Fine‐needle aspiration in all thyroid incidentalomas at <sup>18</sup>F‐<scp>FDG PET</scp>/<scp>CT</scp>: Can <scp>EU</scp>‐<scp>TIRADS</scp> revise the dogma?

Trimboli, Pierpaolo; Paone, Gaetano; Treglia, Giorgio; Virili, Camilla; Ruberto, Teresa; Ceriani, Luca; Piccardo, Arnoldo; Giovanella, Luca

doi:10.1111/cen.13819

Cited by 17 publications

(9 citation statements)

References 16 publications

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“…This system seems to be handy because any characteristics of high suspicion assess a nodule at high risk of malignancy regardless of its echostructure. 7 More recently, we found a very good performance of EU-TIRADS in another context 19 and we feel more confident with this system. However, several US systems [3][4][5][6][7][8][9] have quite similar performance and estimated risk of malignancy in intermediate pattern.…”

Section: Discussionmentioning

confidence: 61%

Dedicated neck ¹⁸F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Trimboli

Piccardo

Alevizaki

et al. 2019

Clinical Endocrinology

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Summary Background Several ultrasound (US) risk stratification systems have been proposed for the assessment of thyroid nodules, and their performance was shown as good. However, the rate of nodules assessed at intermediate risk is not negligible and whether they should be submitted or not to further examination is still under debate. The present study aimed to evaluate the reliability of 18F‐FDG PET/CT in stratifying the risk of malignancy in these lesions. Methods Two institutions participated to this retrospective study in which a dedicated 18F‐FDG PET/CT was proposed to patients having a thyroid nodule with US assessment of EU‐TIRADS 4 or 5. 18F‐FDG PET/CT did not influence the diagnostic and therapeutic decision. Histology was the gold standard for all patients. Results Ninety‐three patients were included for the study with 48 EU‐TIRADS 4 and 45 EU‐TIRADS 5 nodules. Of these, 26 underwent thyroidectomy following FNAC suspicious for or consistent with malignancy, 38 for inconclusive cytology, 27 because of large goitre and 2 for high‐risk lesion at US. At histology, 35 carcinomas and 58 benign lesions were found. Cancer prevalence was 16.7% in EU‐TIRADS 4 and 60% in EU‐TIRADS 5. Overall, 18F‐FDG PET/CT was positive in 33/35 cancers (94.5% sensitivity) and negative in 31/58 benign lesions (53.4% specificity). When considering only EU‐TIRADS 4, 18F‐FDG PET/CT was positive in 7/8 cancers and negative in 20/40 benign lesions; among these, there were 36 cases with FNAC indication according to dimensional cut‐off (ie >1.5 cm), and 18F‐FDG PET/CT showed 85.7% sensitivity and 41.4% specificity. Conclusions 18F‐FDG PET/CT may have a role in stratifying the cancer risk of thyroid nodules with an intermediate ultrasound assessment. More specifically, thyroid lesions classified as EU‐TIRADS 4 and with no 18F‐FDG uptake could be ruled out from further examination, similar to other anamnestic and clinical suspicious factors of patients. Further prospective and cost‐effectiveness studies are needed.

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Section: Discussionmentioning

confidence: 61%

Dedicated neck ¹⁸F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Trimboli

Piccardo

Alevizaki

et al. 2019

Clinical Endocrinology

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“…A PET/CT scan might increase the negative predictive value of the EU-TIRADS scale and allow a 41% reduction in the number of biopsies, while only one case of thyroid cancer would be missed. In another paper, Trimboli et al analyzed the risk of malignancy in incidentally detected lesions, demonstrating increased focal uptake on PET/CT scans and applying the EU-TIRADS scale for risk stratification [32]. The authors conclude that nodules with increased tracer uptake on FDG PET/CT and a high EU-TIRADS category are much more likely to be malignant than lesions with only increased tracer uptake on FDG PET/CT.…”

Section: Discussionmentioning

confidence: 99%

Histopathological Verification of the Diagnostic Performance of the EU-TIRADS Classification of Thyroid Nodules—Results of a Multicenter Study Performed in a Previously Iodine-Deficient Region

Dobruch‐Sobczak

Adamczewski

Szczepanek‐Parulska

et al. 2019

JCM

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Background: To validate the European Thyroid Imaging and Reporting Data System EU-TIRADS classification in a multi-institutional database of thyroid nodules by analyzing the obtained scores and histopathology results. Methods: A total of 842 thyroid lesions (613 benign, 229 malignant) were identified in 428 patients (mean age 62.7 years) and scored according to EU-TIRADS, using ultrasound examination. In all tumors, histopathological verification was performed. Results: In EU-TIRADS 2 (154 nodules) all nodules were benign; in EU-TIRADS 3, only 3/93 malignancies were identified. In EU-TIRADS 4, 12/103 were malignant, and in EU-TIRADS 5 (278 benign vs. 214 malignant). The malignant nodules that would not have qualified for biopsy were: EU-TIRADS 3, 2/3 (67%) malignancies were <20 mm, in EU-TIRADS 4, 7/12 (58%) were <15 mm. In EU-TIRADS 5, 72/214 (34%) were <10 mm; in total, 81/229 (36%) malignant lesions would have been missed. The cutoff between EU-TIRADS 3/4 had sensitivity of 100%, specificity of 25.1%. Using cutoff for EU-TIRADS 5, 93.4%, 54.6%, respectively. Conclusion: The application of EU-TIRADS guidelines allowed us to achieve moderate specificity. The vast majority of malignancies in EU-TIRADS 3, 4, and 5 would not have been recommended for biopsy because having a smaller size than that proposed classification. Recently, the European Thyroid Association (ETA) published the novel European Thyroid Imaging and Reporting Data System (EU-TIRADS), based on the ATA (American Thyroid Association) guidelines, Korean guidelines, American Association of Clinical Endocrinologists (AACE) guidelines, and a review of recent studies [11].The goal of our study was to validate the EU-TIRADS system in a multi-institutional database of thyroid nodules by analyzing the relationship between the obtained scores and the histopathology results. Furthermore, we aimed to evaluate the effectiveness of the EU-TIRADS scale in determining which nodules should be biopsied. To the best of our knowledge, this analysis constitutes the unique multicenter large cohort analysis of the diagnostic performance of the EU-TIRADS scale in a previously iodine-deficient region.

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“…In addition, PET/CT systems and acquisition protocols differ from one center to another thus leading to a variance in SUVmax thresholds (15, 16). For example, utilization of ToF systems and different reconstruction algorithms including point-spread function improves signal to noise ratio and reduces partial volume effect, but results in higher SUV.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of FDG PET-CT Quantitative Parameters and Deauville-Like 5 Point-Scale in Predicting Malignancy of Focal Thyroid Incidentaloma

et al. 2019

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Objective: To evaluate the diagnostic value of FDG PET-CT metabolic parameters and Deauville-like 5 point-scale to predict malignancy in a population of patients presenting focal thyroid incidentaloma (fTI). Design: This retrospective study included 41 fTI, classified according to cytological and histological data as benign (BL) or malignant lesion (ML). FDG PET-CT semi-quantitative parameters (SUVmax, SUVmean, SUVpeak, MTV, TLG), tumor to liver SUVmean ratio (TLRmax and TLRmean), tumor to blood-pool SUVmean ratio (TBRmax and TBRmean) were calculated. Each fTI was also classified on a Deauville-like 5-point scale (DS) currently used in lymphoma. Comparison between BL and ML was performed for each parameter and a ROC analysis was conducted. Results: All quantitative PET metabolic parameters (SUV parameters, volume based parameters and SUV ratio) were higher in ML compared with BL, yet no significant difference was reported. fTI (uptake) malignancy rate according to DS grades 2, 3, 4, and 5 was, respectively, 25% (1 of 4), 28.6% (2 of 7), 8.3% (1 of 12), and 33.3% (6 of 18) with no significant difference between ML and BL groups. Results of ROC analysis showed that mean TBR had the highest AUC in our cohort (0.66 95%CI [0.41; 0.91]) with a cut-off value of 2.2. Specificity of MTV and TLG was 100% (cut-off values: MTV 9.6 ml, TLG 22.9 g) and their sensitivity was 30 and 40%, respectively. Conclusion: Our study did not highlight any FDG PET/CT parameter predictor of fTI malignancy.

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Fine‐needle aspiration in all thyroid incidentalomas at ¹⁸F‐FDG PET/CT: Can EU‐TIRADS revise the dogma?

Cited by 17 publications

References 16 publications

Dedicated neck ¹⁸F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Dedicated neck ¹⁸F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Histopathological Verification of the Diagnostic Performance of the EU-TIRADS Classification of Thyroid Nodules—Results of a Multicenter Study Performed in a Previously Iodine-Deficient Region

Diagnostic Value of FDG PET-CT Quantitative Parameters and Deauville-Like 5 Point-Scale in Predicting Malignancy of Focal Thyroid Incidentaloma

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Fine‐needle aspiration in all thyroid incidentalomas at 18F‐FDG PET/CT: Can EU‐TIRADS revise the dogma?

Cited by 17 publications

References 16 publications

Dedicated neck 18F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Dedicated neck 18F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Histopathological Verification of the Diagnostic Performance of the EU-TIRADS Classification of Thyroid Nodules—Results of a Multicenter Study Performed in a Previously Iodine-Deficient Region

Diagnostic Value of FDG PET-CT Quantitative Parameters and Deauville-Like 5 Point-Scale in Predicting Malignancy of Focal Thyroid Incidentaloma

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Fine‐needle aspiration in all thyroid incidentalomas at ¹⁸F‐FDG PET/CT: Can EU‐TIRADS revise the dogma?

Dedicated neck ¹⁸F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Dedicated neck ¹⁸F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk