The prevalence and clinical significance of 18F–2‐fluoro‐2‐deoxy‐D‐glucose (FDG) uptake in the thyroid gland on PET or PET‐CT in patients with lymphoma
Abstract:F(18) -2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) has become a well established tool in staging and assessing therapy response in lymphoma. Incidental thyroid uptake on PET is not uncommon and can pose a diagnostic and management challenge. We retrospectively evaluate the prevalence and clinical significance of incidental FDG uptake in the thyroid gland in patients with lymphoma. 1868 lymphoma patients underwent PET and PET-CT between August 2002 and August 2008. 52 patients (2.8%) dem… Show more
“…They also reported that the maximum SUV was significantly greater for malignant than benign lesions 84 . In our own experience of 1868 patients with lymphoma, abnormal focal FDG uptake within the thyroid was seen in 1.6% of patients, 30% of which was subsequently found to be malignant, comprising a mix of intercurrent thyroid carcinomas as well as lymphomatous involvement of the thyroid, and we observed no difference in SUV in benign compared with malignant causes of focal thyroid uptake 85 …”
While iodine scanning is the mainstay of functional imaging in differentiated thyroid cancer, there is now a significant body of literature regarding positron emission tomography with 2-fluoro-2-deoxy glucose in thyroid cancer. This clinical review will examine the evidence supporting the use of 2-fluoro-2-deoxy glucose-positron emission tomography throughout the diagnosis and management of thyroid cancer, and provide suggestions for its clinical use and potential future roles.
“…They also reported that the maximum SUV was significantly greater for malignant than benign lesions 84 . In our own experience of 1868 patients with lymphoma, abnormal focal FDG uptake within the thyroid was seen in 1.6% of patients, 30% of which was subsequently found to be malignant, comprising a mix of intercurrent thyroid carcinomas as well as lymphomatous involvement of the thyroid, and we observed no difference in SUV in benign compared with malignant causes of focal thyroid uptake 85 …”
While iodine scanning is the mainstay of functional imaging in differentiated thyroid cancer, there is now a significant body of literature regarding positron emission tomography with 2-fluoro-2-deoxy glucose in thyroid cancer. This clinical review will examine the evidence supporting the use of 2-fluoro-2-deoxy glucose-positron emission tomography throughout the diagnosis and management of thyroid cancer, and provide suggestions for its clinical use and potential future roles.
“…The purpose of this review is to enter into an initial exploratory phase in order to understand the real nature and impact of the problems related to lymphoma and thyroid. This is done through a careful examination of existing evidence regarding a range of issues that are central to the topic: thyroid diseases at risk of lymphoma development, primary thyroid lymphoma (PTL), and thyroid involvement in primitive nodal or extranodal lymphomas . Also, another learning objective is to understand the risk of thyroid dysfunction during therapy with new agents for lymphomas, how they will influence clinical practice, and the significance of incidental imaging–related findings …”
The thyroid gland is often involved in the development of neoplastic diseases, including lymphoproliferative disorders. The aim of this paper is to provide a comprehensive overview of the multiple interactions between lymphoma and thyroid. Through an extensive research among the literature, the relationship between lymphomas and thyroid can be established at various levels, and the possible interconnections are here summarized in 5 points: (1) the greater risk of lymphoma development in some thyroid diseases; (2) the primary thyroid lymphoma, with focus on issues related to the diagnosis, differential diagnosis, and treatment; (3) the incidence of thyroid involvement in primitive nodal lymphomas or in extranodal lymphomas of the other sites; (4) thyroid changes after treatment of lymphoma, in relation to the effects of radiation therapy and immuno-chemotherapy; (5) the incidental findings of thyroid changes, on imaging, in patients with lymphoma, without a direct involvement of the gland in malignant disease. In conclusion, issues that until now have been dealt with separately will therefore be analyzed in a unique paper, allowing a global view of the topic and emphasizing the need of a multidisciplinary approach. Future learning areas in this topic mainly relate to rapidly increasing the knowledge of imaging studies together with expanding the armamentarium of novel biological and targeting agents in lymphoma patients.
“…Incidental focal thyroid uptake carries an approximately 30% risk of malignancy [14,19] while 50-80% cases of focal colorectal FDG uptake are due to pre-malignant polyps or carcinoma [15]. A marked difference in metabolic activity between the known site of malignancy and the incidentally detected lesion, or a discordant metabolic response to therapy, are also scan features suggestive of a second pathology [9].…”
Section: Discussionmentioning
confidence: 97%
“…Although the FDG avidity of incidental malignant or pre-malignant lesions tended to have a higher SUV max (mean = 8.8 vs. 4.8) in our cohort, the number of patients for each specific organ location was too small for us to make general recommendation and warrants further studies with a larger number of patients. From our previous experience of incidental focal thyroid or colorectal lesions found on PET, there is no reliable cut-off or threshold based on metabolic activity where a malignant lesion is more likely [14,15,19].…”
Section: Discussionmentioning
confidence: 97%
“…thyroiditis) whereas approximately 30% of focal uptake can be malignant [14]. Moreover, the degree of FDG avidity in terms of standardised uptake values (SUV), does not appear to be sufficiently adequate in distinguishing between benign and malignant incidental thyroid [14] and colorectal lesions [15].…”
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