Cytological evaluation by fine needle aspiration biopsy of incidental focal increased fluorodeoxyglucose uptake in thyroid on positron emission tomography scan

Li, Yanchun; Cui, Min; Azar, Nami; Nakamoto, Dean A.; Michael, Claire W.

doi:10.1002/dc.23695

Cited by 6 publications

(13 citation statements)

References 27 publications

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“…8 A study of >10,000 FDG PET/CT scans showed a rate of 1.7% incidental thyroid findings and a 33% malignant rate of these findings, agreeing with our findings, while a study of 20 thyroid incidentalomas showed a malignancy rate of 50%. 9,10 Of 12 lung findings, 2 (16.7%) were also ultimately malignant. This agrees with the 4% to 15% quoted in the literature.…”

Section: Discussionmentioning

confidence: 99%

Incidental Findings on FDG PET/CT in Head and Neck Cancer

Britt

Maas

Kennedy

et al. 2017

Otolaryngol.--head neck surg.

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Objective 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) imaging is common in head and neck cancer and often identifies incidental findings that necessitate additional patient evaluations. Our goal was to assess the frequency and nature of these incidental imaging findings on FDG-PET/CT. Study Design Retrospective cohort study. Setting Tertiary medical center. Subjects and Methods All patients with head and neck cancer who had undergone FDG-PET/CT imaging between January 2014 and June 2015 at our institution were evaluated for incidental findings. Results A total of 293 patients met criteria; more than one-third (n = 103) had at least 1 finding unrelated to their head and neck cancer, for a total of 134 incidental findings. Incidental findings within the head and neck (33.5% of all) excluding the thyroid were most common: 35% incidental findings were concerning for malignancy; of these, 25.5% were malignant with further workup. Recommendations were given by the head and neck radiologist on 72 (53.7%) findings: 74.5% of potentially malignant findings and 42.5% of benign findings had recommendations for follow-up. Significantly more patients with findings described as malignant were given recommendations for follow-up ( P = .0004). Conclusion Incidental findings on FDG-PET/CT are present in more than one-third of patients with head and neck cancer. More than one-third of incidental findings were concerning for malignancy. This study illustrates how the incidental findings discovered on FDG PET/CT frequently necessitate additional evaluations unrelated to the index head and neck cancer. The impact of these additional assessments on the cost and quality of health care warrants future evaluation.

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Section: Discussionmentioning

confidence: 99%

Incidental Findings on FDG PET/CT in Head and Neck Cancer

Britt

Maas

Kennedy

et al. 2017

Otolaryngol.--head neck surg.

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“…Due to the widespread use of ultrasound as well as the increasing number of imaging studies performed for reasons other than planned assessment of the thyroid gland (i.e., computed tomography of the chest or cervical spine, magnetic resonance imaging of the cervical spine, and whole-body positron emission tomography), incidental thyroid nodules (TNs) ≤ 10 mm are now common findings [1][2][3][4][5]. The characterization of TNs has improved because of better ultrasound image resolution and the introduction of new diagnostic ultrasound tools such as elastography [6].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

Schenke

Klett²,

Seifert

et al. 2020

JCM

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Due to the widespread use of ultrasound, small thyroid nodules (TNs) ≤ 10 mm are common findings. Standardized approaches for the risk stratification of TNs with Thyroid Imaging Reporting and Data Systems (TIRADS) were evaluated for the clinical routine. With TIRADS, the risk of malignancy in TNs is calculated by scoring the number or combination of suspicious ultrasound features, leading to recommendations for further diagnostic steps. However, there are only scarce data on the performance of TIRADS for small TNs. The aim was to compare three different TIRADS for risk stratification of small TNs in routine clinical practice. We conducted a retrospective cohort analysis of TNs ≤ 10 mm and their available histology. Nodules were classified according to three different TIRADS. In the study, 140 patients (n = 113 female) with 145 thyroid nodules (n = 76 malignant) were included. Most of the malignant nodules were papillary carcinoma (97%), and the remaining 3% were medullary carcinoma. For all tested TIRADS, the prevalence of malignancy rose with increasing category levels. The highest negative predictive value was found for ACR TI-RADS and the highest positive predictive value for Kwak-TIRADS. All tested variants of TIRADS showed comparable diagnostic performance for the risk stratification of small TNs. TIRADS seems to be a promising tool to reliably assess the risk of malignancy of small TNs.

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“…All studies but one [ 29 ] were reported in the English language. Nine studies were performed by Asian/Eastern [ 17 – 20 , 22 – 24 , 27 , 31 ] and six by Western [ 21 , 25 , 26 , 28 – 30 ] authors. They were single-center or observational cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence in the BETHESDA subcategories was substantially unchanged (I 12%, II 47%, III 6%, IV 4%, V 6%, and VI 21%) and the inconsistency remained high (detailed data not shown). A second analysis was performed considering separately the nine studies from Asian/Eastern countries [ 17 – 20 , 22 – 24 , 27 , 31 ] and the six studies from Western authors [ 21 , 25 , 26 , 28 – 30 ] as shown in Table 4 . There was a significantly different prevalence in the BETHESDA category IV between Asian/Eastern and Western studies.…”

Section: Resultsmentioning

confidence: 99%

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The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis

et al. 2021

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Purpose 18F-FDG thyroid incidentaloma (TI) occurs in ~2% of PET/CT examinations with a cancer prevalence of up to 35–40%. Guidelines recommend fine-needle aspiration cytology (FNA) if a focal 18F-FDG TI corresponds to a sonographic nodule >1 cm. The aim of this systematic review and meta-analysis was to provide evidence-based data on the diagnostic distribution of 18F-FDG TIs in the six Bethesda systems for reporting thyroid cytopathology (BETHESDA) subcategories. Methods Original studies reporting 18F-FDG TIs and cytologically classified according to BETHESDA were included. Six separate meta-analyses were performed to obtain the pooled prevalence (95% confidence interval, 95% CI) of 18F-FDG TIs in the six BETHESDA subcategories. Results Fifteen studies were finally included. Nine studies were from Asian/Eastern and six from Western countries. FNA data according to BETHESDA was available in 2304 cases. The pooled prevalence of 18F-FDG TIs according to BETHESDA was BETHESDA I 10% (6–14), BETHESDA II 45% (37–53), BETHESDA III 8% (3–13), BETHESDA IV 8% (5–12), BETHESDA V 6% (4–9), BETHESDA VI 19% (13–25). A significantly different prevalence was found in the BETHESDA IV between Asian/Eastern (2%) and Western (19%) studies. Conclusion Two-thirds of focal 18F-FDG TIs undergoing FNA have either malignant (BETHESDA VI) or benign (BETHESDA II) cytology while a minority will have indeterminate (BETHESDA III or IV) FNA results. Significant differences between Asian/Eastern and Western studies are also present in the prevalence of indeterminate FNA results.

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Cytological evaluation by fine needle aspiration biopsy of incidental focal increased fluorodeoxyglucose uptake in thyroid on positron emission tomography scan

Abstract: Malignancy was identified in 50% of the PET-positive incidentalomas in our series. PTC constitutes the major malignant diagnosis. No diagnostic value of SUV was observed to differentiate malignant from benign lesions. Diagn. Cytopathol. 2017;45:501-506. © 2017 Wiley Periodicals, Inc.

Cited by 6 publications

References 27 publications

Incidental Findings on FDG PET/CT in Head and Neck Cancer

Incidental Findings on FDG PET/CT in Head and Neck Cancer

Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm)

The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis

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