HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Geus-Oei, L.-F. Articles by Oyen, W. J.G. Search for Related Content PubMed PubMed Citation Articles by de Geus-Oei, L.-F. Articles by Oyen, W. J.G.

¹⁸F-FDG PET Reduces Unnecessary Hemithyroidectomies for Thyroid Nodules with Inconclusive Cytologic Results

¹ Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; ² Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; ³ Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and ⁴ Department of Internal Medicine, Slingeland Hospital, Doetinchem, The Netherlands

Correspondence: For correspondence or reprints contact: Lioe-Fee de Geus-Oei, Department of Nuclear Medicine (internal postal code 444), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: L.degeus-oei{at}nucmed.umcn.nl

Fine-needle aspiration biopsy (FNAB) is inconclusive in up to 20% of patients with solitary thyroid nodules. In these cases, hemithyroidectomy is necessary, but only 20% of the nodules prove to be thyroid carcinoma. The aim of this study was to explore the potential of ¹⁸F-FDG PET to reduce the number of unnecessary hemithyroidectomies in the preoperative assessment of thyroid nodules with inconclusive FNAB results. Methods: Forty-four consecutive patients, scheduled for hemithyroidectomy because of inconclusive FNAB findings, participated in this prospective study. ¹⁸F-FDG PET of the thyroid region was performed before hemithyroidectomy, and standardized uptake values were calculated. The final histopathologic diagnosis served as a standard of reference. Results: Histopathologic examination of the surgical specimens revealed 7 well-differentiated thyroid carcinomas in 6 patients, all accumulating ¹⁸F-FDG (negative predictive value, 100%). ¹⁸F-FDG accumulated in 13 of 38 benign nodules. The pre-PET probability for cancer in this study population was 14% (6/44), and the post-PET probability increased to 32% (6/19). The percentage of unnecessary hemithyroidectomies in a hypothetical algorithm using ¹⁸F-FDG PET was only 30% (13/44), compared with 86% (38/44) without ¹⁸F-FDG PET. ¹⁸F-FDG PET reduced the number of futile hemithyroidectomies by 66% (25/38) (95% confidence interval, 49%–80%; Fisher's exact test, P = 0.0038). Semiquantitative analysis using standardized uptake values did not help to further reduce this number. Conclusion: In addition to data in the literature demonstrating accurate detection of thyroid cancer by ¹⁸F-FDG PET, this study showed that ¹⁸F-FDG PET should play an important role in the management of patients with inconclusive cytologic diagnosis of a thyroid nodule. ¹⁸F-FDG PET reduced the number of futile hemithyroidectomies by 66%. Although PET is a relatively costly procedure, this cost outweighs the costs and risks associated with unnecessary thyroid surgery.

Key Words: ¹⁸F-FDG PET • solitary thyroid nodules • inconclusive FNAB • thyroid neoplasms • hemithyroidectomy

This article has been cited by other articles:

				J. Y. Kwak, E.-K. Kim, M. Yun, A. Cho, M. J. Kim, E. J. Son, and K. K. Oh Thyroid Incidentalomas Identified by 18F-FDG PET: Sonographic Correlation Am. J. Roentgenol., August 1, 2008; 191(2): 598 - 603. [Abstract] [Full Text] [PDF]

				A. S Al-Zahrani, M.-E. M Abouzied, S. A. Salam, G. Mohamed, A. Rifai, A. Al Sugair, and T. Amin The role of F-18-fluorodeoxyglucose positron emission tomography in the postoperative evaluation of differentiated thyroid cancer Eur. J. Endocrinol., May 1, 2008; 158(5): 683 - 689. [Abstract] [Full Text] [PDF]

				C. Are, J. F. Hsu, R. A. Ghossein, H. Schoder, J. P. Shah, and A. R. Shaha Histological Aggressiveness of Fluorodeoxyglucose Positron-Emission Tomogram (FDG-PET)-Detected Incidental Thyroid Carcinomas Ann. Surg. Oncol., November 1, 2007; 14(11): 3210 - 3215. [Abstract] [Full Text] [PDF]

				F. M. Sebastianes, J. J. Cerci, P. H. Zanoni, J. Soares Jr., L. K. Chibana, E. K. Tomimori, R. Y. A. de Camargo, M. Izaki, M. C. P. Giorgi, J. Eluf-Neto, et al. Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in Preoperative Assessment of Cytologically Indeterminate Thyroid Nodules J. Clin. Endocrinol. Metab., November 1, 2007; 92(11): 4485 - 4488. [Abstract] [Full Text] [PDF]

				L. Giovanella, L. Ceriani, S. Crippa, and L. Mazzucchelli Langherans Cell Histiocytosis of the Thyroid Gland Detected by 18FDG-PET/CT J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 2866 - 2867. [Full Text] [PDF]

				J. M. Kim, J.-S. Ryu, T. Y. Kim, W. B. Kim, G. Y. Kwon, G. Gong, D. H. Moon, S. C. Kim, S. J. Hong, and Y. K. Shong 18F-Fluorodeoxyglucose Positron Emission Tomography Does Not Predict Malignancy in Thyroid Nodules Cytologically Diagnosed as Follicular Neoplasm J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1630 - 1634. [Abstract] [Full Text] [PDF]

				C. Martinez-Duncker and L.-M. Hurtado-Lopez 18F-FDG PET of Thyroid Nodules with Inconclusive Cytologic Results J. Nucl. Med., September 1, 2006; 47(9): 1555 - 1555. [Full Text] [PDF]

				L.-F. de Geus-Oei and W. J.G. Oyen Reply: 18F-FDG PET of Thyroid Nodules with Inconclusive Cytologic Results. J. Nucl. Med., September 1, 2006; 47(9): 1555a - 11556. [Full Text] [PDF]