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Endocrine

, Volume 43, Issue 3, pp 678–685 | Cite as

F18-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value

  • Francesco BertagnaEmail author
  • Giorgio Treglia
  • Arnoldo Piccardo
  • Elisabetta Giovannini
  • Giovanni Bosio
  • Giorgio Biasiotto
  • El Khayat Bahij
  • Roberto Maroldi
  • Raffaele Giubbini
Original Article

Abstract

Thyroid incidental uptake is defined as a thyroid uptake incidentally and newly detected by imaging techniques performed for an unrelated purpose and especially for non-thyroid diseases. Aim of the study was to establish the prevalence and pathological nature of focal thyroid incidentalomas detected at F18-FDG-PET/CT in patients studied for oncological purposes and not for thyroid disease. Secondary end point was to establish a possible maximum standardised uptake value cut-off over which a malignant lesion should be suspected. We have retrospectively evaluated 49519 patients who underwent F18-FDG-PET/CT for oncologic purposes in three Nuclear Medicine Centres (N.1 = 11278, N.2 = 31076, N.3 = 7165). A focal incidental thyroid uptake was diagnosed in 729 (1.5 %) patients (287–39.4 % male and 442–60.6 % female; average age: 65.26). Of 729 thyroid incidentalomas 211 (28.9 %) underwent further investigation to determine the nature of the nodule; 124/211 (58.8 %) incidentalomas were benign, 72/211 (34.1 %) malignant, 4/211 (1.9 %) non-diagnostic at cytological examination in the absence of surgery and histological evaluation and 11/211 (5.2 %) were indeterminate at cytological examination. A centre-based receiver operating curve (ROC) analysis of the patients with a definitive diagnosis was performed to identify a SUVmax cut-off useful in differentiating benign from malignant incidentalomas. In the centre N.1 it was 4.8 (sensitivity = 95.7 %, specificity = 46.4 %, area under the curve = 0.758); 5.3 in the centre N.2 (sensitivity = 76.3 %, specificity = 72.5 %, area under the curve = 0.815); 7 in the centre N.3 (sensitivity = 57.1 %, specificity = 79.3 %, area under the curve = 0.627). F18-FDG-PET/CT thyroid incidentalomas are a relevant diagnostic reality which requires further investigations and clinical management especially considering that, despite mainly benign, approximately one third of focal thyroid uptakes are malignant.

Keywords

PET/CT F18-FDG Thyroid Incidentaloma 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The authors declare that the experiments comply with the current laws of the country in which they were performed.

References

  1. 1.
    B. Burguera, H. Gharib, Thyroid incidentalomas. Prevalence, diagnosis, significance, and management. Endocrinol. Metab. Clin. N. Am. 29, 187–203 (2000)CrossRefGoogle Scholar
  2. 2.
    N.G. Iyer, A.R. Shaha, C.E. Silver, K.O. Devaney, A. Rinaldo, P.K. Pellitteri, A. Ferlito, Thyroid incidentalomas: to treat or not to treat. Eur. Arch. Otorhinolaryngol. 267, 1019–1026 (2010)PubMedCrossRefGoogle Scholar
  3. 3.
    M. Salvatori, L. Melis, P. Castaldi, M.L. Maussier, V. Rufini, G. Perotti, D. Rubello, Clinical significance of focal and diffuse thyroid diseases identified by (18)F-fluorodeoxyglucose positron emission tomography. Biomed. Pharmacother. 61, 488–493 (2007)PubMedCrossRefGoogle Scholar
  4. 4.
    C. Are, J.F. Hsu, H. Schoder, J.P. Shah, S.M. Larson, A.R. Shaha, FDG-PET detected thyroid incidentalomas: need for further investigation? Ann. Surg. Oncol. 14, 239–247 (2007)PubMedCrossRefGoogle Scholar
  5. 5.
    C. Are, J.F. Hsu, R.A. Chossein, H. Schoder, J.P. Shah, A.R. Shaha, Histological aggressiveness of fluoro deoxyglucose positron-emission tomogram (FDG-PET)-detected incidental thyroid carcinomas. Ann. Surg. Oncol. 14, 3210–3215 (2007)PubMedCrossRefGoogle Scholar
  6. 6.
    M.S. Cohen, N. Arslan, F. Dehdashti, G.M. Doherty, T.C. Lairmore, L.M. Brunt, J.F. Moley, Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography. Surgery 130, 941–946 (2001)PubMedCrossRefGoogle Scholar
  7. 7.
    Y.K. Chen, H.J. Ding, K.T. Chen, Y.L. Chen, A.C. Liao, Y.Y. Shen, C.T. Su, C.H. Kao, Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects. Anticancer Res. 25, 1421–1426 (2005)PubMedGoogle Scholar
  8. 8.
    J.Y. Choi, K.S. Lee, H.J. Kim, Y.M. Shim, O.J. Kwon, K. Park, C.H. Baek, J.H. Chung, K.H. Lee, B.T. Kim, Focal thyroid lesions incidentally identified by integrated 18F-FDG PET/CT: clinical significance and improved characterization. J. Nucl. Med. 47, 609–615 (2006)PubMedGoogle Scholar
  9. 9.
    T.Y. Kim, W.B. Kim, J.S. Ryu, G. Gong, S.J. Hong, Y.K. Shong, 18F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope 115, 1074–1078 (2005)PubMedCrossRefGoogle Scholar
  10. 10.
    T.V. Bogsrud, D. Karantanis, M.A. Nathan, B.P. Mullan, G.A. Wiseman, D.A. Collins, J.L. Kasperbauer, S.E. Strome, C.C. Reading, I.D. Hay, V.J. Lowe, The value of quantifying 18F-FDG uptake in thyroid nodules found incidentally on whole-body PET-CT. Nucl. Med. Commun. 28, 373–381 (2007)PubMedCrossRefGoogle Scholar
  11. 11.
    Q.D. Chu, M.S. Connor, D.L. Lilien, L.W. Johnson, R.H. Turnage, B.D. Li, Positron emission tomography (PET) positive thyroid incidentaloma: the risk of malignancy observed in a tertiary referral center. Am. Surg. 72, 272–275 (2006)PubMedGoogle Scholar
  12. 12.
    H. Nishimori, R. Tabah, M. Hickeson, J. How, Incidental thyroid “PETomas”: clinical significance and novel description of the self-resolving variant of focal FDG-PET thyroid uptake. Can. J. Surg. 54, 83–88 (2011)PubMedCrossRefGoogle Scholar
  13. 13.
    T. Ishimori, P.V. Patel, R.L. Wahl, Detection of unexpected additional primary malignancies with PET/CT. J. Nucl. Med. 46, 752–757 (2005)PubMedGoogle Scholar
  14. 14.
    K.W. Kang, S.K. Kim, H.S. Kang, E.S. Lee, J.S. Sim, I.G. Lee, S.Y. Jeong, S.W. Kim, Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-xuorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects. J. Clin. Endocrinol. Metab. 88, 4100–4104 (2003)PubMedCrossRefGoogle Scholar
  15. 15.
    I.L. Nilsson, F. Arnberg, J. Zedenius, A. Sundin, Thyroid incidentaloma detected by fluorodeoxyglucose positron emission tomography/computed tomography: practical management algorithm. World J. Surg. 35, 2691–2697 (2011)PubMedCrossRefGoogle Scholar
  16. 16.
    T.Y. Ho, M.J. Liou, K.J. Lin, T.C. Yen, Prevalence and significance of thyroid uptake detected by 18F-FDG PET. Endocrine 40, 297–302 (2011)PubMedCrossRefGoogle Scholar
  17. 17.
    B.H. Kim, M.A. Na, I.J. Kim, S.J. Kim, Y.K. Kim, Risk stratification and prediction of cancer of focal thyroid fluorodeoxyglucose uptake during cancer evaluation. Ann. Nucl. Med. 24, 721–728 (2010)PubMedCrossRefGoogle Scholar
  18. 18.
    L. Pagano, M.T. Samà, F. Morani, F. Prodam, M. Rudoni, R. Boldorini, G. Valente, P. Marzullo, R. Baldelli, M. Appetecchia, C. Isidoro, G. Aimaretti, Thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT): clinical and pathological relevance. Clin. Endocrinol. 75, 528–534 (2011)CrossRefGoogle Scholar
  19. 19.
    J.S. Bae, B.J. Chae, W.C. Park, J.S. Kim, S.H. Kim, S.S. Jung, B.J. Song, Incidental thyroid lesions detected by FDG-PET/CT: prevalence and risk of thyroid cancer. World J. Surg. Oncol. 7, 63 (2009)PubMedCrossRefGoogle Scholar
  20. 20.
    G. Zhai, M. Zhang, H. Xu, C. Zhu, B. Li, The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography whole body imaging in the evaluation of focal thyroid incidentaloma. J. Endocrinol. Invest. 33, 151–155 (2010)PubMedGoogle Scholar
  21. 21.
    D.L. King, B.C. Stack Jr, P.M. Spring, R. Walker, D.L. Bodenner, Incidence of thyroid carcinoma in fluorodeoxyglucose positron emission tomography-positive thyroid incidentalomas. Otolaryngol. Head Neck Surg. 137, 400–404 (2007)PubMedCrossRefGoogle Scholar
  22. 22.
    S.Y. Nam, J.L. Roh, J.S. Kim, J.H. Lee, S.H. Choi, S.Y. Kim, Focal uptake of (18)Ffluorodeoxyglucose by thyroid in patients with nonthyroidal head and neck cancers. Clin. Endocrinol. 67, 135–139 (2007)CrossRefGoogle Scholar
  23. 23.
    E. Even-Sapir, H. Lerman, M. Gutman, G. Lievshitz, L. Zuriel, A. Polliack, M. Inbar, U. Metser, The presentation of malignant tumours and pre-malignant lesions incidentally found on PET-CT. Eur. J. Nucl. Med. Mol. Imaging 33, 541–552 (2006)PubMedCrossRefGoogle Scholar
  24. 24.
    K. Ohba, S. Nishizawa, A. Matsushita, M. Inubushi, K. Nagayama, H. Iwaki, H. Matsunaga, S. Suzuki, S. Sasaki, Y. Oki, H. Okada, H. Nakamura, High incidence of thyroid cancer in focal thyroid incidentaloma detected by 18F-fluorodeoxyglucose [corrected] positron emission tomography in relatively young healthy subjects: results of 3-year follow-up. Endocr. J. 57, 395–401 (2010)PubMedCrossRefGoogle Scholar
  25. 25.
    J.Y. Kwak, E.K. Kim, M. Yun, A. Cho, M.J. Kim, E.J. Son, K.K. Oh, Thyroid incidentalomas identified by 18F-FDG PET: sonographic correlation. AJR Am. J. Roentgenol. 191, 598–603 (2008)PubMedCrossRefGoogle Scholar
  26. 26.
    H. Hsieh, S. Lin, B. Yang, Y. Chu, C. Chang, R. Liu, The clinical relevance of thyroid incidentalomas detected by 18F-fluorodeoxyglucose positron emission tomography. Ann. Nucl. Med. Sci. 16, 53–58 (2003)Google Scholar
  27. 27.
    W. Chen, M. Parsons, D.A. Torigian, H. Zhuang, A. Alavi, Evaluation of thyroid FDG uptake incidentally identified on FDG-PET/CT imaging. Nucl. Med. Commun. 30, 240–244 (2009)PubMedCrossRefGoogle Scholar
  28. 28.
    J.A. Eloy, E.M. Brett, G.M. Fatterpekar, L. Kostakoglu, P.M. Som, S.C. Desai, E.M. Genden, The significance and management of incidental [18F]fluorodeoxyglucose-positron-emission tomography uptake in the thyroid gland in patients with cancer. AJNR Am. J. Neuroradiol. 30, 1431–1434 (2009)PubMedCrossRefGoogle Scholar
  29. 29.
    B.J. Kang, J.H. O, J.H. Baik, S.L. Jung, Y.H. Park, S.K. Chung, Incidental thyroid uptake on F-18 FDG PET/CT: correlation with ultrasonography and pathology. Ann. Nucl. Med. 23, 729–737 (2009)PubMedCrossRefGoogle Scholar
  30. 30.
    S. Bonabi, F. Schmidt, M.A. Broglie, S.R. Haile, S.J. Stoeckli, Thyroid incidentalomas in FDG-PET/CT: prevalence and clinical impact. Eur. Arch. Otorhinolaryngol. (2012). doi: 10.1007/s00405-012-1941-7 PubMedGoogle Scholar
  31. 31.
    M.H. Pampaloni, A.Z. Win, Prevalence and characteristics of incidentalomas discovered by whole body FDG PETCT. Int. J. Mol. Imaging (2012). doi: 10.1155/2012/476763 PubMedGoogle Scholar
  32. 32.
    W.M. Lee, B.J. Kim, M.H. Kim, S.C. Choi, S.Y. Ryu, I. Lim, K. Kim, Characteristics of thyroid incidentalomas detected by pre-treatment [F]FDG PET or PET/CT in patients with cervical cancer. J. Gynecol. Oncol. 23, 43–47 (2012)PubMedCrossRefGoogle Scholar
  33. 33.
    D.S. Cooper, G.M. Doherty, B.R. Haugen, R.T. Kloos, S.L. Lee, S.J. Mandel, E.L. Mazzaferri, B. McIver, S.I. Sherman, R.M. Tuttle, American thyroid association guidelines taskforce. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 16, 109–142 (2006)PubMedCrossRefGoogle Scholar
  34. 34.
    R.S. Prichard, M. Cotter, D. Evoy, D. Gibbons, C. Collins, E. McDermott, S. Skehan, Focal thyroid incidentalomas identified with whole-body FDG-PET warrant further investigation. Ir. Med. J. 104, 177–179 (2011)PubMedGoogle Scholar
  35. 35.
    G. Treglia, L. Giovanella, F. Bertagna, D. Di Franco, M. Salvatori, A pooled analysis to calculate the prevalence and risk of malignancy of thyroid incidentalomas detected by fluorine-18-fluorodeoxyglucose positron emission tomography. Thyroid. (2012). doi: 10.1089/thy.2012-0216 PubMedGoogle Scholar
  36. 36.
    F. Bertagna, G. Treglia, A. Piccardo, R. Giubbini, Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J. Clin. Endocrinol. Metab. (2012). doi: 10.1210/jc.2012-2390 Google Scholar
  37. 37.
    F. Pacini, Changing natural history of differentiated thyroid cancer. Endocrine 42, 229–230 (2012)PubMedCrossRefGoogle Scholar
  38. 38.
    L. Pagano, M. Caputo, M.T. Samà, V. Garbaccio, M. Zavattaro, M.G. Mauri, F. Prodam, P. Marzullo, R. Boldorini, G. Valente, G. Aimaretti, Clinical-pathological changes in differentiated thyroid cancer (DTC) over time (1997–2010): data from the University Hospital “Maggiore della Carità” in Novara. Endocrine 42, 382–390 (2012)PubMedCrossRefGoogle Scholar
  39. 39.
    S. Kauhanen, C. Schalin-Jäntti, Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer? Endocrine (2012). doi: 10.1007/s12020-012-9740-x PubMedGoogle Scholar
  40. 40.
    G. Treglia, A. Del Ciello, D. Di Franco, Recurrent lymphoma in the thyroid gland detected by fluorine-18-fluorodeoxyglucose PET/CT. Endocrine (2012). doi: 10.1007/s12020-012-9782-0 Google Scholar
  41. 41.
    G. Fadda, F. Basolo, A. Bondi, G. Bussolati, A. Crescenzi, O. Nappi, F. Nardi, M. Papotti, G. Taddei, L. Palombini, SIAPEC-IAP Italian Consensus Working Group. Cytological classification of thyroid nodules. Proposal of the SIAPEC-IAP Italian Consensus Working Group. Pathologica 102, 405–408 (2010)PubMedGoogle Scholar
  42. 42.
    U. Feine, R. Lietzenmayer, J.P. Hanke, J. Held, H. Wöhrle, W. Müller-Schauenburg, Fluorine-18-FDG and iodine-131-iodide uptake in thyroid cancer. J. Nucl. Med. 37, 1468–1472 (1996)PubMedGoogle Scholar
  43. 43.
    F. Grabellus, J. Nagarajah, A. Bockisch, S. Kurt Werner, S.Y. Sheu, Glucose transporter 1 expression, tumor proliferation, and iodine/glucose uptake in thyroid cancer with emphasis on poorly differentiated thyroid carcinoma. Clin. Nucl. Med. 37, 121–127 (2012)PubMedCrossRefGoogle Scholar
  44. 44.
    F. Morani, L. Pagano, F. Prodam, G. Aimaretti, C. Isidoro, Loss of expression of the oncosuppressor PTEN in thyroid incidentalomas associates with GLUT1 plasmamembrane expression. Panminerva Med. 54, 59–63 (2012)PubMedGoogle Scholar
  45. 45.
    A.L. Traugott, F. Dehdashti, K. Trinkaus, M. Cohen, E. Fialkowski, F. Quayle, H. Hussain, R. Davila, L. Ylagan, J.F. Moley, Exclusion of malignancy in thyroid nodules with indeterminate fine-needle aspiration cytology after negative 18F-fluorodeoxyglucose positron emission tomography: interim analysis. World J. Surg. 34, 1247–1253 (2010)PubMedCrossRefGoogle Scholar
  46. 46.
    A.D. Bloom, L.P. Adler, J.M. Shuck, Determination of malignancy of thyroid nodules with positron emission tomography. Surgery. 114, 728–734; discussion 734–735 (1993)Google Scholar
  47. 47.
    J.C. Mitchell, F. Grant, A.R. Evenson, J.A. Parker, P.O. Hasselgren, S. Parangi, Preoperative evaluation of thyroid nodules with 18FDG-PET/CT. Surgery. 138, 1166–1174; discussion 1174–1175 (2005)Google Scholar
  48. 48.
    J.M. Kim, J.S. Ryu, T.Y. Kim, W.B. Kim, G.Y. Kwon, G. Gong, D.H. Moon, S.C. Kim, S.J. Hong, Y.K. Shong, 18F-fluorodeoxyglucose positron emission tomography does not predict malignancy in thyroid nodules cytologically diagnosed as follicular neoplasm. J. Clin. Endocrinol. Metab. 92, 1630–1634 (2007)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Francesco Bertagna
    • 1
    Email author
  • Giorgio Treglia
    • 2
  • Arnoldo Piccardo
    • 3
  • Elisabetta Giovannini
    • 2
  • Giovanni Bosio
    • 1
  • Giorgio Biasiotto
    • 4
  • El Khayat Bahij
    • 5
  • Roberto Maroldi
    • 5
  • Raffaele Giubbini
    • 1
  1. 1.Nuclear MedicineUniversity of Brescia and Spedali Civili di BresciaBresciaItaly
  2. 2.Nuclear MedicineCatholic University of Sacred HeartRomeItaly
  3. 3.Department of Nuclear MedicineOspedali GallieraGenoaItaly
  4. 4.Biomedical Technology DepartmentUniversity of BresciaBresciaItaly
  5. 5.Department of RadiologyUniversity of Brescia and Spedali Civili di BresciaBresciaItaly

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