Author(s): Brindle R, Mullan D, Yap BK, Gandhi A
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Abstract AIMS: Increasing use of 18F-Fluorodeoxy glucose (FDG) Positron Emission Tomography Computed Tomography (PET CT) has resulted in an increased frequency of incidentally discovered areas of focally increased FDG uptake within the thyroid gland - thyroid incidentalomas. We aimed to compare radiological characteristics of thyroid incidentalomas with cytology, histology and ultrasound findings. MATERIALS AND METHODS: We examined all FDG PET CT scan reports for all patients undergoing this investigation over a 6 year period in a single tertiary cancer centre. All PET CT scans followed an agreed proforma allowing reports mentioning "thyroid" to be identified. Reports commenting on a positive finding within the thyroid gland were investigated further manually. Incidental mentions of thyroid with no underlying abnormality were discounted from analysis. RESULTS: In the study period, 7221 patients underwent FDG PET CT scanning in our unit. Within this group 75 (1\%) showed diffuse FDG uptake and 81 (1.1\%) showed focal uptake (thyroid incidentalomas). Only 30 patients (37\%) with incidentalomas had further investigation and malignancy rate was 23\% (7/30). Median Standardised Uptake Values (SUV) in malignant lesions was 9.9 (range 3.5-17.8) whilst in benign lesions and diffuse lesions it was 5.4 (2.8-32) and 4.2 (2.1-25.6) respectively (p = 0.0013, Kruskal Wallis). CONCLUSION: There remains a need to develop a standardised approach to the investigation and management of thyroid incidentalomas discovered on FDG PET CT scanning. Up to 1 in 4 of these patients will harbour thyroid malignancy. Copyright © 2014 Elsevier Ltd. All rights reserved.
This article was published in Eur J Surg Oncol
and referenced in Endocrinology & Metabolic Syndrome