Thyroid incidentalomas on 18FDG-PET/CT: a metabolico-pathological correlation.
BACKGROUND
Thyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland. Most recent scientific literature tends to demonstrate a detection rate of 0.1-4.3% for incidental findings of thyroid focal uptake identified by18F-fluorodeoxyglugose Positron Emission Tomography with computed tomography (18FDG-PET/CT) initially prescribed for nonthyroid disease. From 10.3 to 80.0% of patients who underwent further evaluation are diagnosed with malignant lesions. Our first objective is to determine the risk of malignancy confined in thyroid incidentalomas(IT) detected on18FDG-PET/CT in patients treated in a tertiary care center (Centre Hospitalier Universitaire de Sherbrooke). Second, we want to identify a cut-off value for SUVmax in order to distinguish benign from malignant IT. Third, we look for predictive criterion that can be outlined to help in their management.


METHODS
We retrospectively reviewed 40 914 charts of patients who had a18FDG-PET/CT done in a tertiary center from 2004 to 2014. For each patient where a thyroid incidentaloma has been identified, Maximum Standardized Uptake Value (SUVmax), ultrasound report, cytology and histopathological results as well as oncologic outcomes were compiled and analyzed.


RESULTS
In this study, the incidence for thyroid incidentaloma detected with18FDG-PET/CT is 0.74%. The rate of malignancy present in IT is 8.2% based on histopathological results. Of the patients who underwent surgery, thyroid malignancy was identified in 54.3% of them. Cytoponction showed a strong correlation with final histopathological results (p = 0.009).


CONCLUSIONS
Thyroid incidentalomas detected with18FDG-PET/CT are relatively infrequent, but the potential risk of malignancy remains elevated. Fine needle aspiration biopsy is the investigation of choice to rule out a malignant incidentaloma when there is no other element in the clinical portrait to preclude such additional work up.
Division of Otorhinolaryngology and Head & Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada. Nadia.Hagenimana@Usherbrooke.ca.
N
N
Hagenimana
Division of Otorhinolaryngology and Head & Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.
J
J
Dallaire
Department of Nuclear Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
É
É
Vallée
Division of Otorhinolaryngology and Head & Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.
M
M
Belzile
D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
18F-fluorodeoxyglugose Positron Emission Tomography with computed tomography; Algorithm; Malignancy risk; SUV; Thyroid incidentalomas