Endocrinology and Metabolism

Original Article

Thyroid
Risk of Malignancy in Thyroid Incidentalomas Identified by Fluorodeoxyglucose-Positron Emission Tomography: A Reum Chun, Hye Min Jo, Seoung Ho Lee, Hong Woo Chun, Jung Mi Park, Kyu Jin Kim, Chan Hee Jung, Ji Oh Mok, Sung Koo Kang, Chul Hee Kim, Bo Yeon Kim; Endocrinol Metab. 2015;30(1):71-77. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.71

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Background

Thyroid incidentalomas detected by 2-deoxy-2-¹⁸F-fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUV_max) in ¹⁸F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy.

Methods

A total of 2,584 subjects underwent ¹⁸F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects.

Results

Of the 2,584 subjects who underwent ¹⁸F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUV_max was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).

Conclusion

Thyroid incidentalomas found on ¹⁸F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUV_max tended to be malignant.

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Review Article

Adrenal gland
Differential Diagnosis of Adrenal Mass Using Imaging Modality: Special Emphasis on F-18 Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography: Hong Je Lee, Jaetae Lee; Endocrinol Metab. 2014;29(1):5-11. Published online March 14, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.1.5

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30 Download
7 Web of Science
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Abstract PDF PubReader

Adrenal incidentalomas are adrenal masses serendipitously detected during an imaging study performed for reasons unrelated to suspicion of adrenal disease. The incidence of adrenal incidentalomas has increased because of the widespread use of various imaging modalities. In oncology patients with adrenal incidentalomas, the characterization of the adrenal masses is challenging because nearly 50% of incidental adrenal masses are metastatic lesions that need special medical attention. Although unenhanced computed tomography (CT) densitometry, chemical shift magnetic resonance imaging (MRI), delayed contrast-enhanced CT and CT histogram analysis have been used as sensitive and specific modalities for differentiating benign from malignant adrenal masses, F-18 fluoro-2-deoxy-D-glucose positron emission tomography (F-18 FDG PET)/CT is a highly accurate imaging modality compared to CT or MRI, especially when these two imaging modalities are combined. In addition, a semiquantitative analysis using standardized uptake value ratio further improves the diagnostic accuracy of F-18 FDG PET/CT in differentiating benign from malignant adrenal masses. Thus, F-18 FDG PET/CT is very helpful for determining the best therapeutic management, especially for assessing the need for surgery.

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