Abstract
Thyroid incidentalomas detected by 18 fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) are a real challenge for nuclear medicine physicians and clinicians. This study aimed to evaluate the risk of malignancy for patients with focal thyroid incidentalomas (TIs) diagnosed through FDG PET/CT. Data from 6900 patients, with a known primary tumor, who had an FDG PET/CT investigation performed were analyzed for the presence of incidental thyroid uptake. The focal TIs were reported, and the patients were referred for further investigation to the endocrinology department. There were 126 patients (1.82%) who presented with focal thyroid uptake, and for 87 of them, investigations were completed with ultrasonography (US), and for 29 with a fine needle aspiration biopsy (FNAB) procedure. Malignancy was detected in 7.93% (10/126) of cases. An arbitrary cutoff value of four was established for the standard uptake value lean body mass (SUVlbm Max) to differentiate the malignant nodules from the benign ones, and this value was significantly associated with malignancy (p = 0.0168). TIs are not so frequent, but they have a potential malignancy risk, and a proper evaluation is required. Even though SUVlbm Max is a predictive factor for malignancy, the FNAB remains the main diagnostic method for the therapeutic management of these patients.
Highlights
Thyroid incidentalomas (TIs) are one of the most common incidental findings on imaging studies.A TI is defined as an unexpected and asymptomatic thyroid nodule discovered accidentally during imaging studies or a surgical intervention performed for unrelated pathologies of the thyroid [1,2].It has been observed that thyroid nodules are common in clinical practice
Thyroid carcinoma incidence has been increasing, with an important impact on life quality [14], and TIs diagnosed on FDG positron emission tomography/computed tomography (PET/computed tomography (CT)) represent a subject of considerable interest and research [15]
Focal thyroid FDG uptake was found in 1.82% of oncologic PET/CT scans, with a malignancy rate of 7.93%
Summary
Thyroid incidentalomas (TIs) are one of the most common incidental findings on imaging studies.A TI is defined as an unexpected and asymptomatic thyroid nodule discovered accidentally during imaging studies or a surgical intervention performed for unrelated pathologies of the thyroid [1,2].It has been observed that thyroid nodules are common in clinical practice. Thyroid incidentalomas (TIs) are one of the most common incidental findings on imaging studies. A TI is defined as an unexpected and asymptomatic thyroid nodule discovered accidentally during imaging studies or a surgical intervention performed for unrelated pathologies of the thyroid [1,2]. It has been observed that thyroid nodules are common in clinical practice. Their prevalence largely depends on the method of screening and the population evaluated. Increasing age, female gender, iodine deficiency, and a history of head and neck radiation seem to increase the risk of thyroid nodules [3,4]. It is estimated that clinically unsuspected nodules have been discovered in 50–60%
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