Luca Giovanella1, Pierpaolo Trimboli1, Arnoldo Piccardo2, Matteo Puntoni3, Marih Dezzana4, Gianluca Bottoni5, Luca Foppiani6, Alessandro Marugo7, Ugo Catrambone8, Martina Ugolini5, Simona Sola4, Martina Gatto5, Giorgio Treglia1,9,10. 1. Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. 2. Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy. arnoldo.piccardo@galliera.it. 3. Clinical Trial Research Unit, Galliera Hospital, Genoa, Italy. 4. Department of Histopathology, Galliera Hospital, Genoa, Italy. 5. Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy. 6. Department of Internal Medicine, Galliera Hospital, Genoa, Italy. 7. Endocrinology Unit, Galliera Hospital, Genoa, Italy. 8. Department of Surgery, Galliera Hospital, Genoa, Italy. 9. Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. 10. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland.
Abstract
PURPOSE: To evaluate the reliability of 18F-FDG PET/CT in distinguishing differentiated thyroid cancers (DTCs) and follicular neoplasms (FNs) from nodular hyperplasias (NH) in thyroid nodules with indeterminate cytology according to the Italian consensus for the classification and reporting of thyroid cytology (ICCRTC). We also tested whether the 18F-FDG PET/CT result was an independent risk factor for DTCs or FNs when sex, age, nodule dimensions, the European Thyroid Imaging and Reporting Data System (EU-TIRADS) and ICCRTC were considered. METHODS: We evaluated all patients with thyroid nodules and indeterminate cytology from September 2015 to May 2019; nodules were classified as low risk (TIR3A) and high risk (TIR3B) according to the ICCRTC. Neck ultrasonography features according to EU-TIRADS were re-evaluated and 18F-FDG PET/CT performed. All these patients were surgically treated. RESULTS: We included 111 patients; 67 nodules were classified as TIR3A and 44 as TIR3B. Overall, we found 27 DTCs, 57 NHs and 27 FNs. Among 73 FDG-negative nodules, we found four low-risk papillary thyroid cancers. All follicular thyroid cancers were identified by 18F-FDG-PET/CT. All TIR3A with low-risk US and negative 18F-FDG-PET/CT were NH. In TIR3A nodules, the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of 18F-FDG PET/CT and EU-TIRADS for DTCs were 77.8%, 41.4%, 92.3%, 17.1% and 66.7%, 56.9%, 91.7%, 19.4%, respectively. In TIR3B nodules, the sensitivity, specificity, NPV and PPV of 18F-FDG PET/CT and EU-TIRADS for DTCs were 88.9%, 38.5%, 83.3%, 50% and 88.2%, 58.3%, 87.5%, 60%, respectively. On multivariate analysis, 18F-FDG-PET/CT (OR 9.04), ICCRTC (O.R. 7.57) and EU-TIRADS (OR 4.41) were all independent risk factors associated to DTCs and FNs. CONCLUSION: 18F-FDG-PET/CT is a reliable rule-out test for DTC even in thyroid nodules with indeterminate high-risk results. In this subgroup, PPV also tends to be considerable. 18F-FDG-PET/CT results, ICCRTC and EU-TIRADS proved independent risk factors associated to DTCs and FNs.
PURPOSE: To evaluate the reliability of 18F-FDG PET/CT in distinguishing differentiated thyroid cancers (DTCs) and follicular neoplasms (FNs) from nodular hyperplasias (NH) in thyroid nodules with indeterminate cytology according to the Italian consensus for the classification and reporting of thyroid cytology (ICCRTC). We also tested whether the 18F-FDG PET/CT result was an independent risk factor for DTCs or FNs when sex, age, nodule dimensions, the European Thyroid Imaging and Reporting Data System (EU-TIRADS) and ICCRTC were considered. METHODS: We evaluated all patients with thyroid nodules and indeterminate cytology from September 2015 to May 2019; nodules were classified as low risk (TIR3A) and high risk (TIR3B) according to the ICCRTC. Neck ultrasonography features according to EU-TIRADS were re-evaluated and 18F-FDG PET/CT performed. All these patients were surgically treated. RESULTS: We included 111 patients; 67 nodules were classified as TIR3A and 44 as TIR3B. Overall, we found 27 DTCs, 57 NHs and 27 FNs. Among 73 FDG-negative nodules, we found four low-risk papillary thyroid cancers. All follicular thyroid cancers were identified by 18F-FDG-PET/CT. All TIR3A with low-risk US and negative 18F-FDG-PET/CT were NH. In TIR3A nodules, the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of 18F-FDG PET/CT and EU-TIRADS for DTCs were 77.8%, 41.4%, 92.3%, 17.1% and 66.7%, 56.9%, 91.7%, 19.4%, respectively. In TIR3B nodules, the sensitivity, specificity, NPV and PPV of 18F-FDG PET/CT and EU-TIRADS for DTCs were 88.9%, 38.5%, 83.3%, 50% and 88.2%, 58.3%, 87.5%, 60%, respectively. On multivariate analysis, 18F-FDG-PET/CT (OR 9.04), ICCRTC (O.R. 7.57) and EU-TIRADS (OR 4.41) were all independent risk factors associated to DTCs and FNs. CONCLUSION: 18F-FDG-PET/CT is a reliable rule-out test for DTC even in thyroid nodules with indeterminate high-risk results. In this subgroup, PPV also tends to be considerable. 18F-FDG-PET/CT results, ICCRTC and EU-TIRADS proved independent risk factors associated to DTCs and FNs.
Authors: Elizabeth J de Koster; Adriana C H van Engen-van Grunsven; Johan Bussink; Cathelijne Frielink; Lioe-Fee de Geus-Oei; Benno Kusters; Hans Peters; Wim J G Oyen; Dennis Vriens Journal: Mol Imaging Biol Date: 2022-10-17 Impact factor: 3.484
Authors: Elizabeth J de Koster; Wyanne A Noortman; Jacob M Mostert; Jan Booij; Catherine B Brouwer; Bart de Keizer; John M H de Klerk; Wim J G Oyen; Floris H P van Velden; Lioe-Fee de Geus-Oei; Dennis Vriens Journal: Eur J Nucl Med Mol Imaging Date: 2022-02-09 Impact factor: 10.057
Authors: Elizabeth J de Koster; Lioe-Fee de Geus-Oei; Adrienne H Brouwers; Eveline W C M van Dam; Lioe-Ting Dijkhorst-Oei; Adriana C H van Engen-van Grunsven; Wilbert B van den Hout; Tamira K Klooker; Romana T Netea-Maier; Marieke Snel; Wim J G Oyen; Dennis Vriens Journal: Eur J Nucl Med Mol Imaging Date: 2022-01-04 Impact factor: 10.057