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Thyroid incidentaloma detected by fluorodeoxyglucose positron emission tomography/computed tomography: practical

Inga-Lena Nilsson¹, Fabian Arnberg, Jan Zedenius

¹Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, 171 77, Sweden. inga-lena.nilsson@ki.se

World Journal of Surgery

|October 13, 2011

Summary

Incidental thyroid lesions on FDG-PET/CT scans indicate a significant risk of thyroid cancer. Further diagnostic workup, including fine-needle aspiration, is recommended for patients who may benefit from thyroidectomy.

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Area of Science:

Nuclear Medicine
Oncology
Endocrinology

Background:

Increasing incidental thyroid findings on FDG-PET/CT necessitate a management algorithm.
FDG-PET/CT is widely used for cancer staging and surveillance.

Purpose of the Study:

To design a practical algorithm for managing incidental thyroid lesions found during FDG-PET/CT scans.
To assess the risk of malignancy in incidentally detected thyroid lesions.

Main Methods:

Retrospective review of 3641 patients undergoing FDG-PET/CT for non-thyroid cancer.
Analysis of focal thyroid FDG uptake, standardized uptake values (SUV), and ratios relative to normal thyroid and liver tissue.

Main Results:

Focal thyroid FDG uptake occurred in 1% of patients (37/3641).
Malignant lesions (papillary thyroid cancer, follicular neoplasia, metastases) were diagnosed in 16 patients.
The ratio of maximum thyroid SUV to mean thyroid SUV ((T)SUV(max)/(thy)SUV(mean)) was significantly higher in malignant lesions and correlated with tumor size.

Conclusions:

Incidental focal FDG uptake in the thyroid carries a significant risk of malignancy.
Ultrasonography-guided fine-needle aspiration and cytology are recommended for further evaluation.
This approach aids in managing incidental thyroid findings and guiding treatment decisions.