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Indeterminate thyroid nodules. The role of 18F-FDG PET/CT in the “era” of ultrasonography risk stratification systems and new thyroid cytology classifications

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Abstract

Purpose

To evaluate the reliability of 18F-FDG PET/CT in distinguishing differentiated thyroid cancers (DTCs) and follicular neoplasms (FNs) from nodular hyperplasias (NH) in thyroid nodules with indeterminate cytology according to the Italian consensus for the classification and reporting of thyroid cytology (ICCRTC). We also tested whether the 18F-FDG PET/CT result was an independent risk factor for DTCs or FNs when sex, age, nodule dimensions, the European Thyroid Imaging and Reporting Data System (EU-TIRADS) and ICCRTC were considered.

Methods

We evaluated all patients with thyroid nodules and indeterminate cytology from September 2015 to May 2019; nodules were classified as low risk (TIR3A) and high risk (TIR3B) according to the ICCRTC. Neck ultrasonography features according to EU-TIRADS were re-evaluated and 18F-FDG PET/CT performed. All these patients were surgically treated.

Results

We included 111 patients; 67 nodules were classified as TIR3A and 44 as TIR3B. Overall, we found 27 DTCs, 57 NHs and 27 FNs. Among 73 FDG-negative nodules, we found four low-risk papillary thyroid cancers. All follicular thyroid cancers were identified by 18F-FDG-PET/CT. All TIR3A with low-risk US and negative 18F-FDG-PET/CT were NH. In TIR3A nodules, the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of 18F-FDG PET/CT and EU-TIRADS for DTCs were 77.8%, 41.4%, 92.3%, 17.1% and 66.7%, 56.9%, 91.7%, 19.4%, respectively. In TIR3B nodules, the sensitivity, specificity, NPV and PPV of 18F-FDG PET/CT and EU-TIRADS for DTCs were 88.9%, 38.5%, 83.3%, 50% and 88.2%, 58.3%, 87.5%, 60%, respectively. On multivariate analysis, 18F-FDG-PET/CT (OR 9.04), ICCRTC (O.R. 7.57) and EU-TIRADS (OR 4.41) were all independent risk factors associated to DTCs and FNs.

Conclusion

18F-FDG-PET/CT is a reliable rule-out test for DTC even in thyroid nodules with indeterminate high-risk results. In this subgroup, PPV also tends to be considerable. 18F-FDG-PET/CT results, ICCRTC and EU-TIRADS proved independent risk factors associated to DTCs and FNs.

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Author notes

  1. These authors contributed equally: Luca Giovanella, Pierpaolo Trimboli

Authors and Affiliations

  1. Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Arnoldo Piccardo, Gianluca Bottoni, Martina Ugolini & Martina Gatto

  2. Clinical Trial Research Unit, Galliera Hospital, Genoa, Italy

    Matteo Puntoni

  3. Department of Histopathology, Galliera Hospital, Genoa, Italy

    Marih Dezzana & Simona Sola

  4. Department of Internal Medicine, Galliera Hospital, Genoa, Italy

    Luca Foppiani

  5. Endocrinology Unit, Galliera Hospital, Genoa, Italy

    Alessandro Marugo

  6. Department of Surgery, Galliera Hospital, Genoa, Italy

    Ugo Catrambone

  7. Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Giorgio Treglia, Luca Giovanella & Pierpaolo Trimboli

  8. Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Giorgio Treglia

  9. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland

    Giorgio Treglia

Authors
  1. Arnoldo Piccardo
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  2. Matteo Puntoni
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  3. Marih Dezzana
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  4. Gianluca Bottoni
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  9. Simona Sola
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  10. Martina Gatto
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  11. Giorgio Treglia
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  12. Luca Giovanella
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  13. Pierpaolo Trimboli
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Corresponding author

Correspondence to Arnoldo Piccardo.

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All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Canton Ticino (Bellinzona, Switzerland). All patients gave their informed consent before participating in the study.

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Piccardo, A., Puntoni, M., Dezzana, M. et al. Indeterminate thyroid nodules. The role of 18F-FDG PET/CT in the “era” of ultrasonography risk stratification systems and new thyroid cytology classifications. Endocrine 69, 553–561 (2020). https://doi.org/10.1007/s12020-020-02239-y

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