Poller David N, Megadmi Hakim, Ward Matthew J A, Trimboli Pierpaolo
Departments of Cytology & Pathology, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
Department of Nuclear Medicine, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
Cancers (Basel). 2020 Nov 27;12(12):3544. doi: 10.3390/cancers12123544.
This study assesses the role of [F] FDG PET/CT, fine needle aspiration (FNA) cytology and ultrasound in the 1-2% of patients with focally positive thyroid nodules on FDG PET/CT. All FDG PET/CT scans with focally increased thyroid FDG PET/CT uptake performed over 37 months in one institution were matched to patients undergoing thyroid FNA. Diffuse FDG PET/CT uptake patients were excluded. A total of 47 patients showed focally increased thyroid uptake. Consistent with previous studies, 18 (38.2%) patients had malignancy-12 primary thyroid carcinoma, 1 parathyroid carcinoma, 3 metastatic carcinoma to the thyroid and 2 lymphoma. A total of 15 (31.9%) lesions categorized as non-malignant contained Hürthle cells/oncocytes. A total of 14 lesions (29.8%) had focally increased FDG PET/CT uptake with no specific cytological or histopathological cause identified. No focally PET avid Hürthle cell/oncocytic lesions were found to be malignant. Exclusion of oncocytic lesions increased the calculated risk of malignancy (ROM) of focally PET avid nodules from 38% to 68%. It may be useful to exclude focally FDG PET/CT avid Hürthle cell/oncocytic lesions, typically reported as follicular neoplasm or suspicious for a follicular neoplasm, Hürthle cell type (Oncocytic) type, RCPath Thy 3F: Bethesda IV or sometimes Thy 3a: Bethesda III FNAs) from ROM calculations. Oncocytic focally PET/CT FDG avid lesions appear of comparatively lower risk of malignancy and require investigation or operation but these lesions should be readily identified by FNA cytology on diagnostic work up of focally PET avid thyroid nodules.
本研究评估了[F] FDG PET/CT、细针穿刺（FNA）细胞学检查及超声在1-2%的FDG PET/CT检查显示甲状腺结节局部阳性患者中的作用。在一家机构37个月内进行的所有甲状腺FDG PET/CT摄取局部增加的FDG PET/CT扫描均与接受甲状腺FNA的患者进行匹配。弥漫性FDG PET/CT摄取的患者被排除。共有47例患者显示甲状腺摄取局部增加。与既往研究一致，18例（38.2%）患者患有恶性肿瘤，其中12例为原发性甲状腺癌，1例为甲状旁腺癌，3例为甲状腺转移癌，2例为淋巴瘤。共有15例（31.9%）分类为非恶性的病变含有许特莱细胞/嗜酸细胞。共有14个病变（29.8%）FDG PET/CT摄取局部增加，但未发现特定的细胞学或组织病理学原因。未发现PET局部摄取增高的许特莱细胞/嗜酸细胞性病变为恶性。排除嗜酸细胞性病变后，局部PET摄取增高结节的计算恶性风险（ROM）从38%增加到68%。在ROM计算中排除局部FDG PET/CT摄取增高的许特莱细胞/嗜酸细胞性病变（通常报告为滤泡性肿瘤或疑似滤泡性肿瘤、许特莱细胞型（嗜酸细胞型）、RCPath Thy 3F：贝塞斯达IV级或有时为Thy 3a：贝塞斯达III级FNA）可能是有用的。嗜酸细胞性局部PET/CT FDG摄取增高病变的恶性风险相对较低，需要进行检查或手术，但在对局部PET摄取增高的甲状腺结节进行诊断性检查时，这些病变应可通过FNA细胞学检查轻易识别。
