Abstract
Incidental focal uptake of 18F-fluorodeoxyglucose (FDG) in the thyroid on positron emission tomography (PET/CT) is rare but often associated with malignancy. The epidemiology of thyroid incidentalomas has only to some extent been described in countries with iodine deficiency. Here we report data from Denmark, a country with known iodine deficiency and wide access to PET/CT. All FDG PET/CT comprising the head and neck region, during 2014, were retrospectively reviewed, and patients with focal FDG uptake in the thyroid gland were identified. A total of 2451 patients had an FDG PET/CT of which 59 (2.4%) patients presented with FDG-avid focal lesions in the thyroid gland. Among the 59 patients with FDG-avid lesions, 33 patients (56%) received work up with ultrasound, thyroid technetium scintigraphy, fine needle aspiration, and/or histology of which 20 patients had a conclusive pathology report. Ten patients with FDG-avid lesions were identified with thyroid malignancy. The risk of thyroid malignancy was 16.9% among patient with incidental FDG-avid thyroid lesions. Our findings indicated a similar frequency of FDG thyroid incidentalomas and malignancy rates in an iodine deficient population compared to summary data from prior studies, studies mostly performed in geographical areas of normal or excess iodine supplementation.
Highlights
Incidental imaging findings in a tissue or organ in patients without signs or symptoms of disease in that tissue are frequently occurring [1]
Patients presented with an incidental, focal FDG-avid lesion in the thyroid (Table 1)
Even though most thyroid cancers were detected in close relation to the initial work-up, we identified one patient with thyroid cancer, which was missed during the initial work-up but diagnosed within two years from the 18F-fluorodeoxyglucose positron emission tomography/computer tomography (PET/CT)
Summary
Incidental imaging findings in a tissue or organ in patients without signs or symptoms of disease in that tissue (incidentalomas) are frequently occurring [1]. Incidental findings with 18F-fluorodeoxyglucose positron emission tomography/computer tomography (FDG PET/CT) has been reported in several tissues [2], including colon [3], prostate [4], breast [5], and the adrenal glands [6]. A notable number of studies and systematic reviews have investigated the frequency and malignancy rate of FDG-avid thyroid incidentalomas in PET/CT [9,10,11,12]. Diagnostics 2018, 8, 46 of 32 original retrospective reports showed a median frequency of 2.3% of FDG-avid lesions in the populations studied, with thyroid cancer in nearly one in every three patients with focal FDG-avid thyroid lesions with follow up [12]. Iodine deficiency is present in several parts of the World, including many areas of Europe (e.g., Scandinavia), Middle
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