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. 2025 Jul;52(8):2875-2886.
doi: 10.1007/s00259-025-07169-3. Epub 2025 Feb 25.

Enhanced staging of differentiated thyroid carcinoma: integrating [18F]FDG digital PET/CT with neck ultrasound

Arnoldo Piccardo  1   2 , Gianluca Bottoni  3   4 , Giorgio Treglia  5   6   7 , Luca Foppiani  4   8 , Federica Mariani  4   9 , Ugo Catrambone  10 , Beatrice Sambucco  11 , Patrizia Morbini  4   12 , Maurilio Deandrea  13 , Alessio Imperiale  14 , Francesco Fiz  3   4 , Pierpaolo Trimboli  5   15
Affiliations

Enhanced staging of differentiated thyroid carcinoma: integrating [18F]FDG digital PET/CT with neck ultrasound

Arnoldo Piccardo et al. Eur J Nucl Med Mol Imaging. 2025 Jul.

Abstract

Purpose: Accurate initial staging of differentiated thyroid carcinoma (DTC) is paramount to avoid disease persistence or relapses. Neck ultrasound (US) is the gold-standard examination for lymph node staging; however, it might miss the central compartment ones. [18F]FDG PET/CT has been used to characterise unclear or suspicious thyroid nodules and can also identify nodal disease. This study tested the diagnostic efficacy of a combined approach, including digital [18F]FDG PET/CT of the cervical region and neck US in DTC staging.

Methods: We retrospectively evaluated consecutive patients treated at our centre with high-risk thyroid who had had a neck US and a neck digital [18F]FDG PET/CT before surgery and at least one year of follow-up. Diagnostic parameters, including sensitivity (Se) and accuracy (Acc), were compared across US alone, [18F]FDG PET/CT alone, and the combined approach using a patient-based analysis (PBA); Se was also tested employing a lesion analysis (LBA). Clinical and SUV parameters were compared with the histology and the one-year outcome via a logistic regression model.

Results: Eighty-two patients (61 females) were included. At the PBA, the combined approach was superior to US alone regarding Se (44% vs 19%, p < 0.05) and Acc (80% vs 72%, p < 0.05) in the central compartment nodes. At the LBA, the combined approach was superior to either method overall (43%, 37%, and 36% for combined, [18F]FDG, and US, respectively, p < 0.01) and to US in the central nodes (25% vs 14%, p < 0.01). SUVratio was an independent predictor of histologically aggressive DTC variants (p = 0.009), central compartment metastases (p = 0.04), and incomplete response at follow-up (p = 0.004).

Conclusions: The combined cervical [18F]FDG PET/CT / US approach improves the initial staging and harbours valuable prognostic information for DTC patients.

Keywords: PET/CT; Staging; Thyroid; Differentiated thyroid carcinoma; Ultrasound.

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Conflict of interest statement

Declarations. Ethics approval: This study was performed following the principles of the Declaration of Helsinki. The local ethics Committee “Comitato Etico Regionale Liguria” (25/1/2022 No. 73/2022) approved this study. Competing interests: The authors have no relevant financial or non-financial interests to disclose.

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