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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

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Abstract

Purpose

A prostate-specific membrane antigen (PSMA) thyroid incidentaloma (PTI) is an unexpected, PSMA-avid thyroid lesion, newly detected during the investigation of an unrelated condition using PSMA PET/CT. The aim of this study is to examine the incidence and clinical significance of PTI and the associated management strategies since the implementation of the PSMA PET/CT scan.

Methods

This study involves a retrospective cohort study of 61 PTI cases depicted on PSMA PET/CT scans performed between January 2016 and July 2021, almost exclusively for (re)staging prostate cancer. The medical records of the included cases were retrospectively reviewed and data of the PSMA PET/CT scans, primary malignancy, thyroid diagnostics, treatment, and follow-up were collected.

Results

PTI was reported in 1.1% of the patients who underwent oncologic PSMA PET/CT scans included in this study. Two PTI cases had a histologically proven thyroid cancer: one a benign thyroid lesion and one a metastasis of a renal cell carcinoma. In none of the cases in whom any form of further thyroid workup was withheld, the PTI became clinically relevant during follow-up (median 1.8 years (1.1–3.3)). Six patients (10%) died due to their primary cancer.

Conclusion

The incidence of thyroid incidentalomas on PSMA PET/CT was low (1.1%) in this large, two-center experience. Less than half of the PTI cases were analyzed and the risk of malignancy, despite being low, was not negligible. The clinical outcome was good using a standard diagnostic workup for PTI, while the prognosis of the patient was determined by the primary malignancy. The consideration to analyze and treat PTI cases should be part of the shared decision-making in cancer patients.

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Authors and Affiliations

  1. Departments of Surgical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands

    Marceline W. Piek, Koen J. Hartemink & Iris M. C. van der Ploeg

  2. Departments of Surgery, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Lisa H. de Vries, Lutske Lodewijk & Menno R. Vriens

  3. Departments of Nuclear Medicine, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands

    Maarten L. Donswijk

  4. Departments of Nuclear Medicine, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Bart de Keizer

  5. Departments of Internal Medicine, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands

    Jan Paul de Boer

  6. Departments of Endocrine Oncology, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Rachel S. van Leeuwaarde

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  1. Marceline W. Piek
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Piek, M.W., de Vries, L.H., Donswijk, M.L. et al. 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 (2022). https://doi.org/10.1007/s00259-022-05679-y

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