Citation Information :
Bozin M, Callahan J, Drummond E, Henderson M, Skandarajah A. Predicting Malignancy in FDG-avid Thyroid Nodules based on Standardized Uptake Value in Oncology Patients. World J Endoc Surg 2021; 13 (2):42-46.
Aim and objective: Concomitant thyroid nodules and cancer found incidentally on 18-fluorodeoxyglucose(FDG) positron-emission tomography (PET-CT) in patients imaged for investigation or staging of malignancy have been progressively encountered. Maximum SUV (SUV-max) may aid diagnosis of concomitant thyroid malignancy.Materials and methods: PET/CT scans were reviewed between2009 and 2014 in whichFDG-avid thyroid incidentalomas were included. Patients who were investigated with biopsy or surgery were further assessed to determine the utility ofSUV-max, mean, and nodule size as a determinate of malignancy.Results: A total of 325 of35,586 patientswere identified with FDG-avidthyroid incidentalomas (TI)–99 wereinvestigated. The incidence was 0.88%.Forty nine were malignant, with a median SUV-max of 14.5(range 2.7–60.4).Malignant nodules had higher median SUV-max than benign nodules at a threshold of 5 (p< 0.0001).Receiver operator curve (ROC) analysis demonstrated an area under the curve of 0.66(95%CI 0.55–0.77, p= 0.005).The sensitivity and specificity were 73.4 and46.9,respectively. The positive and negative likelihood ratio was 3.12(95%CI 1.80–5.50) and a negative likelihood ratio of 0.38.Conclusion: As FDG-avidTI can demonstrate variable uptake, SUV-maxis not a useful tool to discriminate benign from malignant TI. SUV-maxshould remain a theoretical adjunctive tool for predicting thyroid cancer.Clinical significance: The threshold for investigating PET-avidthyroid nodules with ultrasound and FNAC (in the context of primary nonthyroidal malignancy) should be determined by the prognosis of the primary malignancy.
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