American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 29, Issue 2 , Pages 113-118, March 2008

Is there a role for fluorodeoxyglucose positron emission tomography/computed tomography in cytologically indeterminate thyroid nodules?☆

  • Nathan W. Hales, MD
    • ,
  • Greg A. Krempl, MD
    • ,
  • Jesus E. Medina, MD

      Affiliations

    • Corresponding Author InformationCorresponding author. Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, PO Box 26901 WP 1290, Oklahoma City, OK 73190, USA. Tel.: +1 405 271 5504; fax: +1 405 271 3248.

Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

Received 20 January 2008

Abstract 

Objective

The aim of this study was to determine the accuracy of the fluorine 18 (18F)–labeled fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan in the evaluation of thyroid nodules in which the cytopathology of fine-needle aspiration (FNA) biopsies are classified as “indeterminate,” ie, either follicular or Hürthle cell lesion.

Methods

At an academic medical center, we conducted a prospective pilot study of 15 patients with thyroid nodules in whom adequate FNA was diagnosed as indeterminate. All patients underwent a whole-body FDG-PET/CT scan followed by thyroidectomy. Preoperative FDG-PET/CT results and the histopathology of the surgical specimen were compared and statistically analyzed.

Results

The FNA demonstrated follicular cells in 11 (73%) patients, Hürthle cells in 3 (20%) patients, and both types of cells in 1 (7%) patient. The histopathology of the surgical specimen revealed thyroid cancer in 7 (47%) patients. The FDG-PET/CT scan was positive in 8 patients; 4 (50%) patients were found to have cancer. The FDG-PET/CT scan was negative in 7 patients. Four of these patients had benign lesions and 3 had thyroid carcinoma. Thus, 4 (27%) patients had false-positive FDG-PET/CT scans and 3 (20%) patients had false-negative studies. The sensitivity of FDG-PET/CT to detect a malignant focus was 57% with a specificity of 50%. The positive predictive value was 50% and the negative predictive value was 57%.

Conclusions

In this pilot study of patients with cytologically indeterminate thyroid nodules, FDG-PET/CT was not a predictable indicator of benign or malignant disease. Although a larger series may elucidate a role for FDG-PET/CT, the relatively low predictability shown in this study should caution clinicians about using FDG-PET/CT to consider foregoing thyroidectomy for cytologically indeterminate nodules.

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☆ Oral presentation, American Head and Neck Society, 2006 Annual Meeting & Research Workshop on Biology, Prevention and Treatment of Head and Neck Cancer, Chicago, IL, August 19, 2006.☆This project was supported by the Resident Research Fund of The University of Oklahoma Health Sciences Center, Department of Otorhinolaryngology, and by PET Imaging of Oklahoma (Oklahoma City, OK).

PII: S0196-0709(07)00048-8

doi:10.1016/j.amjoto.2007.04.006

American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 29, Issue 2 , Pages 113-118, March 2008

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