Kanhaiyalal Agrawal1, James Weaver2, Fahim Ul-Hassan3, Jean-Pierre Jeannon4, Ricard Simo4, Paul Carroll5, Johnathan G Hubbard6, Ashish Chandra7, Hosahalli Krishnamurthy Mohan3. 1. Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK. 2. Departments of King's College London, London, UK. 3. Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK ; Departments of Clinical PET Centre, King's College London, UK. 4. Departments of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK. 5. Departments of Consultant Endocrinologist, Guy's and St Thomas' NHS Foundation Trust, London, UK. 6. Departments of Consultant Endocrine Surgeon, Guy's and St Thomas' NHS Foundation Trust, London, UK. 7. Departments of Histopathology/Cytology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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.
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.
Authors: Jacob Boeckmann; Twyla Bartel; Eric Siegel; Donald Bodenner; Brendan C Stack Journal: Otolaryngol Head Neck Surg Date: 2012-02-03 Impact factor: 3.497
Authors: M Salvatori; L Melis; P Castaldi; M L Maussier; V Rufini; G Perotti; D Rubello Journal: Biomed Pharmacother Date: 2007-06-13 Impact factor: 6.529
Authors: Chandrakanth Are; John F Hsu; Ronald A Ghossein; Heiko Schoder; Jatin P Shah; Ashok R Shaha Journal: Ann Surg Oncol Date: 2007-08-23 Impact factor: 5.344
Authors: J F de Leijer; M J H Metman; A van der Hoorn; A H Brouwers; S Kruijff; B M van Hemel; T P Links; H E Westerlaan Journal: Front Endocrinol (Lausanne) Date: 2021-10-20 Impact factor: 5.555