Abstract
BackgroundThyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland. Most recent scientific literature tends to demonstrate a detection rate of 0.1–4.3% for incidental findings of thyroid focal uptake identified by 18F-fluorodeoxyglugose Positron Emission Tomography with computed tomography (18FDG-PET/CT) initially prescribed for nonthyroid disease. From 10.3 to 80.0% of patients who underwent further evaluation are diagnosed with malignant lesions.Our first objective is to determine the risk of malignancy confined in thyroid incidentalomas(IT) detected on 18FDG-PET/CT in patients treated in a tertiary care center (Centre Hospitalier Universitaire de Sherbrooke). Second, we want to identify a cut-off value for SUVmax in order to distinguish benign from malignant IT. Third, we look for predictive criterion that can be outlined to help in their management.MethodsWe retrospectively reviewed 40 914 charts of patients who had a 18FDG-PET/CT done in a tertiary center from 2004 to 2014. For each patient where a thyroid incidentaloma has been identified, Maximum Standardized Uptake Value (SUVmax), ultrasound report, cytology and histopathological results as well as oncologic outcomes were compiled and analyzed.ResultsIn this study, the incidence for thyroid incidentaloma detected with 18FDG-PET/CT is 0.74%. The rate of malignancy present in IT is 8.2% based on histopathological results. Of the patients who underwent surgery, thyroid malignancy was identified in 54.3% of them. Cytoponction showed a strong correlation with final histopathological results (p = 0.009).ConclusionThyroid incidentalomas detected with 18FDG-PET/CT are relatively infrequent, but the potential risk of malignancy remains elevated. Fine needle aspiration biopsy is the investigation of choice to rule out a malignant incidentaloma when there is no other element in the clinical portrait to preclude such additional work up.
Highlights
Thyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland
This type of lesion can be identified during a neck surgery unrelated to the thyroid. 18F-fluorodeoxyglugose Positron Emission Tomography with computed tomography (18FDG-PET/ CT) is a nuclear medicine imaging technique based on glucose hypermetabolism from malignant cells
1369 patients were extracted after we questioned CIRESS data bank with the keywords in french «thyroid», «thyroid nodule» and «thyroid incidentalomas» to be written in the nuclear medicine final report
Summary
Thyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland. Thyroid incidentaloma (TI) is defined as a thyroid gland lesion fortuitously discovered during radiology exams, like computed tomography or ultrasound This type of lesion can be identified during a neck surgery unrelated to the thyroid. While a recent meta-analysis identified a rate of malignancy of 19.8% [4], in other studies, the prevalence of TI detected by 18FDG-PET/CT ranged from 0.1 to 4.3% and the risk of malignancy stands between 10.3 and 80.0% [5,6,7,8,9,10,11,12] In this retrospective study, we benefit from Sherbrooke’s significant experience with 18FDG-PET/CT to review the data related to thyroid incidentalomas and to estimate the risk of malignancy for such lesions. We aimed to generate a clinical management algorithm for this day-to-day situation
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