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Risk-stratification of thyroid nodules examined by 18FDG-PET/CT while ensuring congruity between imaging and histopathological localization

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Abstract

Purpose

The risk of malignancy (ROM) in FDG-avid thyroid incidentalomas varies between studies, which may be contributed by discordance between the anatomical localization depicted on 18FDG-PET/CT and by histopathological examination. The purpose was to ensure anatomical congruity between the index tumour identified by 18FDG-PET/CT and the histopathological examination, in order to assess the risk of malignancy (ROM) in PET-positive and PET-negative thyroid nodules. Further, preoperative characteristics indicative of thyroid malignancy were identified.

Methods

Thirty-two patients referred to thyroid surgery were prospectively included. 18FDG-PET/CT, fine-needle aspiration biopsy and thyroid ultrasonography examination were performed in all participants. The exact anatomical localization of the index nodule was established by histopathological examination to ensure concordance with the 18FDG-PET/CT finding.

Results

Forty thyroid nodules were included. Malignancy was identified in 10 of 28 PET-positive nodules and in 1 of 12 PET-negative nodules, resulting in a ROM of 36% and 8%, respectively. A Hurtle cell neoplasm was found in 50% of patients with a benign nodule and a PET-positive scan. One PET-negative nodule represented a papillary microcarcinoma. In PET-positive nodules, hypoechogenicity, irregular margins, and pathological lymph nodes on thyroid ultrasonography were characteristics associated with malignancy.

Conclusions

In this study—ensuring anatomical congruity between PET-findings and the histopathological examination—the risk of malignancy in PET-positive thyroid nodules was 36%. A low ROM was seen in thyroid nodules without suspicious ultrasonographic findings, independent of the 18FDG-PET/CT result.

Trial registration number

NCT02150772 registered 14th of April 2014.

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Data availability

The data is not available in public databases due to Danish legislation.

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Funding

The project was supported financially by Fonden af 17-12-1981 (Copenhagen, Denmark) (Grant for KZS), Aarhus University (Aarhus, Denmark) (Grant for KZS) and by the Central Denmark Region (Denmark) (funding for equipment).

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Authors and Affiliations

  1. Department of Otorhinolaryngology Head- and Neck Surgery, Aarhus University Hospital (AUH), Aarhus, Denmark

    Peter Bakkegaard, Stefano Christian Londero & Kristine Zøylner Swan

  2. Department of Endocrinology, Odense University Hospital (OUH), Odense, Denmark

    Steen Joop Bonnema

  3. Department of Otorhinolaryngology Head- and Neck Surgery, OUH, Odense, Denmark

    Viveque Egsgaard Nielsen

  4. Department of Pathology, AUH, Aarhus, Denmark

    Marie Louise Jespersen

Authors
  1. Peter Bakkegaard
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  2. Stefano Christian Londero
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  3. Steen Joop Bonnema
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  4. Viveque Egsgaard Nielsen
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  5. Marie Louise Jespersen
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  6. Kristine Zøylner Swan
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Corresponding author

Correspondence to Kristine Zøylner Swan.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethics approval

The study was conducted in accordance with the World Medical Association Declaration of Helsinki. The study protocol was approved by the Ethical Committee of the Central Denmark Region, and registered at The Danish Data Protection Agency and on Clinicaltrials.gov (NCT02150772).

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All participants gave written informed consent before inclusion in the study.

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Included patients gave written informed consent for results to be published anonymously.

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Bakkegaard, P., Londero, S.C., Bonnema, S.J. et al. Risk-stratification of thyroid nodules examined by 18FDG-PET/CT while ensuring congruity between imaging and histopathological localization. Eur Arch Otorhinolaryngol 278, 4979–4985 (2021). https://doi.org/10.1007/s00405-021-06733-5

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  • DOI: https://doi.org/10.1007/s00405-021-06733-5

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