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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

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