Could 18F-FDG-PET/CT avoid unnecessary thyroidectomies in patients with cytological diagnosis of follicular neoplasm?

Pérez, Nuria Muñoz; Moral, Jesús María Villar del; Fuentes, M.A. Muros de; Torre, Martín López de la; Martínez, Juan Ignacio Arcelus; Massare, Patricia Becerra; Martínez, Dobón; Cañadas-Garre, Marisa; Rey, E. Coll Del; Laraño, P. Bueno; Orihuela, José Antonio Ferrón

doi:10.1007/s00423-013-1070-9

Cited by 20 publications

(14 citation statements)

References 36 publications

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“…The formers were due to small-sized thyroid nodules or incidental thyroid carcinomas. It is common knowledge that the performance of 18 F-FDG PET/CT is influenced by the size of the target lesion [34,37,41]. Also, microcarcinomas incidentally identified postoperatively, especially if distant from the assessed thyroid nodule, should have been excluded from data analysis.…”

Section: Discussionmentioning

confidence: 99%

“…After removal of 113 duplicates, 673 articles were analyzed for title and abstract; 634 records were excluded (guidelines, reviews, meta-analyses, case reports, imaging modalities other than PET/CT (e.g., elastography), tracers other than FDG (e.g., choline), thyroid disease other than thyroid nodule with indeterminate FNA (e.g., thyroid carcinoma, non-diagnostic cytology), not within the field of the review, studies not in humans. The remaining 39 papers were retrieved in full-text and 8 articles were finally included in the systematic review ( Figure 1) [34][35][36][37][38][39][40][41]. No article was added after screening the references of these papers.…”

Section: Literature Searchmentioning

confidence: 99%

“…Overall, the most important finding is the moderate capacity of this method in discriminating between malignant and benign thyroid nodules with indeterminate FNA, according to the pooled DOR value. [35], Merten [38], Mitchell [34], Muñoz Pérez [37], Nguyen [41], Pathak [39], Piccardo [40]. [35], Merten [38], Mitchell [34], Muñoz Pérez [37], Nguyen [41], Pathak [39], Piccardo [40].…”

Section: Quantitative Analysis (Meta-analysis)mentioning

confidence: 99%

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Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis

Castellana

Trimboli

Piccardo

et al. 2019

JCM

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Thyroid nodules with indeterminate fine-needle aspiration cytology (FNA) represent a major challenge in clinical practice. We conducted a systematic review and meta-analysis evaluating the ability of hybrid imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to appropriately select these nodules for surgery. PubMed, CENTRAL, Scopus, and Web of Science were searched until July 2019. Original articles reporting data on the performance of 18F-FDG PET/CT in thyroid nodules with indeterminate FNA were included. Summary operating points including 95% confidence interval values (95% CI) were estimated using a random-effects model. Out of 786 retrieved papers, eight studies evaluating 104 malignant and 327 benign thyroid nodules were included. The pooled positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of 18F-FDG PET/CT were 1.7 (95% CI: 1.4–2.0), 0.4 (95% CI: 0.2–0.7), and 3.5 (95% CI: 1.7–7.1), respectively. No heterogeneity was found for LR+ and DOR. In patients with thyroid nodules with indeterminate FNA, 18F-FDG PET/CT has a moderate ability to correctly discriminate malignant from benign lesions and could represent a reliable option to reduce unnecessary diagnostic surgeries. However, further studies using standardized criteria for interpretation are needed to confirm the reproducibility of these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Quantitative Analysis (Meta-analysis)mentioning

confidence: 99%

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Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis

Castellana

Trimboli

Piccardo

et al. 2019

JCM

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“…Various studies have considered different criteria for PET positivity; ranging from any focal increased uptake in the region of the thyroid nodule above background [11], [12], [17], [18] to different SUVmax cut-offs ranging from 2 to 7 [13], [15], [20], [21]. However, some studies did not find a SUVmax cut-off to be a definite predictor for malignancy [22].…”

Section: Discussionmentioning

confidence: 99%

A prospective cohort study to assess the role of FDG-PET in differentiating benign and malignant follicular neoplasms

Pathak

Goertzen

Nason

et al. 2016

Annals of Medicine &Amp; Surgery

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BackgroundFollicular and Hürthle cell neoplasms are diagnostic challenges. This prospective study was designed to evaluate the efficacy of [18F]-2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the risk of malignancy in follicular/Hürthle cell neoplasms.Materials and methodsFifty thyroid nodules showing follicular/Hürthle cell neoplasm on prior ultrasonography guided fine needle aspiration cytology (FNAC) were recruited into this study. A FDG-PET/CT scan, performed for neck and superior mediastinum, was reported by a single observer, blinded to the surgical and pathology findings. Receiver operating characteristic (ROC) curve analysis of maximum standardized uptake value (SUVmax) and the area under the curve (AUROC) were used to assess discrimination between benign from malignant nodules. Youden index was used to identify the optimal cut-off SUVmax for diagnosing malignancy. Sensitivity, specificity, predictive values and overall accuracy were used as measures of performance.ResultsOur study group comprises of 31 benign and 19 malignant thyroid nodules. After excluding all Hürthle cell adenomas, the AUROC for discriminating benign and malignant non-Hürthle cell neoplasms was 0.79 (95% CI, 0.64–0.94; p = 0.001); with SUVmax of 3.25 as the best cut-off for the purpose. PET/CT had sensitivity of 79% (95% CI, 54–93%), specificity of 83% (95% CI, 60–94%), positive predictive value (PPV) of 79% (95% CI, 54–93%), and negative predictive value (NPV) of 83% (95% CI, 60–94%). The overall accuracy was 81%.ConclusionsFDG-PET/CT can help in differentiating benign and malignant non-Hürthle cell neoplasms. SUVmax of 3.25 was found to be the best for identifying malignant non-Hürthle cell follicular neoplasms.

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“…Preoperative positron emission tomography-computed tomography or ultrasonography of cytologically indeterminate thyroid nodules could provide reliable information and help in thyroidectomy decision making [81,82,83,84]. Other promising methods such as tissue high-resolution proton magnetic resonance and 99m Tc-methoxyisobutylisonitrile thyroid scintigraphy in thyroid FNA were recently introduced [85,86].…”

Section: The Potential Of Diagnostic and Prognostic Improvement In Aumentioning

confidence: 99%

Thyroid Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: An Indispensable Bethesda 2010 Diagnostic Category or Waste Garbage?

Kholová

Ludvíková²

2014

Acta Cytologica

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Objective: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) was introduced in thyroid cytology in 2007 and is now generally accepted. BSRTC categories include a morphologic description and risk of malignancy as well as follow-up suggestions in each group. However, the category entitled ‘atypia of undetermined significance or follicular lesion of undetermined significance' (AUS/FLUS) is problematic. This category is heterogeneous and has been overused so far. Study Design: Twenty-six studies were included in a meta-analysis. In addition to AUS/FLUS percentage, we analysed repeated AUS/FLUS percentage, cytological and histological correlations, and risk of malignancy and neoplasm for AUS/FLUS. Furthermore, stratification, inter- and intra-observer variability, and the possibility of a switch to another category and its clinical consequences were reviewed. Results: Out of a total of 81,833 cases, AUS/FLUS accounted for 10.9%, with a 34% risk of malignancy. Persistent AUS/FLUS was found in 21.6% in repeated cytology. Cytohistological correlation was analysed from 16 studies (4,964 cases), revealing 10.4% as AUS/FLUS and a 21.5% risk of malignancy. Conclusions: An AUS/FLUS category seems to be currently reasonable with clearly defined cytomorphological criteria which do not correspond unequivocally with those of the other categories. An AUS/FLUS category is justified and possible means of its improvement with immunohistochemistry, molecular analysis and imaging are discussed.

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Could 18F-FDG-PET/CT avoid unnecessary thyroidectomies in patients with cytological diagnosis of follicular neoplasm?

Abstract: (18)F-FDG-PET/CT can play a role in the management of thyroid nodules larger than 2 cm cytologically reported as follicular neoplasm without oncocytic differentiation, allowing the avoidance of a significant number of thyroidectomies for definitive benign lesions.

Cited by 20 publications

References 36 publications

Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis

Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis

A prospective cohort study to assess the role of FDG-PET in differentiating benign and malignant follicular neoplasms

Thyroid Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance: An Indispensable Bethesda 2010 Diagnostic Category or Waste Garbage?

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