Abstract
BackgroundThe indeterminate fine needle aspiration biopsy (FNAB) results present a clinical dilemma for physicians. The aim of this study was to evaluate the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography (18 F-FDG PET) in the detection of these indeterminate lesions.MethodsSeven studies (involving a total of 267 patients) published before November 2012 were reviewed. Systematic methods were used to identify, select, and evaluate the methodological quality of the studies as well as to summarize the overall findings of sensitivity and specificity.ResultsA total number of 70 patients were confirmed to have malignant lesions, with a cancer prevalence of 26.2% (70/267; ranging from 19.6% to 40.0% in these studies). The pooled sensitivity and specificity of PET or PET/CT for the detection of cancer was 89.0% (95% CI: 79.0% ~ 95.0%) and 55.0% (95% CI: 48.0% ~ 62.0%), respectively. There was no evidence of threshold effects or publication bias. The area [±standard error (±SE)] under the symmetrical sROC curve was 0.7207 ± 0.1041. Although SUVmax was higher in malignant lesions (P < 0.01), there was still a great overlap. The best cut-off value of SUVmax for differentiation was 2.05; but with a high sensitivity of 89.8% and low specificity of 42.0%.ConclusionF-FDG PET or PET/CT showed a high sensitivity in detecting thyroid cancers in patients with indeterminate FNAB results. Further examination was strongly recommended when an FDG-avid lesion was detected.
Highlights
The indeterminate fine needle aspiration biopsy (FNAB) results present a clinical dilemma for physicians
The overall LR+, LR- and diagnostic odds ratio (DOR) were 1.87, 0.24 and 8.15, respectively
SUVmax was higher in malignant lesions (8.6 ± 7.0 vs 5.0 ± 4.3; P < 0.01), there was still a great overlap
Summary
The indeterminate fine needle aspiration biopsy (FNAB) results present a clinical dilemma for physicians. Thyroid cancer is the most common endocrine malignancy. Current guidelines recommend performing fine needle aspiration biopsy (FNAB) for nodules with a diameter larger than 5 mm to 20 mm, depending on patient clinical history and presence of suspicious ultrasonographic findings [3]. A number of reports have shown that between 11% and 42% of FNABs of thyroid lesions are reported as indeterminate [4,5,6] These cytological indeterminate nodules present a clinical dilemma to the evaluating clinician. Patients with indeterminate or suspicious FNAB results have to undergo diagnostic hemithyroidectomy to exclude malignancy [7]. Because only 20% to 30% of these nodules are malignant [8], most patients are undergoing unnecessary thyroid surgery with the potential risk of irreversible complications
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
