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. 2019 Aug 7;9(3):92.
doi: 10.3390/diagnostics9030092.

Evaluation of Malignancy Risk in 18F-FDG PET/CT Thyroid Incidentalomas

Maria-Iulia Larg  1   2 , Dragoș Apostu  3 , Claudiu Peștean  4   3 , Katalin Gabora  4   3 , Iulian Claudiu Bădulescu  3 , Elena Olariu  4 , Doina Piciu  4   3
Affiliations

Evaluation of Malignancy Risk in 18F-FDG PET/CT Thyroid Incidentalomas

Maria-Iulia Larg et al. Diagnostics (Basel). .

Abstract

Thyroid incidentalomas detected by 18 fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) are a real challenge for nuclear medicine physicians and clinicians. This study aimed to evaluate the risk of malignancy for patients with focal thyroid incidentalomas (TIs) diagnosed through FDG PET/CT. Data from 6900 patients, with a known primary tumor, who had an FDG PET/CT investigation performed were analyzed for the presence of incidental thyroid uptake. The focal TIs were reported, and the patients were referred for further investigation to the endocrinology department. There were 126 patients (1.82%) who presented with focal thyroid uptake, and for 87 of them, investigations were completed with ultrasonography (US), and for 29 with a fine needle aspiration biopsy (FNAB) procedure. Malignancy was detected in 7.93% (10/126) of cases. An arbitrary cutoff value of four was established for the standard uptake value lean body mass (SUVlbm Max) to differentiate the malignant nodules from the benign ones, and this value was significantly associated with malignancy (p = 0.0168). TIs are not so frequent, but they have a potential malignancy risk, and a proper evaluation is required. Even though SUVlbm Max is a predictive factor for malignancy, the FNAB remains the main diagnostic method for the therapeutic management of these patients.

Keywords: FDG PET/CT; malignancy risk; thyroid incidentalomas.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Types and distribution of primary malignant diseases.
Figure 2
Figure 2
Axial section computed tomography (CT) (A), axial section positron emission tomography (PET) (B), and fusion (C) Fluorine-18 (F18)-18 fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) showing an increased FDG uptake in the multinodular thyroid gland of a patient followed-up with FDG PET/CT for cervix cancer; the histology report after thyroidectomy revealed papillary thyroid carcinoma incidentally identified in PET/CT.
Figure 3
Figure 3
SUVlbm Max distribution.
See this image and copyright information in PMC

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