Retrospective Analyses of <sup>18</sup>FDG-PET/CT Thyroid Incidentaloma in Adults: Incidence, Treatment, and Outcome in a Tertiary Cancer Referral Center

Piek, Marceline W; Boer, Jan Paul de; Vriens, Menno R.; Leeuwaarde, Rachel S van; Stokkel, Marcel P. M.; Hartemink, Koen J.; Duijnhoven, Frederieke van; Kessels, Rob; Ploeg, Iris M. C. van der

doi:10.1089/thy.2021.0226

Cited by 7 publications

(2 citation statements)

References 22 publications

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“…Vogsen et al reported a second primary malignancy in 3.8% of high-risk BC patients undergoing FDG-PET/CT. [21]Notably, 10 patients in this study were diagnosed with thyroid cancer, which is a frequently reported incidental finding on FDG-PET/CT scans [ 23 ]. A correlation between BC and thyroid cancer has been reported; thyroid cancer occurs at an incidence of 0.1% among patients with BC [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of non-breast cancer related findings on FDG-PET/CT scan prior to neoadjuvant chemotherapy in patients with breast cancer

van Olmen,

Schrijver,

Stokkel

et al. 2024

Breast Cancer Res Treat

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Purpose Breast cancer (BC) patients undergoing FDG-PET/CT scans for neoadjuvant chemotherapy (NAC) may have additional non-BC related findings. The aim of this study is to describe the clinical implications of these findings. Methods We included BC patients who underwent an FDG-PET/CT scan in our institute between 2011–2020 prior to NAC. We focused on patients with an additional non-BC related finding (i.e. BC metastases were excluded) for which diagnostic work-up was performed. Information about the diagnostic work-up and the clinical consequences was retrospectively gathered. A revision of all FDG-PET/CT scans was conducted by an independent physician to assess the suspicion level of the additional findings. Results Of the 1337 patients who underwent FDG-PET/CT, 202 patients (15%) had an non-BC related additional finding for which diagnostic work-up was conducted, resulting in 318 examinations during the first year. The non-BC related findings were mostly detected in the endocrine region (26%), gastro-intestinal region (16%), or the lungs (15%). Seventeen patients (17/202: 8%, 17/1337: 1.3%) had a second primary malignancy. Only 8 patients (8/202: 4%, 8/1337: 0.6%) had a finding that was considered more prognosis-determining than their BC disease. When revising all FDG-PET/CT scans, 57 (202/57: 28%) of the patients had an additional finding categorized as low suspicious, suggesting no indication for diagnostic work-up. Conclusion FDG-PET/CT scans used for dissemination imaging in BC patients detect a high number of non-BC related additional findings, often clinically irrelevant and causing a large amount of unnecessary work-up. However, in 8% of the patients undergoing diagnostic work-up for an additional finding, a second primary malignancy was detected, warranting diagnostic attention in selected patients.

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Section: Discussionmentioning

confidence: 99%

Clinical implications of non-breast cancer related findings on FDG-PET/CT scan prior to neoadjuvant chemotherapy in patients with breast cancer

van Olmen,

Schrijver,

Stokkel

et al. 2024

Breast Cancer Res Treat

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“…A large retrospective study of 52,693 oncology patients undergoing F18-fluorodeoxyglucose (FDG) PET/CT showed 1003 (1.9%) hypermetabolic thyroid nodules; although only 47 patients ultimately underwent thyroid surgery, 31 (66%) were found have thyroid cancer. However, death was largely related to pre-existing malignancy, with only one due to medullary thyroid cancer [27 ▪▪ ]. A study assessing FDG-avid lymph nodes with TI-RADS showed an overall rate of malignancy of 34%; the majority of FDG-avid thyroid nodules were classified as TR-4 and 5 (71%), which had particularly high rates of malignancy (24–68%) [28].…”

Section: Thyroid Nodule Workup: Thyroid Imaging Reporting and Data Sy...mentioning

confidence: 99%

Advanced imaging and theranostics in thyroid cancer

Roseland

Dewaraja

Wong

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewThyroid cancers are endocrine neoplasms with diverse gene expression and behavior, for which constantly evolving anatomic and functional imaging/theranostic agents have an essential role for diagnosis, staging, and treatment. Recent findingsTo achieve definitive diagnosis, neck ultrasound and associated risk stratification systems, notably Thyroid Imaging Reporting and Data System (TI-RADS), allow improved thyroid nodule characterization and management guidance. Radioactive iodine-131 (RAI) has long played a role in management of differentiated thyroid cancer (DTC), with recent literature emphasizing its effectiveness for intermediate-high risk cancers, exploring use of dosimetry for personalized medicine, and potential for retreatment with RAI following tumor redifferentiation. Iodine-124 positron emission tomography/computed tomography (PET/ CT) has promising application for DTC staging and dosimetry. F18-fluorodeoxyglucose (FDG) PET/CT is used for staging of high risk DTC and identification of noniodine-avid disease recurrences, with metabolic uptake consistently portending poor prognosis. Poorly differentiated and anaplastic thyroid cancers are best assessed with anatomic imaging and F18-FDG PET/ CT, though recent studies show a potential theranostic role for Ga68/Lu177-prostate-specific membrane antigen. Medullary thyroid cancers are evaluated with ultrasound, CT, magnetic resonance imaging, and various positron-emitting radiotracers for PET imaging (F18-DOPA, F18-FDG, and recently Ga68-1,4,7,10-tetraazacyclododecane-1,4,7,10tetraacetic acid (DOTA)--octreotate (DOTATATE)); the latter may enable treatment with Lu177-DOTATATE. SummaryMultidisciplinary collaboration is essential to streamline appropriate management, given the wide array of available imaging and new therapies for metabolic and genetically complex cancers.

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Incidence of PSMA PET thyroid incidentaloma depends on analysis method and tracer

et al. 2023

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Retrospective Analyses of ¹⁸FDG-PET/CT Thyroid Incidentaloma in Adults: Incidence, Treatment, and Outcome in a Tertiary Cancer Referral Center

Cited by 7 publications

References 22 publications

Clinical implications of non-breast cancer related findings on FDG-PET/CT scan prior to neoadjuvant chemotherapy in patients with breast cancer

Clinical implications of non-breast cancer related findings on FDG-PET/CT scan prior to neoadjuvant chemotherapy in patients with breast cancer

Advanced imaging and theranostics in thyroid cancer

Incidence of PSMA PET thyroid incidentaloma depends on analysis method and tracer

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Retrospective Analyses of 18FDG-PET/CT Thyroid Incidentaloma in Adults: Incidence, Treatment, and Outcome in a Tertiary Cancer Referral Center

Cited by 7 publications

References 22 publications

Clinical implications of non-breast cancer related findings on FDG-PET/CT scan prior to neoadjuvant chemotherapy in patients with breast cancer

Clinical implications of non-breast cancer related findings on FDG-PET/CT scan prior to neoadjuvant chemotherapy in patients with breast cancer

Advanced imaging and theranostics in thyroid cancer

Incidence of PSMA PET thyroid incidentaloma depends on analysis method and tracer

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Retrospective Analyses of ¹⁸FDG-PET/CT Thyroid Incidentaloma in Adults: Incidence, Treatment, and Outcome in a Tertiary Cancer Referral Center