24948789 DOI: 10.1177/0284185114537928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/11/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The literature is sparse concerning 18F-fluorodeoxyglucose (18F-FDG) accumulation in the Hürthle cell neoplasm (HCN) of the thyroid. Given the difficulty of accurately diagnosing HCN, even with ultrasound (US) and fine needle aspiration biopsy (FNAB), the ability to accurately characterize these lesions by 18F-FDG positron emission tomography (PET) would be of value. PURPOSE To describe six cases of oncocytic proliferation in the thyroid gland that mimics the presence of metastatic disease and was detected incidentally by an 18F-FDG PET scan. MATERIAL AND METHODS We conducted whole-body 18F-FDG PET examinations for cancer staging in 1862 oncological patients from 2012 to 2013. Among them, six subjects (4 women, 2 men; age range, 45-85 years) with focal-enhanced 18F-FDG accumulation in the thyroid gland were selected from the study population. This study group was further investigated using 99 m-Tc-pertechnetate scintigraphy, US, and FNAB. Two experienced nuclear physicians reviewed the images. Gray-scale US and color Doppler (CD) sonographic examinations of the thyroid were undertaken for all subjects using a sonographic device Logiq 5 Expert (GE Medical Systems, Osaka, Japan) equipped with a 7-12 MHz linear array transducer. RESULTS In all six cases, abnormal 18F-FDG uptake was found locally in the thyroid. The average SUVmax of the HCN was 5.8 (range, 2.6-16). In all six cases, 99 m-Tc-pertechnetate scintigraphy showed a cold spot. Compared with normal parenchymal vascularity, five of the six masses were shown to be hypervascular by CD ultrasonography. CONCLUSION On PET scans, oncocytic proliferations of the thyroid may mimic metastases of other malignancies. The focal-enhanced uptake of 18F-FDG PET may be associated with a focal increase in the metabolic activity of the thyroid parenchyma due to the presence of oncocytes. Our study emphasizes the importance of obtaining cytological evidence before making a diagnosis of metastatic disease.
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Affiliation(s)
- Shahin Zandieh
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Wolfgang Pokieser
- Institute of Pathology, Wilhelminenspital, Teaching Hospital of Medical University of Vienna, Austria
| | - Peter Knoll
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Teaching Hospital of Medical University of Vienna, Austria
| | - Charlotte Sonneck-Koenne
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Teaching Hospital of Medical University of Vienna, Austria
| | - Martina Kudlacek
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Teaching Hospital of Medical University of Vienna, Austria
| | - Siroos Mirzaei
- Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Teaching Hospital of Medical University of Vienna, Austria
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Agrawal K, Weaver J, Ul-Hassan F, Jeannon JP, Simo R, Carroll P, Hubbard JG, Chandra A, Mohan HK. Incidence and Significance of Incidental Focal Thyroid Uptake on (18)F-FDG PET Study in a Large Patient Cohort: Retrospective Single-Centre Experience in the United Kingdom. Eur Thyroid J 2015; 4:115-22. [PMID: 26279997 PMCID: PMC4521059 DOI: 10.1159/000431319] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/11/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the prevalence and pathological nature of incidental focal thyroid uptake on (18)F-FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) PET (positron emission tomography) and examine the role of the maximum standardised uptake value (SUVmax) to differentiate benign from malignant thyroid pathology. MATERIAL AND METHODS (18)F-FDG PET reports were retrospectively reviewed. Incidental focal tracer uptake in the thyroid was noted in 147 patients (0.5%). Patients with known primary thyroid malignancy were excluded. The final diagnosis was made following ultrasonography of the neck, fine-needle aspiration cytology (FNAC) or histopathology of the surgically resected specimen where surgery was indicated. A Mann-Whitney U test was used to compare the SUVmax of benign and malignant thyroid pathology. Receiver operating characteristic (ROC) analysis was performed to identify an SUVmax cutoff in differentiating benign from malignant pathology. RESULTS A final diagnosis was achieved in 47/147 (32%) of the patients. The diagnoses included benign lesions in 36 patients and malignancy in 9 patients. In 2 patients, FNAC demonstrated indeterminate follicular lesions; however, surgical excision was not performed. There was a highly significant difference in the mean SUVmax of malignant focal thyroid uptake (15.7 ± 5.9) compared to that of benign lesions (7.1 ± 6.8) with a p value of 0.000123. An SUVmax of 9.1 achieved a sensitivity of 81.6%, specificity of 100% and area under the curve of 0.915 in the ROC analysis differentiating benign from malignant disease. CONCLUSION The malignancy potential of incidental focal thyroid uptake remains high and warrants prompt and appropriate follow-up by the clinician. The SUVmax may aid in further characterisation of the lesion and its management.
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Affiliation(s)
- Kanhaiyalal Agrawal
- Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- *Dr. Kanhaiyalal Agrawal, MBBS, MD, Department of Nuclear Medicine, Guy's Hospital, Great Maze Pond, London SE19RT (UK), E-Mail
| | - James Weaver
- Departments of King's College London, London, UK
| | - Fahim Ul-Hassan
- Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Departments of Clinical PET Centre, King's College London, UK
| | - Jean-Pierre Jeannon
- Departments of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ricard Simo
- Departments of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Carroll
- Departments of Consultant Endocrinologist, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Johnathan G. Hubbard
- Departments of Consultant Endocrine Surgeon, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ashish Chandra
- Departments of Histopathology/Cytology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hosahalli Krishnamurthy Mohan
- Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Departments of Clinical PET Centre, King's College London, UK
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Pituitary 18F-FDG Uptake Correlates With Serum TSH Levels in Subjects With Diffuse Thyroid 18F-FDG Uptake. Clin Nucl Med 2015; 40:632-6. [PMID: 26018720 DOI: 10.1097/rlu.0000000000000793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study was to evaluate the relationship among FDG uptake in the pituitary gland (FDGp), FDG uptake in the thyroid gland (FDGt), and serum thyroid-stimulating hormone (TSH) levels in patients with diffuse FDGt incidentally noted on positron emission tomography/computed tomography (PET/CT). PATIENTS AND METHODS We retrospectively reviewed FDG PET/CT scans of 2,945 subjects who underwent health screening. Of these, 44 subjects had diffuse FDGt and available thyroid function tests. FDGt and FDGp were correlated with serum TSH. FDGp in 44 paired control subjects without FDGt and 15 thyroid cancer patients undergoing thyroid hormone withdrawal were additionally measured, and compared with FDGp in the 44 subjects with FDGt divided into 3 groups according to serum TSH levels. RESULTS In the 44 subjects, there was a strong correlation found between FDGp and TSH (P < 0.001, r = 0.618). As well, there were statistically significant differences in FDGp between the low, normal, and high TSH groups (P < 0.001). FDGp in the paired control subjects was not different from that in the normal TSH group (P = 0.384), and FDGp in the TSH-stimulated thyroid cancer patients was not different from that in the high TSH group (P = 0.463). CONCLUSION We found a strong positive correlation between pituitary FDG uptake and serum TSH. Pituitary FDG uptake seems to hold an important clue to the functional status of the thyroid in subjects with diffuse thyroid FDG uptake. Furthermore, physiologic FDG uptake in the pituitary gland caused by hypothyroidism should not be confused with pathologic conditions such as macroadenoma or metastases.
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Yoon JH, Cho A, Lee HS, Kim EK, Moon HJ, Kwak JY. Thyroid incidentalomas detected on 18F-fluorodeoxyglucose-positron emission tomography/computed tomography: Thyroid Imaging Reporting and Data System (TIRADS) in the diagnosis and management of patients. Surgery 2015; 158:1314-22. [PMID: 25958065 DOI: 10.1016/j.surg.2015.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/10/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Our aim was to evaluate the role of the Thyroid Imaging Reporting and Data System (TIRADS) in the risk stratification of thyroid incidentalomas detected on (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography ((18)F-FDG-PET/CT) scans. METHODS Eighty-seven thyroid nodules in 84 patients showing incidentally detected increased uptake on (18)F-FDG-PET/CT who also had ultrasonography (US)-guided fine needle aspiration performed were included. On review of the US images, a TIRADS category was assigned to each thyroid nodule based on the number of suspicious US features. The correlation between the TIRADS category and the standard uptake values (SUV) on (18)F-FDG-PET/CT were calculated and compared. RESULTS Of the 87 thyroid nodules, 47 (54%) were benign, and 40 (46%) were malignant. The malignancy rate of the TIRADS categories were as follows: 9% for category 3, 15% for category 4a, 39% for category 4b, 72% for category 4c, and 100.0% for category 5. Combining the TIRADS with the SUV showed increased specificity and positive predictive value but decreased sensitivity and negative predictive value compared with TIRADS alone (all P < .05). The area under the receiver operating characteristics curve value of TIRADS was the greatest, comparable with the combined TIRADS and SUV (0.737 to 0.724, P = .788). CONCLUSION TIRADS may be applied in the risk stratification of thyroid incidentalomas detected on (18)F-FDG-PET/CT. Considering the high malignancy rate of thyroid incidentalomas showing increased (18)F-FDG uptake, ultrasonography-guided fine needle aspiration is mandatory even if there are no suspicious features present on US.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Arthur Cho
- Department of Nuclear Medicine, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Medical Research Center, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, Seoul, South Korea.
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Thyroid incidentalomas on PET imaging – Evaluation of management and clinical outcomes. Surgeon 2015; 13:116-20. [DOI: 10.1016/j.surge.2014.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/22/2014] [Accepted: 06/23/2014] [Indexed: 01/31/2023]
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Chun AR, Jo HM, Lee SH, Chun HW, Park JM, Kim KJ, Jung CH, Mok JO, Kang SK, Kim CH, Kim BY. Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography. Endocrinol Metab (Seoul) 2015; 30:71-7. [PMID: 25325277 PMCID: PMC4384680 DOI: 10.3803/enm.2015.30.1.71] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 06/03/2014] [Accepted: 07/07/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Thyroid incidentalomas detected by 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUVmax) in 18F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy. METHODS A total of 2,584 subjects underwent 18F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects. RESULTS Of the 2,584 subjects who underwent 18F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUVmax was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001). CONCLUSION Thyroid incidentalomas found on 18F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUVmax tended to be malignant.
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Affiliation(s)
- A Reum Chun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hye Min Jo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seoung Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hong Woo Chun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jung Mi Park
- Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kyu Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chan Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Oh Mok
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Koo Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Chul Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bo Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
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Agrawal K, Weaver J, Ngu R, Krishnamurthy Mohan H. Clinical significance of patterns of incidental thyroid uptake at (18)F-FDG PET/CT. Clin Radiol 2015; 70:536-43. [PMID: 25687827 DOI: 10.1016/j.crad.2014.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
Incidental uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) in the thyroid gland is not uncommonly encountered in day-to-day practice of oncological (18)F-FDG positron-emission tomography/computed tomography (PET/CT). These are often felt to be "nuisance lesions" by referring clinicians and radiologists alike. However, recognition of the importance of different patterns of FDG uptake in the thyroid gland and knowledge of the possible underlying aetiologies are crucial in ensuring that patients are managed appropriately in the clinical context of their primary diagnosis, as the underlying pathological condition may be clinically important in a significant minority of such cases. This review describes the various patterns of (18)F-FDG uptake within the thyroid and discusses the clinical significance and possible impact on patient management. Incidental low-grade homogeneous diffuse increased thyroid (18)F-FDG uptake is usually seen in the patients with chronic thyroiditis, Grave's disease, and hypothyroidism. Thyroid function tests and antibody profiling are advised in these patients. Incidental focal (18)F-FDG thyroid uptake should raise the possibility of underlying malignancy. Ultrasound with or without fine-needle aspiration cytology is usually recommended for the evaluation of these lesions. Heterogeneous uptake with prominent focal uptake in the thyroid should be further evaluated to exclude malignancy.
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Affiliation(s)
- K Agrawal
- Dept of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - J Weaver
- School of medicine, King's College London, London, UK
| | - R Ngu
- Department of Dental Maxillofacial Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Krishnamurthy Mohan
- Dept of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Clinical PET Centre, St Thomas' Hospital, London, UK
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Pruthi A, Choudhury PS, Gupta M, Taywade S. Does the intensity of diffuse thyroid gland uptake on F-18 fluorodeoxyglucose positron emission tomography/computed tomography scan predict the severity of hypothyroidism? Correlation between maximal standardized uptake value and serum thyroid stimulating hormone levels. Indian J Nucl Med 2015; 30:16-20. [PMID: 25589800 PMCID: PMC4290060 DOI: 10.4103/0972-3919.147528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Context: F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) scan and hypothyroidism. Aims: The aim was to determine whether the intensity of diffuse thyroid gland uptake on F-18 FDG PET/CT scans predicts the severity of hypothyroidism. Materials and Methods: A retrospective analysis of 3868 patients who underwent F-18 FDG PET/CT scans, between October 2012 and June 2013 in our institution for various oncological indications was done. Out of them, 106 (2.7%) patients (79 females, 27 males) presented with bilateral diffuse thyroid gland uptake as an incidental finding. These patients were investigated retrospectively and various parameters such as age, sex, primary cancer site, maximal standardized uptake value (SUVmax), results of thyroid function tests (TFTs) and fine-needle aspiration cytology results were noted. The SUVmax values were correlated with serum thyroid stimulating hormone (S. TSH) levels using Pearson's correlation analysis. Statistical Analysis Used: Pearson's correlation analysis. Results: Clinical information and TFT (serum FT3, FT4 and TSH levels) results were available for 31 of the 106 patients (27 females, 4 males; mean age 51.5 years). Twenty-six out of 31 patients (84%) were having abnormal TFTs with abnormal TSH levels in 24/31 patients (mean S. TSH: 22.35 μIU/ml, median: 7.37 μIU/ml, range: 0.074-211 μIU/ml). Among 7 patients with normal TSH levels, 2 patients demonstrated low FT3 and FT4 levels. No significant correlation was found between maximum standardized uptake value and TSH levels (r = 0.115, P > 0.05). Conclusions: Incidentally detected diffuse thyroid gland uptake on F-18 FDG PET/CT scan was usually associated with hypothyroidism probably caused by autoimmune thyroiditis. Patients should be investigated promptly irrespective of the intensity of FDG uptake with TFTs to initiate replacement therapy and a USG examination to look for any suspicious nodules.
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Affiliation(s)
- Ankur Pruthi
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha Sarathi Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sameer Taywade
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Joven MH, Hutfless GS, Anderson RJ. Follicular Thyroid Cancer with Pulmonary Metastasis Presenting as Toxic Autonomously Functioning Thyroid Nodule. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14384.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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