Exclusion of malignancy in thyroid nodules with indeterminate fine-needle aspiration cytology after negative 18f-fluorodeoxyglucose positron emission tomography: Interim analysis

Amber L. Traugott, Farrokh Dehdashti, Kathryn Trinkaus, Mark Cohen, Elizabeth Fialkowski, Frank Quayle, Hameda Hussain, Rosa Davila, Lourdes Ylagan, Jeffrey F. Moley

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

Background In all, 20% of fine-needle aspiration (FNA) biopsies of thyroid nodules have an indeterminate diagnosis; of these, 80% are found to be benign after thyroidectomy. Some previous reports indicate that positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) imaging may predict malignancy status. We now report results on the first 51 patients in the largest prospective study of FDG-PET in patients with an indeterminate thyroid nodule FNA. Methods Eligible patients had a dominant thyroid nodule that was palpable or ≥1 cm in greatest dimension as seen by ultrasonography, and indeterminate histology of the FNA biopsy specimen. Participants underwent preoperative neck FDG-PET alone or FDG-PET with computed tomography (FDG-PET/CT). Images were evaluated qualitatively and semiquantitatively using the maximum standardized uptake value (SUVmax). Final diagnosis was determined by histopathologic analysis after thyroidectomy. Descriptive statistical analysis was performed. Results A total of 51 patients underwent preoperative FDG-PET or FDG-PET/CT. Studies without focally increased uptake localized to the lesion were considered negative. For all lesions (10 malignant, 41 benign), the sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) were 80%, 61%, 33%, and 93%, respectively. Postoperatively, two malignant and six benign lesions were found to be<1 cm by pathology examination; one lesion was not measured. When these lesions were excluded, the sensitivity, specificity, PPV, and NPV were 100%, 59%, 36%, and 100%, respectively. Conclusions Based on these preliminary data, FDG-PET may have a role in excluding malignancy in thyroid nodules with an indeterminate FNA biopsy. This finding justifies ongoing accrual to our target population of 125 participants.

Original languageEnglish (US)
Pages (from-to)1247-1253
Number of pages7
JournalWorld journal of surgery
Volume34
Issue number6
DOIs
StatePublished - Jun 2010

ASJC Scopus subject areas

  • Surgery

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