Hagenimana N, Dallaire J, Vallée É, Belzile M
Division of Otorhinolaryngology and Head & Neck Surgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Department of Nuclear Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
J Otolaryngol Head Neck Surg. 2017 Mar 21;46(1):22. doi: 10.1186/s40463-017-0200-8.
Thyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland. Most recent scientific literature tends to demonstrate a detection rate of 0.1-4.3% for incidental findings of thyroid focal uptake identified by F-fluorodeoxyglugose Positron Emission Tomography with computed tomography (FDG-PET/CT) initially prescribed for nonthyroid disease. From 10.3 to 80.0% of patients who underwent further evaluation are diagnosed with malignant lesions. Our first objective is to determine the risk of malignancy confined in thyroid incidentalomas(IT) detected on FDG-PET/CT in patients treated in a tertiary care center (Centre Hospitalier Universitaire de Sherbrooke). Second, we want to identify a cut-off value for SUVmax in order to distinguish benign from malignant IT. Third, we look for predictive criterion that can be outlined to help in their management.
We retrospectively reviewed 40 914 charts of patients who had a FDG-PET/CT done in a tertiary center from 2004 to 2014. For each patient where a thyroid incidentaloma has been identified, Maximum Standardized Uptake Value (SUVmax), ultrasound report, cytology and histopathological results as well as oncologic outcomes were compiled and analyzed.
In this study, the incidence for thyroid incidentaloma detected with FDG-PET/CT is 0.74%. The rate of malignancy present in IT is 8.2% based on histopathological results. Of the patients who underwent surgery, thyroid malignancy was identified in 54.3% of them. Cytoponction showed a strong correlation with final histopathological results (p = 0.009).
Thyroid incidentalomas detected with FDG-PET/CT are relatively infrequent, but the potential risk of malignancy remains elevated. Fine needle aspiration biopsy is the investigation of choice to rule out a malignant incidentaloma when there is no other element in the clinical portrait to preclude such additional work up.
甲状腺偶发瘤是指在影像学检查或进行与甲状腺无关的手术时意外发现的甲状腺病变。最新科学文献表明，最初因非甲状腺疾病而进行氟脱氧葡萄糖正电子发射断层扫描联合计算机断层扫描（FDG-PET/CT）检查时，甲状腺局灶性摄取偶发发现的检出率为0.1%-4.3%。在接受进一步评估的患者中，10.3%-80.0%被诊断为恶性病变。我们的首要目标是确定在三级医疗中心（舍布鲁克大学医院中心）接受治疗的患者中，通过FDG-PET/CT检测到的甲状腺偶发瘤（IT）的恶性风险。其次，我们想确定SUVmax的临界值，以区分良性和恶性IT。第三，我们寻找可概述的预测标准，以帮助对其进行管理。
我们回顾性分析了2004年至2014年在一家三级中心进行FDG-PET/CT检查的40914例患者的病历。对于每例发现甲状腺偶发瘤的患者，收集并分析最大标准化摄取值（SUVmax）、超声报告、细胞学和组织病理学结果以及肿瘤学结局。
在本研究中，FDG-PET/CT检测到甲状腺偶发瘤的发生率为0.74%。根据组织病理学结果，IT中的恶性率为8.2%。在接受手术的患者中，54.3%被发现患有甲状腺恶性肿瘤。细针穿刺与最终组织病理学结果显示出强烈相关性（p = 0.009）。
通过FDG-PET/CT检测到的甲状腺偶发瘤相对少见，但恶性风险仍然较高。当临床情况中没有其他因素排除进一步检查时，细针穿刺活检是排除恶性偶发瘤的首选检查方法。
