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A Risk-Adapted Approach Using US Features and FNA Results in the Management of Thyroid Incidentalomas Identified by 18F-FDG PET

 J. S. Choi  ;  Y.- J. Choi  ;  E. K. Kim  ;  J. H. Yoon  ;  J. H. Youk  ;  K. H. Han  ;  H. J. Moon  ;  W. J. Kang  ;  J. Y. Kwak 
 ULTRASCHALL IN DER MEDIZIN, Vol.35(1) : 51-58, 2014 
Journal Title
Issue Date
Adenocarcinoma, Follicular/diagnostic imaging ; Adenocarcinoma, Follicular/pathology ; Age Factors ; Aged ; Algorithms ; Biomarkers, Tumor/blood ; Biopsy, Fine-Needle* ; Diagnosis, Differential ; Early Detection of Cancer ; Female ; Fluorodeoxyglucose F18* ; Humans ; Incidental Findings* ; Male ; Middle Aged ; Neoplasm Recurrence, Local/diagnostic imaging ; Neoplasm Recurrence, Local/pathology ; Neoplasms, Second Primary/diagnostic imaging ; Neoplasms, Second Primary/pathology ; Positron-Emission Tomography* ; Risk Adjustment* ; Risk Factors ; Sensitivity and Specificity ; Sex Factors ; Thyroid Gland/diagnostic imaging* ; Thyroid Gland/pathology* ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Neoplasms/pathology* ; Thyroid Nodule/diagnostic imaging ; Thyroid Nodule/pathology ; Tomography, X-Ray Computed* ; Tumor Burden ; Ultrasonography
thyroid incidentaloma ; ultrasound ; PET-CT ; PET ; fine-needle aspiration
Purpose: To assess the risk of malignancy of thyroid incidentalomas found on 18F-FDG PET/CT by US features and cytologic results, and to evaluate the clinical usage of a combination of US features and cytology for post-FNA management of thyroid incidentalomas on 18F-FDG PET/CT.

Materials and Methods: From September 2006 to December 2008, 132 patients with 134 thyroid incidentalomas detected on 18F-FDG PET/CT who had undergone US and US-FNA were included in this study. We evaluated the malignancy rate of thyroid incidentalomas in different subgroups subdivided by US features and US-FNA cytology results. Several variables were compared between the benign and malignant group.

Results: The risk of malignancy was 58.2 % (78/132) in thyroid incidentalomas on 18F-FDG PET/CT. Age, gender, and tumor size were not significantly different between the malignant and benign group. Malignancy rate of thyroid incidentalomas was significantly higher in the suspicious malignant (88.9 %) than in the probably benign group (11.3 %) on US (p < 0.001). Malignancy rates were high in thyroid nodules with “malignancy”, “suspicious for malignancy”, or “follicular neoplasm” on cytologic results, regardless of US features. However, malignancy rates of thyroid incidentalomas with “unsatisfactory” or “benign” results on cytology were higher in the suspicious malignant (75 %, 12.5 %, respectively) than in the probably benign (0 %) group on US. 

Conclusions: This study demonstrated that the risk of malignancy was high in thyroid incidentalomas on 18F-FDG PET/CT even without suspicious US features. However, there was no malignancy in nodules with no suspicious US features and benign cytology. Based on these results, we concluded that US may not replace FNA in the diagnosis of PET incidentalomas, and that a follow-up may be considered of thyroid incidentalomas with benign cytology and no suspicious US features.
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1. College of Medicine (의과대학) > Research Institute (부설연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Won Jun(강원준) ORCID logo https://orcid.org/0000-0002-2107-8160
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Youk, Ji Hyun(육지현) ORCID logo https://orcid.org/0000-0002-7787-780X
Yoon, Jung Hyun(윤정현) ORCID logo https://orcid.org/0000-0002-2100-3513
Han, Kyung Hwa(한경화)
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