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  • Title: Fluorine-18 fluorodeoxyglucose avid thyroid incidentalomas on PET/CT scan in cancer patients: how sinister are they?
    Author: Hassan A, Riaz S, Zafar W.
    Journal: Nucl Med Commun; 2016 Oct; 37(10):1069-73. PubMed ID: 27571130.
    Abstract:
    OBJECTIVE: To evaluate the prevalence of malignancy in incidental thyroidal uptake on PET with fluorine-18 deoxyglucose integrated with computed tomography (F-FDG PET/CT) in Pakistani cancer patients and to assess the role of standardized uptake value (SUV) in deciding which lesions to investigate further. METHOD: We retrospectively reviewed all patients who underwent F-FDG PET/CT scans over a period of 59 months and further analysed those with visually increased thyroidal uptake. Uptake was classified as focal or diffuse. RESULTS: Out of 10 012 F-FDG PET/CT scans done for evaluation of known, nonthyroid malignancies, 173 (1.7%) showed incidental thyroid uptake. Of these, 29 were malignant (33%; 24 focal, five diffuse) and 58 were benign (67%; 26 focal, 32 benign) cases. The prevalence of malignancy was significantly higher in cases of focal uptake (P=0.002). After controlling for sex, age, and SUV those with focal uptake were 6.5 times more likely to have malignancy compared with those with diffuse uptake. Odds ratio 6.5; 95% confidence interval 2.0-20.9; P less than 0.01. We found no correlation of SUV with the incidence or type of malignancy. CONCLUSION: Focal thyroid uptake on F-FDG PET/CT imaging should be sonographically correlated and if indicated with cytological analysis. Although diffuse uptake is usually benign, lymphoma is the leading malignant differential. Nonavid lesions have a low likelihood of malignancy.
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