Incidence and Significance of Incidental Focal Thyroid Uptake on (18)F-FDG PET Study in a Large Patient Cohort: Retrospective Single-Centre Experience in the United Kingdom.
OBJECTIVE
To assess the prevalence and pathological nature of incidental focal thyroid uptake on (18)F-FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) PET (positron emission tomography) and examine the role of the maximum standardised uptake value (SUVmax) to differentiate benign from malignant thyroid pathology.


METHODS
(18)F-FDG PET reports were retrospectively reviewed. Incidental focal tracer uptake in the thyroid was noted in 147 patients (0.5%). Patients with known primary thyroid malignancy were excluded. The final diagnosis was made following ultrasonography of the neck, fine-needle aspiration cytology (FNAC) or histopathology of the surgically resected specimen where surgery was indicated. A Mann-Whitney U test was used to compare the SUVmax of benign and malignant thyroid pathology. Receiver operating characteristic (ROC) analysis was performed to identify an SUVmax cutoff in differentiating benign from malignant pathology.


RESULTS
A final diagnosis was achieved in 47/147 (32%) of the patients. The diagnoses included benign lesions in 36 patients and malignancy in 9 patients. In 2 patients, FNAC demonstrated indeterminate follicular lesions; however, surgical excision was not performed. There was a highly significant difference in the mean SUVmax of malignant focal thyroid uptake (15.7 ± 5.9) compared to that of benign lesions (7.1 ± 6.8) with a p value of 0.000123. An SUVmax of 9.1 achieved a sensitivity of 81.6%, specificity of 100% and area under the curve of 0.915 in the ROC analysis differentiating benign from malignant disease.


CONCLUSIONS
The malignancy potential of incidental focal thyroid uptake remains high and warrants prompt and appropriate follow-up by the clinician. The SUVmax may aid in further characterisation of the lesion and its management.
Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Kanhaiyalal
K
Agrawal
Departments of King's College London, London, UK.
James
J
Weaver
Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK ; Departments of Clinical PET Centre, King's College London, UK.
Fahim
F
Ul-Hassan
Departments of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Jean-Pierre
JP
Jeannon
Departments of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Ricard
R
Simo
Departments of Consultant Endocrinologist, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Paul
P
Carroll
Departments of Consultant Endocrine Surgeon, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Johnathan G
JG
Hubbard
Departments of Histopathology/Cytology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Ashish
A
Chandra
Departments of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK ; Departments of Clinical PET Centre, King's College London, UK.
Hosahalli Krishnamurthy
HK
Mohan
18F-FDG; PET; Thyroid; Uptake