Although ultrasound (US)-guided fine needle aspiration biopsy (FNAB) is widely prescribed in nonpalpable thyroid nodules, the goal of this study was to define precisely the indications and limits of US-FNAB in a series of 450 nonpalpable nodules. Among 94 surgically controlled cases, 20 (8 infracentimetric and 12 centimetric or supracentimetric) carcinomas were diagnosed. The diagnosis of malignancy was successfully made by US-FNAB in 16 of 20 carcinomas, 3 were missed because of insufficient cytological material, and 1 was misdiagnosed. US-FNAB sensitivity and specificity were 94% and 63%, respectively. A logistic model indicated that nodule size (P < 0.6) was not associated with histological diagnosis, but that solid hypoechoic features were more likely to be malignant (P < 0.0003), with US sensitivity and specificity for malignancy of 80% and 70%, respectively. Logistic regression indicated that adequate cytological material significantly increased with nodule size (P < 0.0001). This result outlined the limits of US-FNAB in small nodules. Hence, indication of US-FNAB appears judicious in centimetric or supracentimetric nodules or in solid and hypoechoic ones. Such a management would allow the discovery of 15 of 20 carcinomas and would avoid 16% of unnecessary biopsies.

Background To evaluate FCH‐PET/CT and parathyroid 4D‐CT so as to guide surgery in patients with primary hyperparathyroidism (pHPT) and prior neck surgery. Methods Medical records of all patients referred for a FCH‐PET/CT in our institution were systematically reviewed. Only patients with pHPT, a history of neck surgery (for pHPT or another reason) and an indication of reoperation were included. All patients had parathyroid ultrasound (US) and Tc‐99m‐sestaMIBI scintigraphy, and furthermore, some patients had 4D‐CT. Gold standard was defined by pathological findings and/or US‐guided fine‐needle aspiration with PTH level measurement in the washing liquid. Results Twenty‐nine patients were included in this retrospective study. FCH‐PET/CT identified 34 abnormal foci including 19 ectopic localizations. 4D‐CT, performed in 20 patients, detected 11 abnormal glands at first reading and 6 more under FCH‐PET/CT guidance. US and Tc‐99m‐sestaMIBI found concordant foci in 8/29 patients. Gold standard was obtained for 32 abnormal FCH‐PET/CT foci in 27 patients. On a per‐lesion analysis, sensitivity, specificity, positive and negative predictive values were, respectively, 96%, 13%, 77% and 50% for FCH‐PET/CT, 75%, 40%, 80% and 33% for 4D‐CT. On a per‐patient analysis, sensitivity was 85% for FCH‐PET/CT and 63% for 4D‐CT. FCH‐PET/CT results made it possible to successfully remove an abnormal gland in 21 patients, including 12 with a negative or discordant US/Tc‐99m‐sestaMIBI scintigraphy result, with a global cure rate of 73%. Conclusion FCH‐PET/CT is a promising tool in the challenging population of reoperative patients with pHPT. Parathyroid 4D‐CT appears as a confirmatory imaging modality.

A combination of the available diagnostic methods provides substantial benefit in the preoperative selection of patients with an isolated thyroid nodule.

Background Primary hyperparathyroidism (HPT1) is the most frequent endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Its surgical management is challenging. We aimed to describe and compare the imaging findings of parathyroid ultrasound (US), sestaMIBI scintigraphy (sestaMIBI), and 18F‐fluorocholine (FCH) PET/CT in a series of MEN1 patients with HPT1. Methods Retrospective analysis of a cohort of MEN1 patients with HPT1 assessed by parathyroid US, sestaMIBI scintigraphy and SPECT/CT, and FCH‐PET/CT for potential surgery between 2015 and 2019. Results Twenty‐two patients with a confirmed diagnosis of MEN1 who presented with HPT1 and were assessed by the 3 imaging modalities were included. After imaging workups, 11 patients were operated on for the first time, 4 underwent a redo surgery, and 7 did not undergo an operation. The overall patient‐based positivity rate of imaging was 91% (20 of 22) for parathyroid US and 96% (21 of 22) for both sestaMIBI and FCH‐PET/CT. The 3 imaging modalities demonstrated negative findings in 1/22 patient who did not undergo surgery. Overall, 3 pathologic glands were not detected by any imaging technique. SestaMIBI and FCH‐PET/CT both resulted in the same 3 false‐positive results in ectopic areas with a significant uptake on two thymic carcinoid tumors and one inflammatory lymph node. FCH‐PET/CT provided more surgically relevant data than sestaMIBI in 4/11 patients with initial surgery and in 1/4 patient who underwent redo surgery. Conclusions Compared to sestaMIBI scintigraphy, FCH‐PET/CT provides additional information regarding the number of pathologic parathyroid glands and their localization in MEN1 patients with HPT1.