Brindle R, Mullan D, Yap B K, Gandhi A
North West Deanery, Manchester, UK.
The Christie NHS Foundation Trust, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
Eur J Surg Oncol. 2014 Nov;40(11):1528-32. doi: 10.1016/j.ejso.2014.05.005. Epub 2014 May 24.
Increasing use of 18F-Fluorodeoxy glucose (FDG) Positron Emission Tomography Computed Tomography (PET CT) has resulted in an increased frequency of incidentally discovered areas of focally increased FDG uptake within the thyroid gland - thyroid incidentalomas. We aimed to compare radiological characteristics of thyroid incidentalomas with cytology, histology and ultrasound findings.
We examined all FDG PET CT scan reports for all patients undergoing this investigation over a 6 year period in a single tertiary cancer centre. All PET CT scans followed an agreed proforma allowing reports mentioning "thyroid" to be identified. Reports commenting on a positive finding within the thyroid gland were investigated further manually. Incidental mentions of thyroid with no underlying abnormality were discounted from analysis.
In the study period, 7221 patients underwent FDG PET CT scanning in our unit. Within this group 75 (1%) showed diffuse FDG uptake and 81 (1.1%) showed focal uptake (thyroid incidentalomas). Only 30 patients (37%) with incidentalomas had further investigation and malignancy rate was 23% (7/30). Median Standardised Uptake Values (SUV) in malignant lesions was 9.9 (range 3.5-17.8) whilst in benign lesions and diffuse lesions it was 5.4 (2.8-32) and 4.2 (2.1-25.6) respectively (p = 0.0013, Kruskal Wallis).
There remains a need to develop a standardised approach to the investigation and management of thyroid incidentalomas discovered on FDG PET CT scanning. Up to 1 in 4 of these patients will harbour thyroid malignancy.
18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描计算机断层扫描（PET CT）的使用日益增加，导致甲状腺内偶然发现的FDG摄取局部增加区域——甲状腺偶发瘤的频率上升。我们旨在比较甲状腺偶发瘤的放射学特征与细胞学、组织学及超声检查结果。
我们检查了在一个单一的三级癌症中心6年期间接受该检查的所有患者的所有FDG PET CT扫描报告。所有PET CT扫描均遵循一致的格式，以便识别提及“甲状腺”的报告。对提及甲状腺内阳性发现的报告进行进一步人工调查。分析中排除无潜在异常的甲状腺偶然提及情况。
在研究期间，我们科室有7221例患者接受了FDG PET CT扫描。在该组中，75例（1%）显示弥漫性FDG摄取，81例（1.1%）显示局灶性摄取（甲状腺偶发瘤）。仅有30例（37%）偶发瘤患者进行了进一步检查，恶性率为23%（7/30）。恶性病变的标准化摄取值（SUV）中位数为9.9（范围3.5 - 17.8），而良性病变和弥漫性病变的SUV中位数分别为5.4（2.8 - 32）和4.2（2.1 - 25.6）（p = 0.0013，Kruskal Wallis检验）。
仍需制定一种标准化方法，用于对FDG PET CT扫描中发现的甲状腺偶发瘤进行检查和管理。这些患者中多达四分之一可能患有甲状腺恶性肿瘤。
