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Thyroid incidentalomas in PSMA PET/CT: a systematic review and meta-analysis

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Abstract

Purpose

Thyroid incidentaloma is an abnormal finding detected by imaging exams and which was not the initial reason for performing it. This article aimed to verify the prevalence of TI in PSMA PET/CT and to analyze its risk of malignancy through a systematic review and meta-analysis.

Methods

A systematic search through electronic databases was conducted until April 2022 to identify relevant articles on thyroid findings in PSMA PET/CT. Observational studies that reported TI detected with PSMA PET/CT were eligible for inclusion.

Results

Three hundred and eighty-four abstracts were reviewed in electronic databases and bibliographic references, including 5 studies containing 8422 patients for qualitative and quantitative analysis. PSMA PET/CT identified 96 TI (1.3%), of which 6 were malignant. Only three studies describe TI uptake pattern. The prevalence of TI with a focal pattern was 67.6% (95% CI 57.2–77.2%; I2 = 0%), while the risk of malignancy in focal lesions alone was 9.0% (95% CI 3.0–17.7%; I2 = 0.0%).

Conclusion

TI is rarely detected on PSMA PET/CT, and the risk of malignancy can reach considerable values in lesions with a focal pattern. Therefore, follow-up and appropriate clinical investigation of lesions with focal PSMA uptake in the thyroid are important.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Haberkorn U, Eder M, Kopka K et al (2016) New strategies in prostate cancer: prostate-specific membrane antigen (PSMA) ligands for diagnosis and therapy. Clin Cancer Res 22:9–15. https://doi.org/10.1158/1078-0432.CCR-15-0820

    Article  CAS  PubMed  Google Scholar 

  2. Farolfi A, Calderoni L, Mattana F et al (2021) Current and emerging clinical applications of PSMA PET diagnostic imaging for prostate cancer. J Nucl Med 62:596–604. https://doi.org/10.2967/jnumed.120.257238

    Article  CAS  PubMed  Google Scholar 

  3. Giovacchini G, Giovannini E, Riondato M, Ciarmiello A (2017) PET/CT With 68Ga-PSMA in prostate cancer: radiopharmaceutical background and clinical implications. Curr Radiopharm 11:4–13. https://doi.org/10.2174/1874471010666171101121803

    Article  CAS  Google Scholar 

  4. Keidar Z, Gill R, Goshen E et al (2018) 68Ga-PSMA PET/CT in prostate cancer patients – patterns of disease, benign findings and pitfalls. Cancer Imaging 18:39. https://doi.org/10.1186/s40644-018-0175-3

    Article  PubMed  PubMed Central  Google Scholar 

  5. Berlin L (2011) The incidentaloma: a medicolegal dilemma. Radiol Clin North Am 49:245–255. https://doi.org/10.1016/j.rcl.2010.11.002

    Article  PubMed  Google Scholar 

  6. Schaaf WE, Patel Z, Retrouvey M et al (2014) Frequency and clinical relevance of PET/CT incidentalomas. Abdom Imaging 39:657–662. https://doi.org/10.1007/s00261-014-0086-0

    Article  PubMed  Google Scholar 

  7. Jin J, McHenry CR (2012) Thyroid incidentaloma. Best Pract Res Clin Endocrinol Metab 26:83–96. https://doi.org/10.1016/j.beem.2011.06.004

    Article  PubMed  Google Scholar 

  8. Makis W, Ciarallo A (2017) Thyroid Incidentalomas on 18F-[18F]FDG PET/CT: clinical significance and controversies. Malecular Imaging Radionuclide Ther 26:93–100. https://doi.org/10.4274/mirt.94695

    Article  Google Scholar 

  9. Bonabi S, Schmidt F, Broglie MA et al (2012) Thyroid incidentalomas in [18F]FDG-PET/CT: prevalence and clinical impact. Eur Archiv Otorhinolaryngol 269:2555–2560. https://doi.org/10.1007/s00405-012-1941-7

    Article  Google Scholar 

  10. Shi H, Yuan Z, Yang C et al (2019) Role of multi-modality functional imaging in differentiation between benign and malignant thyroid 18F-fluorodeoxyglucose incidentaloma. Clin Transl Oncol 21:1561–1567. https://doi.org/10.1007/s12094-019-02089-9

    Article  CAS  PubMed  Google Scholar 

  11. Gough J, Scott-Coombes D, Fausto Palazzo F (2008) Thyroid incidentaloma: an evidence-based assessment of management strategy. World J Surg 32:1264–1268. https://doi.org/10.1007/s00268-008-9503-2

    Article  PubMed  Google Scholar 

  12. Piek MW, de Vries LH, Donswijk ML et al (2022) Retrospective analysis of PSMA PET/CT thyroid incidental uptake in adults: incidence, diagnosis, and treatment/outcome in a tertiary cancer referral center and University Medical Center. Eur J Nucl Med Mol Imaging 49:2392–2400. https://doi.org/10.1007/s00259-022-05679-y

    Article  PubMed  Google Scholar 

  13. Parghane RV, Basu S (2022) Thyroid incidentaloma on 68Ga-PSMA-11 PET/CT leading to detection of thyroid metastasis in metastatic prostate carcinoma. Clin Nucl Med 47:e300–e301. https://doi.org/10.1097/RLU.0000000000003954

    Article  PubMed  Google Scholar 

  14. Usmani S, Al-Turkait D, Al-Kandari F, Ahmed N (2021) Thyroid cancer detected on 68Ga-PMSA PET/CT. J Pak Med Assoc 71:1511–1512

    PubMed  Google Scholar 

  15. Ciappuccini R, Edet-Sanson A, Saguet-Rysanek V et al (2019) Thyroid Incidentaloma on 18F-fluorocholine PET/CT and 68Ga-PSMA PET/CT revealing a medullary thyroid carcinoma. Clin Nucl Med 44:663–665. https://doi.org/10.1097/RLU.0000000000002559

    Article  PubMed  Google Scholar 

  16. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan—a web and mobile app for systematic reviews. Syst Rev 5:210. https://doi.org/10.1186/s13643-016-0384-4

    Article  PubMed  PubMed Central  Google Scholar 

  18. National Institute of Health (2021) NIH Study Quality Assessment Tools. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed 1 Aug 2022

  19. Gossili F, Petersen LJ, Zacho HD (2020) The frequency of thyroid incidental findings and risk of malignancy detected by 68Ga-labeled prostate-specific membrane antigen PET/CT in prostate cancer. Hell J Nucl Med 23:240–245. https://doi.org/10.1967/s002449912202

    Article  PubMed  Google Scholar 

  20. Osman MM, Iravani A, Hicks RJ, Hofman MS (2017) Detection of synchronous primary malignancies with 68Ga-labeled prostate-specific membrane antigen PET/CT in patients with prostate cancer: frequency in 764 patients. J Nucl Med 58:1938–1942. https://doi.org/10.2967/jnumed.117.190215

    Article  CAS  PubMed  Google Scholar 

  21. Perry E, Talwar A, Sharma S et al (2022) Non-prostate cancer tumours: incidence on 18F-DCFPyL PSMA PET/CT and uptake characteristics in 1445 patients. Eur J Nucl Med Mol Imaging 49:3277–3288. https://doi.org/10.1007/s00259-022-05721-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. McEwan L, McBean R, Yaxley J, Wong D (2019) Unexpected significant findings non-related to prostate cancer identified using combined prostate-specific membrane antigen positron emission tomography/CT and diagnostic CT scan in primary staging for prostate cancer. J Med Imaging Radiat Oncol 63:318–323. https://doi.org/10.1111/1754-9485.12864

    Article  PubMed  Google Scholar 

  23. Conway RE, Petrovic N, Li Z et al (2006) Prostate-specific membrane antigen regulates angiogenesis by modulating integrin signal transduction. Mol Cell Biol 26:5310–5324. https://doi.org/10.1128/MCB.00084-06

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Moore M, Panjwani S, Mathew R et al (2017) Well-differentiated thyroid cancer neovasculature expresses prostate-specific membrane antigen—a possible novel therapeutic target. Endocr Pathol 28:339–344. https://doi.org/10.1007/s12022-017-9500-9

    Article  CAS  PubMed  Google Scholar 

  25. Derlin T, Kreipe HH, Schumacher U, Soudah B (2017) PSMA expression in tumor neovasculature endothelial cells of follicular thyroid adenoma as identified by molecular imaging using 68Ga-PSMA Ligand PET/CT. Clin Nucl Med 42:e173–e174. https://doi.org/10.1097/RLU.0000000000001487

    Article  PubMed  Google Scholar 

  26. Verma P, Malhotra G, Meshram V et al (2021) Prostate-specific membrane antigen expression in patients with differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy using 68Ga-PSMA-HBED-CC PET/CT. Clin Nucl Med 46:e406–e409. https://doi.org/10.1097/RLU.0000000000003655

    Article  PubMed  Google Scholar 

  27. Treglia G, Bertagna F, Sadeghi R et al (2013) Focal thyroid incidental uptake detected by 18F-fluorodeoxyglucose positron emission tomography. Nuklearmedizin 52:130–136. https://doi.org/10.3413/Nukmed-0568-13-03

    Article  CAS  PubMed  Google Scholar 

  28. de Leijer JF, Metman MJH, van der Hoorn A et al (2021) Focal thyroid incidentalomas on 18F-[18F]FDG PET/CT: a systematic review and meta-analysis on prevalence, risk of malignancy and inconclusive fine needle aspiration. Front Endocrinol (Lausanne) 12:723394. https://doi.org/10.3389/fendo.2021.723394

    Article  PubMed  Google Scholar 

  29. Bychkov A, Vutrapongwatana U, Tepmongkol S, Keelawat S (2017) PSMA expression by microvasculature of thyroid tumors – potential implications for PSMA theranostics. Sci Rep 7:5202. https://doi.org/10.1038/s41598-017-05481-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Ghosh A, Heston WDW (2004) Tumor target prostate specific membrane antigen (PSMA) and its regulation in prostate cancer. J Cell Biochem 91:528–539. https://doi.org/10.1002/jcb.1066

    Article  CAS  PubMed  Google Scholar 

  31. Heitkötter B, Steinestel K, Trautmann M et al (2018) Neovascular PSMA expression is a common feature in malignant neoplasms of the thyroid. Oncotarget 9:9867–9874

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sood A, Vadi SK, Kumar R et al (2020) Incidental Detection of Hypothyroidism on 68Ga-PSMA-HBED-CC PET/CT Imaging. Clin Nucl Med 45:e217–e218. https://doi.org/10.1097/RLU.0000000000002965

    Article  PubMed  Google Scholar 

  33. Califaretti E, Dallarmellina S, Rovera G et al (2022) The role of PET/CT in thyroid autoimmune diseases. Quart J Nucl Med Mol Imaging 66:218–228

    Article  Google Scholar 

  34. Are C, Hsu JF, Schoder H et al (2006) [18F]FDG-PET detected thyroid incidentalomas: need for further investigation? Ann Surg Oncol 14:239–247. https://doi.org/10.1245/s10434-006-9181-y

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Real Nuclear, Real Hospital Português de Pernambuco, Recife, Pernambuco, Brazil

    Kaylon Kelvin dos Santos Godê, Felipe Alves Mourato, Antônio Felipe de França Sales & Paulo José de Almeida Filho

  2. Medicina Nuclear, Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil

    Felipe Alves Mourato & Simone Cristina Soares Brandão

  3. Nuclear Medicine and PET/CT Laboratory, Center of Imaging Sciences and Health Physics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    Lauro Wichert-Ana

Authors
  1. Kaylon Kelvin dos Santos Godê
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  2. Felipe Alves Mourato
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  3. Antônio Felipe de França Sales
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  4. Paulo José de Almeida Filho
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Contributions

KKdSG: literature search and review, writing initial draft, and content planning. FAM: literature search and review, meta-analysis, and content planning. AFdFS: literature search and review, and content planning. PJdAF: interpretation of data and critical revision for intellectual content. SCSB: interpretation of data and critical revision for intellectual content. LW-A: interpretation of data and critical revision for intellectual content.

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Correspondence to Felipe Alves Mourato.

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Godê, K.K.S., Mourato, F.A., Sales, A.F.F. et al. Thyroid incidentalomas in PSMA PET/CT: a systematic review and meta-analysis. Clin Transl Imaging 11, 263–269 (2023). https://doi.org/10.1007/s40336-022-00537-1

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  • DOI: https://doi.org/10.1007/s40336-022-00537-1

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