甲状腺结节性质不明。在超声风险分层系统和新的甲状腺细胞病理学分类的“时代”，F-FDG PET/CT的作用
Indeterminate thyroid nodules. The role of F-FDG PET/CT in the "era" of ultrasonography risk stratification systems and new thyroid cytology classifications.
作者信息
Piccardo Arnoldo, Puntoni Matteo, Dezzana Marih, Bottoni Gianluca, Foppiani Luca, Marugo Alessandro, Catrambone Ugo, Ugolini Martina, Sola Simona, Gatto Martina, Treglia Giorgio, Giovanella Luca, Trimboli Pierpaolo
机构信息
Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy.
Clinical Trial Research Unit, Galliera Hospital, Genoa, Italy.
出版信息
Endocrine. 2020 Sep;69(3):553-561. doi: 10.1007/s12020-020-02239-y. Epub 2020 Mar 2.
PURPOSE
To evaluate the reliability of F-FDG PET/CT in distinguishing differentiated thyroid cancers (DTCs) and follicular neoplasms (FNs) from nodular hyperplasias (NH) in thyroid nodules with indeterminate cytology according to the Italian consensus for the classification and reporting of thyroid cytology (ICCRTC). We also tested whether the F-FDG PET/CT result was an independent risk factor for DTCs or FNs when sex, age, nodule dimensions, the European Thyroid Imaging and Reporting Data System (EU-TIRADS) and ICCRTC were considered.
METHODS
We evaluated all patients with thyroid nodules and indeterminate cytology from September 2015 to May 2019; nodules were classified as low risk (TIR3A) and high risk (TIR3B) according to the ICCRTC. Neck ultrasonography features according to EU-TIRADS were re-evaluated and F-FDG PET/CT performed. All these patients were surgically treated.
RESULTS
We included 111 patients; 67 nodules were classified as TIR3A and 44 as TIR3B. Overall, we found 27 DTCs, 57 NHs and 27 FNs. Among 73 FDG-negative nodules, we found four low-risk papillary thyroid cancers. All follicular thyroid cancers were identified by F-FDG-PET/CT. All TIR3A with low-risk US and negative F-FDG-PET/CT were NH. In TIR3A nodules, the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of F-FDG PET/CT and EU-TIRADS for DTCs were 77.8%, 41.4%, 92.3%, 17.1% and 66.7%, 56.9%, 91.7%, 19.4%, respectively. In TIR3B nodules, the sensitivity, specificity, NPV and PPV of F-FDG PET/CT and EU-TIRADS for DTCs were 88.9%, 38.5%, 83.3%, 50% and 88.2%, 58.3%, 87.5%, 60%, respectively. On multivariate analysis, F-FDG-PET/CT (OR 9.04), ICCRTC (O.R. 7.57) and EU-TIRADS (OR 4.41) were all independent risk factors associated to DTCs and FNs.
CONCLUSION
F-FDG-PET/CT is a reliable rule-out test for DTC even in thyroid nodules with indeterminate high-risk results. In this subgroup, PPV also tends to be considerable. F-FDG-PET/CT results, ICCRTC and EU-TIRADS proved independent risk factors associated to DTCs and FNs.
目的
根据意大利甲状腺细胞病理学分类与报告共识（ICCRTC），评估¹⁸F-FDG PET/CT在鉴别甲状腺细针穿刺活检结果不确定的甲状腺结节中的分化型甲状腺癌（DTC）、滤泡性肿瘤（FN）与结节性增生（NH）方面的可靠性。我们还检验了在考虑性别、年龄、结节大小、欧洲甲状腺影像报告和数据系统（EU-TIRADS）以及ICCRTC的情况下，¹⁸F-FDG PET/CT结果是否为DTC或FN的独立危险因素。
方法
我们评估了2015年9月至2019年5月期间所有甲状腺结节且细针穿刺活检结果不确定的患者；根据ICCRTC将结节分为低风险（TIR3A）和高风险（TIR3B）。重新评估了根据EU-TIRADS的颈部超声特征并进行了¹⁸F-FDG PET/CT检查。所有这些患者均接受了手术治疗。
结果
我们纳入了111例患者；67个结节被分类为TIR3A，44个为TIR3B。总体而言，我们发现了27例DTC、57例NH和27例FN。在73个¹⁸F-FDG阴性结节中，我们发现了4例低风险的乳头状甲状腺癌。所有滤泡状甲状腺癌均通过¹⁸F-FDG-PET/CT得以识别。所有具有低风险超声且¹⁸F-FDG-PET/CT阴性的TIR3A均为NH。在TIR3A结节中，¹⁸F-FDG PET/CT和EU-TIRADS对DTC的敏感性、特异性、阴性和阳性预测值（NPV、PPV）分别为77.8%、41.4%、92.3%、17.1%和66.7%、56.9%、91.7%、19.4%。在TIR3B结节中，¹⁸F-FDG PET/CT和EU-TIRADS对DTC的敏感性、特异性、NPV和PPV分别为88.9%、38.5%、83.3%、50%和88.2%、58.3%、87.5%、60%。多因素分析显示，¹⁸F-FDG-PET/CT（OR 9.04）、ICCRTC（OR 7.57）和EU-TIRADS（OR 4.41）均为与DTC和FN相关的独立危险因素。
结论
即使在细针穿刺活检结果为高风险不确定的甲状腺结节中，¹⁸F-FDG-PET/CT也是排除DTC的可靠检查方法。在这一亚组中，PPV也往往相当可观。¹⁸F-FDG-PET/CT结果、ICCRTC和EU-TIRADS被证明是与DTC和FN相关的独立危险因素。
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