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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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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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