PET/CT and prediction of thyroid cancer in patients with follicular neoplasm or atypia.

Abstract

To examine whether addition of 18F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) to fine needle aspiration biopsy (FNAB) would improve prediction of thyroid cancer in patients with FNAB-derived follicular neoplasm or atypia, classified according to focal, multifocal, diffuse, or no FDG uptake. Consecutive patients with FNAB-derived follicular neoplasm or atypia planned for surgery from September 2013 to March 2016 were prospectively included and considered for analysis. All patients underwent preoperative PET/CT and a clinical head and neck examination, including ultrasound of the neck and the thyroid gland. Patients with obvious signs of thyroid malignancy were excluded from the study. Histology of the surgical specimen was used as reference standard for statistical analysis. Of the 108 patients included (85 women, median age 53.4years), 31 (29%) had a thyroid nodule that was histologically verified as malignant. Sensitivity and specificity for PET/CT in detection of thyroid cancer was 79 and 32%, respectively, including a derived positive predictive value (PPV) of 31%, and a negative predictive value (NPV) of 79%. Univariate and multivariate analyses showed no significant increase in the risk of thyroid cancer among patients with focal or multifocal FDG uptake compared to patients with no FDG uptake. Addition of PET/CT to FNAB did not improve prediction of thyroid cancer in patients with FNAB-derived follicular neoplasm or atypia.