Positron emission tomography‐positive thyroid nodules: rate of malignancy and histological features

Flukes, Stephanie; Lenzo, Nat; Moschilla, Girolamo; Sader, Chady

doi:10.1111/ans.12834

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…Because the precise risk for disease progression is not well established in BRAF V600E -positive (24), fluorodeoxyglucose (FDG)-positive PMCs (25,26), or patients with other potentially aggressive molecular phenotypes (27), they were included in the appropriate candidate category until further studies provide a basis for making them either ideal or inappropriate candidates. At this time, molecular characterization of the tumors is not required prior to an active surveillance management approach.…”

Section: Rationale For Classification As An Appropriate Candidate Formentioning

confidence: 99%

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma

Brito

Ito

Miyauchi

et al. 2016

Thyroid

276

261

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Section: Rationale For Classification As An Appropriate Candidate Formentioning

confidence: 99%

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma

Brito

Ito

Miyauchi

et al. 2016

Thyroid

276

261

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“…Also in patients with the clinical risk factors mentioned in Table 1 and with the high pretest likelihood for thyroid cancer associated with these features, FNA at sizes lower than those recommended can be considered [1, 13]. PET positive nodules have a higher incidence of malignancy ~40–45 % and FNA is recommended in nodules > 1 cm [1, 57, 58]. …”

Section: Diagnosis and Evaluation Of Thyroid Nodulesmentioning

confidence: 99%

Thyroid nodule update on diagnosis and management

Tamhane

Gharib

2016

Clin Diabetes Endocrinol

119

109

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Thyroid nodules are common. The clinical importance of thyroid nodules is related to excluding malignancy (4.0 to 6.5% of all thyroid nodules), evaluate their functional status and assess for the presence of pressure symptoms. Incidental thyroid nodules are being diagnosed with increasing frequency in the recent years with the use of newer and highly sensitive imaging techniques. The high prevalence of thyroid nodules necessitates that the clinicians use evidence-based approaches for their assessment and management. New molecular tests have been developed to help with evaluation of malignancy in thyroid nodules. This review addresses advances in thyroid nodule evaluation, and their management considering the current guidelines and supporting evidence.

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“…In the index test domain, 16 studies were classified as being of unclear risk of bias as it was not described how 18 F-FDG PET/CTs were assessed ( 24 , 30 , 32 , 35 , 39 , 45 , 47 , 51 , 52 , 61 , 65 , 66 , 73 – 75 , 79 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the patient flow domain, 27 studies were classified as high risk because not all included patients received FNAC and/or surgery ( 24 , 26 , 27 , 30 , 31 , 33 , 34 , 37 , 39 , 41 , 45 , 47 , 48 , 50 , 52 , 55 , 56 , 59 , 61 , 63 , 64 , 67 , 70 , 71 , 73 , 81 , 82 ). Another 8 studies were considered to have a high risk of bias because FNACs were performed only after suspicious US ( 25 , 40 , 44 , 51 , 62 , 66 , 72 , 77 ).…”

Section: Resultsmentioning

confidence: 99%

Focal Thyroid Incidentalomas on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration

et al. 2021

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BackgroundThe rising demand for 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) has led to an increase of thyroid incidentalomas. Current guidelines are restricted in giving options to tailor diagnostics and to suit the individual patient.ObjectivesWe aimed at exploring the extent of potential overdiagnostics by performing a systematic review and meta-analysis of the literature on the prevalence, the risk of malignancy (ROM) and the risk of inconclusive FNAC (ROIF) of focal thyroid incidentalomas (FTI) on 18F-FDG PET/CT.Data SourcesA literature search in MEDLINE, Embase and Web of Science was performed to identify relevant studies.Study SelectionStudies providing information on the prevalence and/or ROM of FTI on 18F-FDG PET/CT in patients with no prior history of thyroid disease were selected by two authors independently. Sixty-one studies met the inclusion criteria.Data AnalysisA random effects meta-analysis on prevalence, ROM and ROIF with 95% confidence intervals (CIs) was performed. Heterogeneity and publication bias were tested. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool.Data SynthesisFifty studies were suitable for prevalence analysis. In total, 12,943 FTI were identified in 640,616 patients. The pooled prevalence was 2.22% (95% CI = 1.90% - 2.54%, I2 = 99%). 5151 FTI had cyto- or histopathology results available. The pooled ROM was 30.8% (95% CI = 28.1% - 33.4%, I2 = 57%). 1308 (83%) of malignant nodules were papillary thyroid carcinoma (PTC). The pooled ROIF was 20.8% (95% CI = 13.7% - 27.9%, I2 = 92%).LimitationsThe main limitations were the low to moderate methodological quality of the studies and the moderate to high heterogeneity of the results.ConclusionFTI are a common finding on 18F-FDG PET/CTs. Nodules are malignant in approximately one third of the cases, with the majority being PTC. Cytology results are non-diagnostic or indeterminate in one fifth of FNACs. These findings reveal the potential risk of overdiagnostics of FTI and emphasize that the workup of FTI should be performed within the context of the patient’s disease and that guidelines should adopt this patient tailored approach.

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Positron emission tomography‐positive thyroid nodules: rate of malignancy and histological features

Abstract: Our data indicate that PET-positive thyroid nodules are associated with a high incidence of malignancy. This finding provides strong support for further investigation including FNA biopsy in all surgically suitable patients.

Cited by 9 publications

References 26 publications

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma

Thyroid nodule update on diagnosis and management

Focal Thyroid Incidentalomas on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration

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