SUVmax of 18F-FDG PET/CT in the differential diagnosis of benign and malignant thyroid nodules according to tumor volume

Abstract

BackgroundThe aim of this study was to investigate whether the maximum standardized uptake value (SUVmax) measured on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) could be used as the primary means of differential diagnosis of thyroid nodules when tumor volume is assessed.MethodsWe studied 192 patients who underwent preoperative 18F-FDG PET/CT followed by thyroidectomy. We evaluated the correlation between the volume of thyroid nodules, 18F-FDG uptake on visual analysis, and the mean SUVmax measured on 18F-FDG PET/CT.ResultsWhen stratified by tumor volume, the mean SUVmax was higher in malignant than in benign nodules in nodules ≥1 cm3 (p < 0.001). However, it did not differ between benign and malignant nodules smaller than 1 cm3. At a cut-off value of SUVmax of 6, the respective sensitivities of 18F-FDG PET/CT, ultrasonography, and fine needle aspiration cytology were 60.8, 96.4, and 99.1 %, and the respective specificities were 95.9, 98.2, and 96.8 %.Conclusions18F-FDG PET/CT is limited as a primary modality in the differential diagnosis of benign and malignant thyroid nodules because of its low sensitivity.

Valor de la 18F-FDG-PET/CT en la estadificación inicial de pacientes con cáncer de tiroides de moderado/alto riesgo con subtipos histológicos agresivos

“…Un tercio de los hallazgos evaluados son malignos. No se ha identificado un límite adecuado de valor de captación estandarizado (SUV) capaz de distinguir entre lesiones benignas y malignas Kim y col. 26 refieren que las imágenes de la 18 F-FDG PET / CT que muestra el aumento captación de FDG en nódulos con volúmenes ≥ 1 cm y un SUVmáx mayor que 6, la probabilidad de malignidad es muy alta.…”

Differential diagnosis of thyroid nodules through a combination of multiple ultrasonography techniques: A decision‑tree model

“…Medical imaging is critical to the diagnosis of thyroid nodules. However, the limited resolution of cross-sections from computed tomography, magnetic resonance imaging and positron emission tomography provide little useful information for the diagnosis of small nodules (6)(7)(8). Technological advances, including higher resolution and reproducibility, and the advantages associated with the lack of radiation, have pushed US imaging toward the frontline of differential diagnosis.…”

Efficacy of 18F‐fluorodeoxyglucose PET/CT for Detecting Lymph Node Metastasis in Papillary Thyroid Carcinoma

“…It is especially useful in establishing recurrence in patients with elevated serum thyroglobulin and negative radioiodine whole-body scans after total thyroidectomy. 11,12 There have been a few studies analyzing the features and diagnostic value of 18 F-FDG PET/CT in evaluating cervical LN metastasis in PTC, but most of these studies were based on low numbers of patients or contained bias because they were multicenter studies. Also, they set an arbitrary maximum standardized uptake value (SUVmax) of 2.0, which is the general cancer uptake criterion for thyroid nodules themselves.…”

“…In recent years, 18 F‐FDG PET/CT has become widely used to detect primary tumors, occult LN metastasis, and distant metastasis in a variety of malignancies, including thyroid cancer. It is especially useful in establishing recurrence in patients with elevated serum thyroglobulin and negative radioiodine whole‐body scans after total thyroidectomy 11,12 . There have been a few studies analyzing the features and diagnostic value of 18 F‐FDG PET/CT in evaluating cervical LN metastasis in PTC, but most of these studies were based on low numbers of patients or contained bias because they were multicenter studies.…”