[18F]FDG-PET/CT to prevent futile surgery in indeterminate thyroid nodules: a blinded, randomised controlled multicentre trial

Abstract Purpose To assess the impact of an [18F]FDG-PET/CT-driven diagnostic workup to rule out malignancy, avoid futile diagnostic surgeries, and improve patient outcomes in thyroid nodules with indeterminate cytology. Methods In this double-blinded, randomised controlled multicentre trial, 132 adult euthyroid patients with scheduled diagnostic surgery for a Bethesda III or IV thyroid nodule underwent [18F]FDG-PET/CT and were randomised to an [18F]FDG-PET/CT-driven or diagnostic surgery group. In the [18F]FDG-PET/CT-driven group, management was based on the [18F]FDG-PET/CT result: when the index nodule was visually [18F]FDG-positive, diagnostic surgery was advised; when [18F]FDG-negative, active surveillance was recommended. The nodule was presumed benign when it remained unchanged on ultrasound surveillance. In the diagnostic surgery group, all patients were advised to proceed to the scheduled surgery, according to current guidelines. The primary outcome was the fraction of unbeneficial patient management in one year, i.e., diagnostic surgery for benign nodules and active surveillance for malignant/borderline nodules. Intention-to-treat analysis was performed. Subgroup analyses were performed for non-Hürthle cell and Hürthle cell nodules. Results Patient management was unbeneficial in 42% (38/91 [95% confidence interval [CI], 32–53%]) of patients in the [18F]FDG-PET/CT-driven group, as compared to 83% (34/41 [95% CI, 68–93%]) in the diagnostic surgery group (p < 0.001). [18F]FDG-PET/CT-driven management avoided 40% (25/63 [95% CI, 28–53%]) diagnostic surgeries for benign nodules: 48% (23/48 [95% CI, 33–63%]) in non-Hürthle cell and 13% (2/15 [95% CI, 2–40%]) in Hürthle cell nodules (p = 0.02). No malignant or borderline tumours were observed in patients under surveillance. Sensitivity, specificity, negative and positive predictive value, and benign call rate (95% CI) of [18F]FDG-PET/CT were 94.1% (80.3–99.3%), 39.8% (30.0–50.2%), 95.1% (83.5–99.4%), 35.2% (25.4–45.9%), and 31.1% (23.3–39.7%), respectively. Conclusion An [18F]FDG-PET/CT-driven diagnostic workup of indeterminate thyroid nodules leads to practice changing management, accurately and oncologically safely reducing futile surgeries by 40%. For optimal therapeutic yield, application should be limited to non-Hürthle cell nodules. Trial registration number This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544.

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Hürthle Cells on Fine-Needle Aspiration Cytology Are Important for Risk Assessment of Focally PET/CT FDG Avid Thyroid Nodules

Cancers ◽

10.3390/cancers12123544 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3544

Author(s):

David N. Poller ◽

Hakim Megadmi ◽

Matthew J. A. Ward ◽

Pierpaolo Trimboli

Keyword(s):

Fine Needle Aspiration ◽

Fdg Pet ◽

Thyroid Nodules ◽

Needle Aspiration ◽

Follicular Neoplasm ◽

Fine Needle ◽

Hürthle Cell ◽

Pet Ct ◽

Risk Of Malignancy ◽

Fdg Pet Ct

This study assesses the role of [18F] 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.

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18F-FDG PET/CT and Urothelial Carcinoma: Impact on Management and Prognosis—A Multicenter Retrospective Study

Cancers ◽

10.3390/cancers11050700 ◽

2019 ◽

Vol 11 (5) ◽

pp. 700 ◽

Cited By ~ 5

Author(s):

Fabio Zattoni ◽

Elena Incerti ◽

Fabrizio Dal Moro ◽

Marco Moschini ◽

Paolo Castellucci ◽

...

Keyword(s):

Overall Survival ◽

Urothelial Carcinoma ◽

Fdg Pet ◽

Patient Management ◽

Survival Prediction ◽

Primary Tumor Site ◽

Kaplan Meier ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Objectives: To evaluate the ability of 18F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict survivorship of patients with bladder cancer (BC) and/or upper urinary tract carcinoma (UUTC). Materials: Data from patients who underwent FDG PET/CT for suspicion of recurrent urothelial carcinoma (UC) between 2007 and 2015 were retrospectively collected in a multicenter study. Disease management after the introduction of FDG PET/CT in the diagnostic algorithm was assessed in all patients. Kaplan-Meier and log-rank analysis were computed for survival assessment. A Cox regression analysis was used to identify predictors of recurrence and death, for BC, UUTC, and concomitant BC and UUTC. Results: Data from 286 patients were collected. Of these, 212 had a history of BC, 38 of UUTC and 36 of concomitant BC and UUTC. Patient management was changed in 114/286 (40%) UC patients with the inclusion of FDG PET/CT, particularly in those with BC, reaching 74% (n = 90/122). After a mean follow-up period of 21 months (Interquartile range: 4–28 mo.), 136 patients (47.4%) had recurrence/progression of disease. Moreover, 131 subjects (45.6%) died. At Kaplan-Meier analyses, patients with BC and positive PET/CT had a worse overall survival than those with a negative scan (log-rank < 0.001). Furthermore, a negative PET/CT scan was associated with a lower recurrence rate than a positive examination, independently from the primary tumor site. At multivariate analysis, in patients with BC and UUTC, a positive FDG PET/CT resulted an independent predictor of disease-free and overall survival (p < 0,01). Conclusions: FDG PET/CT has the potential to change patient management, particularly for patients with BC. Furthermore, it can be considered a valid survival prediction tool after primary treatment in patients with recurrent UC. However, a firm recommendation cannot be made yet. Further prospective studies are necessary to confirm our findings.

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Dedicated neck 18 F‐FDG PET/CT: An additional tool for risk assessment in thyroid nodules at ultrasound intermediate risk

Clinical Endocrinology ◽

10.1111/cen.13949 ◽

2019 ◽

Vol 90 (5) ◽

pp. 737-743 ◽

Cited By ~ 2

Author(s):

Pierpaolo Trimboli ◽

Arnoldo Piccardo ◽

Maria Alevizaki ◽

Camilla Virili ◽

Mehrdad Naseri ◽

...

Keyword(s):

Risk Assessment ◽

Fdg Pet ◽

Thyroid Nodules ◽

Intermediate Risk ◽

Additional Tool ◽

Pet Ct ◽

Fdg Pet Ct

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Hounsfield unit value has null effect on thyroid nodules at 18F-FDG PET/CT scans

Archives of Endocrinology and Metabolism ◽

10.20945/2359-3997000000063 ◽

2018 ◽

Vol 62 (4) ◽

pp. 460-465

Author(s):

Filiz Eksi Haydardedeoglu ◽

Gulay Simsek Bagir ◽

Nese Torun ◽

Emrah Kocer ◽

Mehmet Reyhan ◽

...

Keyword(s):

Fdg Pet ◽

Thyroid Nodules ◽

Hounsfield Unit ◽

Ct Scans ◽

Null Effect ◽

Unit Value ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Value of FDG PET/CT in Patient Management and Outcome of Skeletal and Soft Tissue Sarcomas

PET Clinics ◽

10.1016/j.cpet.2015.03.003 ◽

2015 ◽

Vol 10 (3) ◽

pp. 375-393 ◽

Cited By ~ 20

Author(s):

Sara Sheikhbahaei ◽

Charles Marcus ◽

Nima Hafezi-Nejad ◽

Mehdi Taghipour ◽

Rathan M. Subramaniam

Keyword(s):

Soft Tissue ◽

Fdg Pet ◽

Patient Management ◽

Soft Tissue Sarcomas ◽

Pet Ct ◽

Fdg Pet Ct

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Initial [18F]FDG PET/CT in high-risk DTC patients

Nuklearmedizin ◽

10.3413/nukmed-0766-15-09 ◽

2016 ◽

Vol 55 (03) ◽

pp. 99-103 ◽

Cited By ~ 7

Author(s):

Ina Binse ◽

Andreas Bockisch ◽

Sandra Rosenbaum-Krumme ◽

Marcus Ruhlmann

Keyword(s):

High Risk ◽

Fdg Pet ◽

Patient Management ◽

Whole Body ◽

Prognostic Impact ◽

Full Remission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

SummaryIn a previous paper, we published the impact of initial [18F]FDG PET/CT (FDG-PET/CT) in high-risk patients with differentiated thyroid cancer (DTC) and described the changes in therapy management. The aim of the present study was to evaluate the prognostic impact of the initial FDG-PET/CT on a patient’s follow-up over three years and the rate of complete remission. Patients, methods: This study included 109 DTC patients who underwent radioiodine treatment (RIT), including posttherapeutic whole-body scintigraphy with FDG-PET/CT and a follow-up over three years. The follow-up included high-resolution sonography of the neck and determination of serum Tg as well as Tg antibodies every six months. The results of initial FDG-PET/CT and whole-body scintigraphy were compared with the status after three years of follow-up. Results: 24/109 patients (22%) presented FDG-positive lesions, 22/109 patients (20%) only iodine-positive lesions, and 63/109 patients (58%) neither FDG-positive nor iodine-positive lesions. After three years, 83/109 patients (76%) revealed full remission, 15/109 patients (14%) tumour persistence and 11/109 patients (10%) a progressive disease. The negative predictive value (NPV) was calculated for patients without FDG-positive lesions (NPV 85%) and patients without any lesions (NPV 91%) regarding full remission in the follow-up. Conclusion: FDG-PET/CT has a high NPV (85% to 91%) in DTC patients regarding recurrence-free follow-up after three years. The change in patient management in patients with iodine-negative lesions can lead to a higher rate of full remissions in the follow-up after additional surgery. Therefore, FDG-PET/ CT should be performed in all high-risk DTC patients in the context of the first RIT to improve patient management and risk stratification.

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