A Piccardo1, M Puntoni2, G Treglia3, L Foppiani4, F Bertagna5, F Paparo6, M Massollo7, B Dib7, G Paone3, A Arlandini8, U Catrambone8, S Casazza9, A Pastorino9, M Cabria7, L Giovanella10. 1. Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy arnoldo.piccardo@galliera.it. 2. Clinical Trial UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy. 3. Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland. 4. Internal MedicineGalliera Hospital, Genoa, Italy. 5. Department of Nuclear MedicineUniversity of Brescia and Spedali Civili di Brescia, Brescia, Italy. 6. Department of RadiologyGalliera Hospital, Genoa, Italy. 7. Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy. 8. Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy. 9. Department of PathologyGalliera Hospital, Genoa, Italy. 10. Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland arnoldo.piccardo@galliera.it.
Abstract
PURPOSE: To evaluate the role of (18)F-flurodeoxiglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. PATIENTS AND METHODS: We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent (18)F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and (99m)Tc-methoxyisobutylisonitrile scintigraphy ((99m)Tc-MIBI-scan). Histopathology was the standard of reference. We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (NPV) values of (18)F-FDG-PET/CT with those of (99m)Tc-MIBI-scan and MPUS in detecting cancer. Univariate and multivariate analyses evaluated the association between each diagnostic tool and histopathology. RESULTS: On histopathology, 69 out of 87 nodules were found to be benign and 18 to be malignant. The SE, SP, AC, PPV and NPV of (18)F-FDG-PET/CT were 94, 58, 66, 37 and 98% respectively. The SE, AC and NPV of (18)F-FDG-PET/CT were significantly higher than those of MPUS and (99m)Tc-MIBI-scan. The association of both positive (18)F-FDG-PET/CT and MPUS (FDG+/MPUS+) showed significantly lower SE (61% vs 94%) and NPV (88% vs 98%) than (18)F-FDG-PET/CT alone, but significantly higher SP (77% vs 58%). On univariate analysis, (18)F-FDG-PET/CT and the combination of FDG+/MPUS+ and of FDG+/MIBI- were all significantly associated with histopathology. On multivariate analysis, only FDG+/MIBI- was significantly associated with histopathology. CONCLUSION: The AC of (18)F-FDG-PET /CT in detecting thyroid malignancy is higher than that of (99m)Tc-MIBI-scan and MPUS. A negative (18)F-FDG-PET/CT correctly predicts benign findings on histopathology. The association of FDG+/MPS+ is significantly more specific than (18)F-FDG-PET/CT alone in identifying differentiated thyroid cancer. A positive (18)F-FDG-PET/CT is significantly associated with malignancy when qualitative (99m)Tc-MIBI-scan is rated as negative.
PURPOSE: To evaluate the role of (18)F-flurodeoxiglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. PATIENTS AND METHODS: We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent (18)F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and (99m)Tc-methoxyisobutylisonitrile scintigraphy ((99m)Tc-MIBI-scan). Histopathology was the standard of reference. We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (NPV) values of (18)F-FDG-PET/CT with those of (99m)Tc-MIBI-scan and MPUS in detecting cancer. Univariate and multivariate analyses evaluated the association between each diagnostic tool and histopathology. RESULTS: On histopathology, 69 out of 87 nodules were found to be benign and 18 to be malignant. The SE, SP, AC, PPV and NPV of (18)F-FDG-PET/CT were 94, 58, 66, 37 and 98% respectively. The SE, AC and NPV of (18)F-FDG-PET/CT were significantly higher than those of MPUS and (99m)Tc-MIBI-scan. The association of both positive (18)F-FDG-PET/CT and MPUS (FDG+/MPUS+) showed significantly lower SE (61% vs 94%) and NPV (88% vs 98%) than (18)F-FDG-PET/CT alone, but significantly higher SP (77% vs 58%). On univariate analysis, (18)F-FDG-PET/CT and the combination of FDG+/MPUS+ and of FDG+/MIBI- were all significantly associated with histopathology. On multivariate analysis, only FDG+/MIBI- was significantly associated with histopathology. CONCLUSION: The AC of (18)F-FDG-PET /CT in detecting thyroid malignancy is higher than that of (99m)Tc-MIBI-scan and MPUS. A negative (18)F-FDG-PET/CT correctly predicts benign findings on histopathology. The association of FDG+/MPS+ is significantly more specific than (18)F-FDG-PET/CT alone in identifying differentiated thyroid cancer. A positive (18)F-FDG-PET/CT is significantly associated with malignancy when qualitative (99m)Tc-MIBI-scan is rated as negative.
Authors: Luca Giovanella; Anca M Avram; Ioannis Iakovou; Jennifer Kwak; Susan A Lawson; Elizabeth Lulaj; Markus Luster; Arnoldo Piccardo; Matthias Schmidt; Mark Tulchinsky; Frederick A Verburg; Ely Wolin Journal: Eur J Nucl Med Mol Imaging Date: 2019-08-07 Impact factor: 9.236
Authors: Salvatore Sciacchitano; Luca Lavra; Alessandra Ulivieri; Fiorenza Magi; Gian Paolo De Francesco; Carlo Bellotti; Leila B Salehi; Maria Trovato; Carlo Drago; Armando Bartolazzi Journal: Oncotarget Date: 2017-07-25
Authors: Stefano Gay; Simone Schiaffino; Graziana Santamorena; Barbara Massa; Gianluca Ansaldo; Giovanni Turtulici; Massimo Giusti; Thyroid Team At The Policlinico San Martino Genoa Journal: Med Sci Monit Date: 2018-09-08
Authors: Stefano Valabrega; Giuliano Santolamazza; Francesco Romanelli; Giorgia Scapicchio; Francesco D'Angelo; Carlo Bellotti; Paolo Aurello; Luciano Izzo; Maria R Giovagnoli; Pierpaolo Trimboli Journal: Front Endocrinol (Lausanne) Date: 2018-07-10 Impact factor: 5.555