title: Predictive value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodules according to Bethesda categories of fine needle aspiration biopsy results.
abstract: The current study was aimed to investigate the clinical value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodule (TN) with inconclusive fine-needle aspiration biopsy (FNAB) results. The current study enrolled 200 patients who showed F-18 FDG incidentaloma and were performed FNAB. The intratumoral heterogeneity of F-18 FDG uptake was represented as the heterogeneity factor (HF), defined as the derivative (dV/dT) of a volume-threshold function for a primary tumor. The diagnostic and predictive values of HF and F-18 FDG PET/CT parameters were evaluated for characterization of inconclusive FNAB results. Among F-18 FDG PET/CT parameters, SUVmax, MTV, and TLG of malignant group were statistically higher than those of Bethesda category of suspicious malignant group. However, HF values were not statistically different between the groups of Bethesda categories (Kruskal-Wallis statistics, 9.924; p = 0.0774). In ROC analysis, when HF > 2.751 was used as cut-off value, the sensitivity and specificity for prediction of malignant TN were 100 % (95 % CI 69.2-100 %) and 60 % (95 % CI 42.1-76.1 %), respectively. The AUC was 0.826 (95 % CI 0.684-0.922) and standard error was 0.0648 (p < 0.0001). In conclusion, the intratumoral heterogeneity of F-18 FDG uptake represented by HF could be a predictor for characterization of TN with inconclusive FNAB results. Additional large population-based prospective studies are needed to validate the diagnostic utility of HF of F-18 FDG PET/CT.
authors.affiliation: Department of Nuclear Medicine, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea. growthkim@daum.net.|Biomedical Research Institute, Pusan National University Hospital, Busan, 602-739, Republic of Korea. growthkim@daum.net.
authors.forename: Seong-Jang
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, University of Colorado School of Medicine, 12401, 17th Ave, Aurora, CO, 80045, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Chang
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D002291:Carcinoma, Papillary; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: F-18 FDG PET/CT; FNAB; Inconclusive; Thyroid nodule