Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France.
INSERM 1086 ANTICIPE, Caen University, Caen, France.
Thyroid. 2021 May;31(5):800-809. doi: 10.1089/thy.2020.0555. Epub 2020 Dec 23.
Refining the risk of malignancy in patients presenting with thyroid nodules with indeterminate cytology (IC) is a critical challenge. We investigated the performances of F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) to predict malignancy. Between May 2016 and March 2019, 107 patients presenting with a thyroid nodule ≥15 mm with IC and eligible for surgery were included in this prospective study. Head-and-neck PET/CT acquisitions were performed 20 and 60 minutes after injection of 1.5 MBq/kg of FCH. PET/CT acquisition was scored positive when maximal standardized uptake value in the IC nodule was higher than in the thyroid background. Pathology was the gold standard for diagnosis. At pathology, 19 (18%) nodules were malignant, 87 were benign, and one was a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Sensitivity, specificity, accuracy, positive-predictive value (PPV), and negative-predictive value (NPV) of FCH PET/CT in detecting cancer or NIFTP were 90%, 50%, 55%, 29%, and 96% at 20 minutes and 85%, 49%, 67%, 28%, and 94% at 60 minutes, respectively. Higher specificity (58% vs. 33%, = 0.01) was observed in nononcocytic ( = 72) than in oncocytic IC nodules ( = 35). The pre-PET/CT probability of cancer or NIFTP in Bethesda III-IV nodules was 11% and the post-PET/CT probability was 19% in PET-positives and 0% in PET-negatives. In retrospective analysis, 42% of surgeries would have been unnecessary after PET/CT and 81% before ( < 0.001), resulting in a hypothetical 48% reduction (95% confidence interval [32-64]). FCH PET/CT offers high NPV to reliably exclude cancer in PET-negative IC nodules, but suffers from low PPV, particularly in those with oncocytic cytology. ClinicalTrials.gov identifier: NCT02784223.
在具有不确定细胞学（IC）的甲状腺结节患者中，提高恶性肿瘤风险的准确性是一个关键挑战。我们研究了 F-氟胆碱（FCH）正电子发射断层扫描/计算机断层扫描（PET/CT）预测恶性肿瘤的性能。 2016 年 5 月至 2019 年 3 月期间，纳入了 107 例具有 15mm 以上 IC 并适合手术的甲状腺结节患者进行前瞻性研究。在注射 1.5MBq/kg FCH 后 20 分钟和 60 分钟进行头颈部 PET/CT 采集。当 IC 结节的最大标准化摄取值高于甲状腺背景时，将 PET/CT 采集评分阳性。病理学是诊断的金标准。 在病理上，19 个（18%）结节为恶性，87 个为良性，1 个为无侵袭性滤泡性甲状腺肿瘤伴乳头状核特征（NIFTP）。20 分钟时，FCH PET/CT 检测癌症或 NIFTP 的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为 90%、50%、55%、29%和 96%，60 分钟时分别为 85%、49%、67%、28%和 94%。在非嗜酸细胞性（ = 72）IC 结节中观察到更高的特异性（58%比 33%， = 0.01），而在嗜酸细胞性 IC 结节中为 35%。Bethesda III-IV 级结节的术前癌症或 NIFTP 概率为 11%，PET 阳性的术后概率为 19%，PET 阴性的概率为 0%。在回顾性分析中，PET/CT 后有 42%的手术是不必要的，而在 PET/CT 前有 81%是不必要的（ < 0.001），假设减少了 48%（95%置信区间 [32-64]）。 FCH PET/CT 提供了高度的阴性预测值，可以可靠地排除 PET 阴性 IC 结节中的癌症，但阳性预测值较低，特别是在具有嗜酸细胞细胞学的结节中。临床试验标识符：NCT02784223。
