Can the Pathology of a Thyroid Nodule Be Determined by Positron Emission Tomography Uptake?

Abstract

All thyroid nodules with focal uptake on (18)F-fluorodeoxyglucose-PET/CT should be considered at higher risk of malignancy than those discovered incidentally by other imaging modalities. Higher SUV(max) values are more indicative of malignant lesions. All lesions should be evaluated with ultrasonography ± fine-needle aspiration if no clinical contraindications exist. Size of the primary nodule does not influence SUV(max) uptake.

Incidence and Significance of Incidental Focal Thyroid Uptake on ¹⁸F-FDG PET Study in a Large Patient Cohort: Retrospective Single-Centre Experience in the United Kingdom

“…Literature evidenceon the SUV max in benign and malignant lesions vary with several reports showing a statistically significant difference [9,13,19,21,22,23,34,41] whilst many others have shown no significant difference [8,14,15,27,30,32,33,35,36]. Previous studies have also reported cutoff SUV values ranging from 3.5 to 5 in differentiated benign to malignant thyroid lesions [24,34,41]. In our study, a highly statistical difference was present between the SUV max of benign and malignant lesions.…”

Thyroid incidentalomas detected on 18F-fluorodeoxyglucose-positron emission tomography/computed tomography: Thyroid Imaging Reporting and Data System (TIRADS) in the diagnosis and management of patients

“…[7][8][9][10][11] Studies of thyroid incidentalomas detected on 18 F-FDG-PET recommend ultrasonography-guided fine needle aspiration (US-FNA) for diagnosis of these thyroid nodules. 3,5,9,10 US features are also useful in evaluating the characteristics of thyroid incidentalomas, among which certain suspicious US features are well known for their accuracy in predicting malignancy in thyroid nodules. [12][13][14] The Thyroid Imaging Reporting and Data System (TIRADS), recently proposed by our group, 14 is a practical and convenient method that uses the number of suspicious US features displayed by the thyroid nodule in the stratification of the risk of malignancy.…”

Is integrated 18F-FDG PET/MRI superior to 18F-FDG PET/CT in the differentiation of incidental tracer uptake in the head and neck area?

“…Although Choi et al (28) found increased focal tracer uptake to be a strong predictor for malignancy, more recent studies showed that also benign nodules show a strong tracer uptake and that the frequency of malignant nodules is lower than initially reported (29). Still, focal asymmetrical 18 F-FDG uptake in the thyroid demands further investigation (25,29,30). Unfortunately, MRI is not superior to CT in the differentiation between benign and malignant thyroid lesions (31).…”