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FIGURE 2. A 58-y-old patient (oxyphilic, follicular, pT3 N0 M0 G2), who had undergone total thyroidectomy and ablative radioiodine treatment 2 y earlier, presented with markedly elevated TG level but without any iodine accumulation. Sonography-guided fine-needle aspiration biopsy of a suggestive cervical lymph node revealed cells suggestive of tumor. Preoperative PET showed intense 18F-FDG uptake in the suspected, left cervical lymph node as demonstrated on the coronal slice (A). However, PET detected a second tumor focus that was located more caudally. For this second tumor, shown on the transverse PET slice (B), no corresponding abnormality could be localized on CT images (C). Only by fusion of PET and CT images (D) could the second lesion be precisely identified (located between esophagus and dorsolateral trachea) and be removed surgically. Histopathology revealed a 5-mm lymph node metastasis. At 2 y after surgery, the patient had no tumor recurrence.
