Pozitron emisyon tomografi-bilgisayarlı tomografide insidental saptanan tiroid nodüllerinin ultrasonografi ve patoloji sonuçlarının değerlendirilmesi: Tek merkez sonuçları

Öz

Amaç: Bu çalışmada, 18F-FDG PET-BT’de tiroid insidentaloması saptanan hastaların tiroid patolojilerini belirlemek, klinik, görüntüleme, histopatoloji ve cerrahi tedavi sonuçlarını ortaya koymak ve 18F-FDG tutulum paternleri ile Maksimum Standart Uptake Değerleri (SUVmax) arasındaki ilişkiyi değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Ocak 2021 ile Şubat 2024 tarihleri arasında herhangi bir nedenle PET-BT çekilen 1837 hastanın verileri retrospektif olarak analiz edilmiştir. Dahil edilme kriterlerini karşılayan hastaların demografik verileri, ultrasonografi (USG) ve 18F-FDG PET-BT görüntüleri ile cerrahi ve histopatolojik bulguları incelenmiştir. Bulgular: Tiroid tutulumu saptanan 71 hasta USG ile değerlendirilmiş ve 46 hastada (%2,5) tiroid nodülü tespit edilmiştir. İnce iğne aspirasyon biyopsisi (İİAB) yapılan 22 nodülden 12’si benign olarak raporlanmıştır. Cerrahi uygulanan 6 nodülün (2’si Bethesda V, 3’ü Bethesda VI ve 1’i Bethesda III) üçü benign, diğer üçü (%13,6) ise malign (papiller tiroid karsinomu) olarak sonuçlanmıştır. Fokal tutulum gösteren nodüllerde malignite oranı %16,6 (3/18) olarak belirlenmiştir. Benign ve malign nodüllerin ortanca SUVmax değerleri arasında istatistiksel olarak anlamlı fark saptanmamıştır (p = 0,164). Sonuç: Özellikle 18F-FDG PET-BT görüntülemesinde fokal tiroid tutulumu saptanan hastalarda tanısal inceleme gerekliliğinin belirlenmesi, bu müdahalelerin sonuçlarının ortaya konulması ve farkındalığın artırılması önemlidir. Ultrasonografik olarak riskli değerlendirilen nodüllerde, SUVmax değerinden bağımsız olarak İİAB yapılması gerektiği düşünülmektedir.

Anahtar Kelimeler

• pozitron emisyon tomografi-bilgisayarlı tomografi
• tiroid nodülü
• ultrasonografi

Evaluation of ultrasonography and pathology results of incidental thyroid nodules detected on positron emission tomography- computed tomography: Single center results

Öz

Aim: We aimed to determine the thyroid pathologies of patients with thyroid incidentalomas detected on 18F-FDG PET-CT, to obtain clinical, imaging, histopathology, and surgical treatment results, and to reveal the relationship between 18F-FDG uptake patterns and Maximum Standard Uptake Values (SUVmax) and diagnostic results. Material and Methods: Data from 1,837 patients who underwent PET-CT for any reason between January 2021 and February 2024 were retrospectively analyzed. Demographic data, ultrasonography (USG), 18F-FDG PET-CT images, and surgical and histopathological data of all patients meeting the inclusion criteria were reviewed. Results: Patients with uptake (n = 71) were evaluated with US, and thyroid nodules were detected in 46 patients (46/1837) (2.5%). Of the 22 nodules that underwent fine needle aspiration biopsy (FNAB), 12 were diagnosed with benign pathology. Among the six nodules that underwent surgery (2 Bethesda V, 3 Bethesda VI, and 1 Bethesda III), three were confirmed as benign, while the other three (13.6%) were diagnosed as malignant (papillary thyroid carcinoma). The malignancy rate in nodules with focal uptake was 16.6% (3/18). No statistically significant difference was observed in the median SUVmax values between benign and malignant nodules (p = 0.164). Conclusion: It is essential to determine the need for diagnostic evaluations, reveal the outcomes of diagnostic interventions, and raise awareness, especially in patients with focal thyroid uptake observed on 18F-FDG PET-CT imaging. When focal uptake is detected on 18F-FDG PET-CT, it is crucial to perform FNAB if the nodule is considered risky on US, regardless of the SUVmax value.

Anahtar Kelimeler

• positron emission tomography-computed tomography
• thyroid nodule
• ultrasonography

Kaynakça

1. Erdoğan M, Atlı T, Ekinci C, Genç Y, Gökmen H, Erdoğan G. Spectrum and prevalence of thyroid disorders in the elderly living in an iodine deficient community. Turk J Geriatr 2002; 5: 49-53.
2. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74: 229-63.
3. Treglia G, Bertagna F, Sadeghi R, Verburg FA, Ceriani L, Giovanella L. Focal thyroid incidental uptake detected by (18)F-fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk. Nuklearmedizin 2013; 52: 130-6.
4. Bertagna F, Treglia G, Piccardo A, Giubbini R. Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J Clin Endocrinol Metab 2012; 97: 3866-75.
5. Signore G, Albano D, Giovanella L, Bertagna F, Treglia G. Evidence-based data about prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals. Curr Radiopharm 2020; 13: 89-93.
6. Vriens D, de Wilt JH, van der Wilt GJ, Netea-Maier RT, Oyen WJ, de Geus-Oei LF. The role of [18F]-2-fluoro-2-deoxy-d-glucose-positron emission tomography in thyroid nodules with indeterminate fine-needle aspiration biopsy: systematic review and meta-analysis of the literature. Cancer 2011; 117: 4582-94.
7. Russ G, Bonnema SJ, Erdogan MF, Durante C, Ngu R, Leenhardt L. European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults: The EU-TIRADS. Eur Thyroid J 2017; 6: 225-37.
8. Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for reporting thyroid cytopathology. J Am Soc Cytopathol 2023; 12: 319-25.

9. de Leijer JF, Metman MJH, van der Hoorn A, Brouwers AH, Kruijff S, van Hemel BM et al. Focal Thyroid Incidentalomas on (18)F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration. Front Endocrinol (Lausanne) 2021; 12: 723394.
10. Kang KW, Kim SK, Kang HS, Lee ES, Sim JS, Lee IG et al. Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects. J Clin Endocrinol Metab 2003; 88: 4100-4.
11. Bae JS, Chae BJ, Park WC, Kim JS, Kim SH, Jung SS et al. Incidental thyroid lesions detected by FDG-PET/CT: prevalence and risk of thyroid cancer. World J Surg Oncol 2009; 7: 63.
12. Kim TY, Kim WB, Ryu JS, Gong G, Hong SJ, Shong YK. 18F-fluorodeoxyglucose uptake in thyroid from positron emission tomogram (PET) for evaluation in cancer patients: high prevalence of malignancy in thyroid PET incidentaloma. Laryngoscope 2005; 115: 1074-8.
13. Are C, Hsu JF, Schoder H, Shah JP, Larson SM, Shaha AR. FDG-PET detected thyroid incidentalomas: need for further investigation? Ann Surg Oncol 2007; 14: 239-47.
14. Bogsrud TV, Karantanis D, Nathan MA, Mullan BP, Wiseman GA, Collins DA et al. The value of quantifying 18F-FDG uptake in thyroid nodules found incidentally on whole-body PET-CT. Nucl Med Commun 2007; 28: 373-81.
15. Kresnik E, Gallowitsch HJ, Mikosch P, Stettner H, Igerc I, Gomez I et al. Fluorine-18-fluorodeoxyglucose positron emission tomography in the preoperative assessment of thyroid nodules in an endemic goiter area. Surgery 2003; 133: 294-9.
16. Do Cao C, Haissaguerre M, Lussey-Lepoutre C, Donatini G, Raverot V, Russ G. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules: Initial work-up for thyroid nodules. Ann Endocrinol (Paris) 2022; 83: 380-8.
17. Trimboli P, Paone G, Treglia G, Virili C, Ruberto T, Ceriani L et al. Fine-needle aspiration in all thyroid incidentalomas at (18) F-FDG PET/CT: Can EU-TIRADS revise the dogma? Clin Endocrinol (Oxf) 2018; 89: 642-8.
18. Wadsley J, Balasubramanian SP, Madani G, Munday J, Roques T, Rowe CW et al. Consensus statement on the management of incidentally discovered FDG avid thyroid nodules in patients being investigated for other cancers. Clin Endocrinol 2024; 101: 557-61.
19. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26: 1-133.
20. Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1: 1-122.
21. McCrory D, Li C, Devlin B. Five-year review of incidental thyroid nodule management in the ENT outpatient department. Ann Thyroid 2023; 8: 12.
22. Thuillier P, Roudaut N, Crouzeix G, Cavarec M, Robin P, Abgral R et al. Malignancy rate of focal thyroid incidentaloma detected by FDG PET-CT: results of a prospective cohort study. Endocr Connect 2017; 6: 413-21.
23. Elzein S, Ahmed A, Lorenz E, Balasubramanian SP. Thyroid incidentalomas on PET imaging--evaluation of management and clinical outcomes. Surgeon 2015; 13: 116-20.
24. Li H, Wang Z, Liu JS, Zou BS, Chen HR, Xu Z et al. Association Between Breast and Thyroid Lesions: A Cross-Sectional Study Based on Ultrasonography Screening in China. Thyroid 2020; 30: 1150-8.
25. Ma CY, Liang XY, Ran L, Hu L, Zeng FL, She RL et al. Prevalence and risk factors of thyroid nodules in breast cancer women with different clinicopathological characteristics: a cross-sectional study. Clin Transl Oncol 2024; 26: 2380-7.