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Risk Stratification of Thyroid Incidentalomas Found on PET/CT: The Value of Iodine Content on Noncontrast Computed Tomography

 Kim Dongwoo  ;  Hwang Sang Hyun  ;  Yun Mijin  ;  Lee Narae  ;  Jo Kwanhyeong  ;  Cha Jongtae 
 THYROID, Vol.25(11) : 1249-1254, 2015 
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Adult ; Aged ; Aged, 80 and over ; Female ; Fluorodeoxyglucose F18 ; Humans ; Incidental Findings* ; Male ; Middle Aged ; Retrospective Studies ; Risk ; Risk Assessment ; Sensitivity and Specificity ; Thyroid Gland/diagnostic imaging* ; Thyroid Neoplasms/diagnostic imaging* ; Tomography, X-Ray Computed
BACKGROUND: The Hounsfield unit (HU) ratio of thyroid nodules was assessed compared to the contralateral thyroid lobe on noncontrast computed tomography (CT) to stratify further the risk of malignancy in thyroid incidentalomas found on (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/CT (PET/CT). METHODS: This retrospective analysis included 82 patients who had thyroid incidentalomas on PET/CT in 2011. On PET/CT, the maximal standardized uptake value ratios of the thyroid nodule compared to liver (T/BSUV) and the HU ratios of the thyroid nodule compared to contralateral thyroid lobe (T/BHU) were calculated. Diagnostic performances of the T/BSUV and T/BHU were compared. RESULTS: The area under the curve of T/BHU was higher than that of T/BSUV (0.941 vs. 0.689, p < 0.0001). The sensitivity, specificity, and accuracy of T/BHU were significantly higher than those of T/BSUV (100% vs. 77.8%, p = 0.0313; 80.0% vs. 60.0%, p = 0.0433; 86.6% vs. 65.9%, p = 0.0041, respectively). The risk of malignancy was much higher (71.1%) in nodules with a T/BHU cutoff value ≤0.68, whereas it was 0% in nodules with a T/BHU of >0.68. In this study, there were 18 nodules with nondiagnostic (n = 7) or atypia of undetermined significance or follicular lesion of undetermined significance cytologies (n = 11) after fine-needle aspiration biopsy (FNAB). When the T/BHU cutoff value was applied, three (60%) of the five nodules with a T/BHU of ≤0.68 were found to be papillary carcinomas. The remaining 13 nodules with a T/BHU of >0.68 were all benign with a risk of malignancy of 0%. CONCLUSIONS: T/BHU is a simple and effective parameter to stratify the risk of malignancy in thyroid incidentalomas found on PET/CT. This may be of clinical relevance in those nodules with nondiagnostic or undetermined significance cytologies upon FNAB in the scheme of current clinical practice.
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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dongwoo(김동우) ORCID logo https://orcid.org/0000-0002-1723-604X
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Na Rae(이나래)
Cha, Jongtae(차종태)
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