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

Lioe-Fee de Geus-Oei1, Gerlach F.F.M. Pieters2, Johannes J. Bonenkamp3, Aart H. Mudde4, Chantal P. Bleeker-Rovers1, Frans H.M. Corstens1 and Wim J.G. Oyen1

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


Figure 1
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  		FIGURE 1.  In this 38-y-old woman, FNAB showed follicular proliferation. 18F-FDG PET demonstrated 2 lesions in right thyroid lobe. Final histopathologic diagnosis revealed right-sided pT3 follicular thyroid carcinoma and pT1 papillary thyroid carcinoma cranial from this lesion.

 

Figure 2
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  		FIGURE 2.  18F-FDG SUV for all 44 patients plotted against final histologic diagnosis. In this plot, SUV of invisible nodules on 18F-FDG PET was set at zero. SUV did not help to separate malignant from benign lesions, as indicated by distinct overlap.

 

Figure 3
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  		FIGURE 3.  Diagnostic algorithm including 18F-FDG PET. In existing diagnostic algorithm, nodules with inconclusive cytologic diagnosis must be removed, and hemithyroidectomy is necessary to allow reliable histologic diagnosis. In proposed diagnostic algorithm, 18F-FDG PET is implemented as shown.

 

Figure 4
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  		FIGURE 4.  This 42-y-old woman (patient 37) had inconclusive findings, with many atypical Hürthle cells, on FNAB. 18F-FDG PET showed intensely increased 18F-FDG uptake in right thyroid lobe. Histologic examination demonstrated 2.7-cm follicular adenoma with focal Hürthle cell changes.

 




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