Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients

Gavriel, Haim; Tang, Adrian; Eviatar, Ephraim; Chan, Sor Way

doi:10.1007/s00405-014-3120-5

Cited by 12 publications

(11 citation statements)

References 17 publications

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“…Our results confirmed data reporting that malignant nodules had higher [ 18 F]FDG uptake (SUV max ) than those resulted benign (Gavriel et al 2015 ; Demir et al 2016 ; Chun et al 2015 ; Kim and Chang 2015 ). However, although SUV max is the conventional PET parameter most used in clinical practice, there are several sources of bias and variability including patients’ status (e.g., blood glucose level, impaired renal function), that affect its measurement (Kinahan and Fletcher 2010 ; Huang 2000 ).…”

Section: Discussionsupporting

confidence: 92%

“…Both SUV max (conventional parameter) and skewness (histogram-based feature) differed significantly in benign and malignant thyroid nodules. In our cohort, we report prevalence of thyroid incidentaloma in line with literature data (2.6% versus 1.2–4.3%) (Rigo et al 1996 ; Mitchell and Parangi 2005 ; Liu et al 2010 ), with a low rate (i.e., < 55% (Gavriel et al 2015 )) of additional workup (ultrasound and cytology available in 19% and 12% of subjects, respectively), but a relatively high rate of malignancy (36%).…”

Section: Discussionsupporting

confidence: 89%

“…These data are in line with a recent meta-analysis which reported a prevalence of thyroid incidentalomas of 1.8% (3659 cases out of 197,296 [ 18 F]FDG-PET/CT examinations), of which a third (36.6%) were evaluated with cytopathology or histopathology (Nayan et al 2014 ). Although the overall incidence of thyroid incidentalomas detected on PET imaging is low, the chance of malignancy among incidentalomas detected by [ 18 F]FDG is higher than incidental nodules discovered with other imaging modalities, with a chance for malignancy ranging from 14 to 59% (Gavriel et al 2015 ; Lee et al 2014 ; Demir et al 2016 ; Chun et al 2015 ; Are et al 2007 ; Pagano et al 2011 ; Cohen et al 2001 ; Nilsson et al 2011 ). Nonetheless, we have a limited understanding of the incidentaloma natural history (Davies et al 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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[18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results

Sollini

Cozzi

Pepe

et al. 2017

European J Hybrid Imaging

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Backgroundsignificance of incidental thyroid 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake on positron emission tomography/computed tomography (PET/CT) scans remains controversial. We aimed to evaluate the ability of [18F]FDG-PET/CT texture analysis to predict final diagnosis in thyroid incidentaloma.MethodsWe retrospectively evaluated medical records of all patients who performed a [18F]FDG-PET/CT from January 2012 to October 2016. Those patients who presented a thyroid incidentaloma described in the medical records and performed a fine needle aspiration in our institution were considered for the analysis. Cytological and/or histological results were used as reference standard to define the final diagnosis. In case of negative cytology, the nodule was considered benign. In case of non-diagnostic or inconclusive results ultrasound, follow-up and further cytology/histology were used as final diagnosis. For suspected or positive cytological result, histology was used as reference standard. PET images were segmented using a General Electric AW workstation running PET VCAR software (GE Healthcare, Waukesha, WI, USA) settled with a threshold of 40% SUVmax. LifeX software (http://www.lifexsoft.org) was used to perform texture analysis. Statistical analysis was performed with R package (https://www.r-project.org).ResultsWe identified 55 patients with incidental thyroid [18F]FDG uptake. Five patients were excluded from the analysis because a final diagnosis was not available. Thirty-two out of 50 patients had benign nodules while in 18/50 cases a malignancy (primary thyroid cancer = 15, metastases = 3) was diagnosed. Conventional PET parameters and histogram-based features were calculated for all 50 patients, while other matrices-based features were available for 28/50 patients. SUVmax and skewness resulted significantly different in benign and malignant nodules (p = 0.01 and = 0.02, respectively). Using ROC analysis, seven features were identified as potential predictors. Among all the textural features tested, skewness showed the best area under the curve (= 0.66). SUV-based parameters resulted in the highest specificity while MTV, TLG, skewness and kurtosis, as well as correlationGLCM resulted better in sensitivity.Conclusions[18F]FDG-PET/CT texture analysis seems to be a promising approach to stratify the patients with thyroid incidentaloma identified on PET scans, with respect to the risk of the diagnosis of a malignant thyroid nodule and thus, could refine the selection of the patients to be referred for cytology.Electronic supplementary materialThe online version of this article (10.1186/s41824-017-0009-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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[18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results

Sollini

Cozzi

Pepe

et al. 2017

European J Hybrid Imaging

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“…In our study, the distribution of FNAB cytology results from different non-thyroid cancers seems to be similar although breast cancer was the most frequent non-thyroid cancer type. The distribution of non-thyroid cancers was different in previous studies (11,18,22,25,26). Indeed, the possible effects of the specific types of the non-thyroid cancer on the malignancy rates of thyroid incidentalomas is not known.…”

Section: Discussioncontrasting

confidence: 55%

Thyroid Malignancy Risk of Incidental Thyroid Nodules in Patients with Non-Thyroid Cancer

et al. 2016

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Context. Thyroid incidentaloma is a common disorder in endocrinology practice. Current literature regarding the risk of thyroid cancer in incidentalomas found in patients with non-thyroid cancer is limited.Objective. The aim of the present study was to investigate the frequency of thyroid malignancy in thyroid incidentalomas detected in patients with non-thyroid cancer.Design. Case control study. Subjects and Methods. The database of 287 thyroid nodules from 161 patients with a history of nonthyroid cancer followed between 2008 and 2014 were retrospectively evaluated.Results. From 287 thyroid nodules, 69.7 % had a benign final cytology. Thyroid cancer detected in one nodule while follicular neoplasia detected in 4 nodules, atypia of unknown significance (AUS) detected in 10 nodules, Hurthle cell neoplasia detected in 5 nodules and suspicious for malignancy detected in 6 nodules according to fine needle aspiration biopsy results. Metastasis of the non-thyroid cancer to the thyroid gland was detected in 4 nodules. Twenty seven nodules from 15 patients were removed with surgery. There were 3 malignant nodules found after surgery (1 papillary, 1 follicular and 1 medullary cancer). In addition to these three thyroid cancers, two patients with benign nodules had co-incidental thyroid cancer detected after surgery. Finally, 11.1 % of thyroid nodules which underwent thyroid surgery had malignant histopathology except for co-incidental and metastatic cancers.Conclusions. The frequency of thyroid malignancy seems not to be substantially increased in incidental thyroid nodules detected in patients with non-thyroid cancer when these patients were evaluated in nodule-based approach.

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“…There are many studies in the literature investigating the clinical significance of thyroidal 18 F-FDG uptake. Overall malignancy rate in an incidentally detected thyroid lesion is in a wide range:13-59% (72) .The pattern of 18 F-FDG uptake is important for evaluation of the etiology of the uptake. Diffuse thyroidal 18 F-FDG uptake has been generally reported to be related to thyroiditis and autoimmune process, and it is seen in about 0.6-3.3% of all 18 F-FDG PET/CT studies (73).…”

Section: Thyroid Incidentalomamentioning

confidence: 99%

18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography for Other Thyroid Cancers: Medullary, Anaplastic, Lymphoma and So Forth

Araz

Çayir²

2017

Mirt

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Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) is used in staging, restaging, and evaluation of therapy response in many cancers as well as differentiated thyroid carcinomas especially in non-iodine avid variants. Its potential in less frequent thyroid tumors like medullary, anaplastic thyroid cancers, thyroid lymphoma and metastatic tumors of the thyroid however, is not well established yet. The aim of this review is to provide an overview on the recent applications and indications of 18F-FDG PET/CT in these tumors and to focus on the controversies in the clinical setting.

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Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients

Cited by 12 publications

References 17 publications

[18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results

[18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results

Thyroid Malignancy Risk of Incidental Thyroid Nodules in Patients with Non-Thyroid Cancer

18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography for Other Thyroid Cancers: Medullary, Anaplastic, Lymphoma and So Forth

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