Focal thyroid incidental uptake detected by ¹⁸F-fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk.

AIM To perform a meta-analysis of published data on the prevalence and risk of malignancy of focal thyroid incidental uptake (FTIs) detected by Fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/CT. METHODS A comprehensive literature search of studies published up to and including December 2012 was performed. Pooled prevalence and malignancy risk of FTIs were calculated, including a sub-analysis for the geographic areas of origin of the studies. RESULTS 34 studies including 215,057 patients were selected. Pooled prevalence of FTIs was 1.92% (95% confidence interval [95%CI]: 1.87-1.99%). Overall, 1522 FTIs underwent histopathology evaluation. Pooled risk of malignancy was 36.2% (95%CI: 33.8-38.6%), without significant differences among various geographic areas. CONCLUSIONS FTIs are observed in about 2% of 18F-FDG-PET or PET/CT scans and carry a significant risk of malignancy. Therefore, further investigation is warranted whenever FTIs are detected by 18F-FDG-PET or PET/CT.

[1]  A. Piccardo,et al.  F18-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value , 2013, Endocrine.

[2]  T. Bartel,et al.  Focal thyroid uptake on 18F-fluorodeoxyglucose positron emission tomography: interpreting the data. , 2013, Thyroid : official journal of the American Thyroid Association.

[3]  G. Treglia,et al.  Meta-analyses and systematic reviews on PET and PET/CT in oncology: the state of the art , 2013, Clinical and Translational Imaging.

[4]  A. Padhy,et al.  Thyroid Incidentalomas on Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography: Incidence, Malignancy Risk, and Comparison of Standardized Uptake Values , 2012, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[5]  M. Salvatori,et al.  A pooled analysis to calculate the prevalence and risk of malignancy of thyroid incidentalomas detected by Fluorine-18-Fluorodeoxyglucose positron emission tomography. , 2012 .

[6]  L. Hegedüs,et al.  Risk of malignancy in thyroid incidentalomas detected by 18F-fluorodeoxyglucose positron emission tomography: a systematic review. , 2012, Thyroid : official journal of the American Thyroid Association.

[7]  Jianping Zhang,et al.  Prevalence and risk of cancer of thyroid incidentaloma identified by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. , 2012, Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale.

[8]  A. Win,et al.  Prevalence and Characteristics of Incidentalomas Discovered by Whole Body FDG PETCT , 2012, International journal of molecular imaging.

[9]  E. Siegel,et al.  Can the Pathology of a Thyroid Nodule Be Determined by Positron Emission Tomography Uptake? , 2012, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[10]  I. Lim,et al.  Characteristics of thyroid incidentalomas detected by pre-treatment [18F]FDG PET or PET/CT in patients with cervical cancer , 2012, Journal of gynecologic oncology.

[11]  A. Sundin,et al.  Thyroid Incidentaloma Detected by Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Practical Management Algorithm , 2011, World Journal of Surgery.

[12]  P. Marzullo,et al.  Thyroid incidentaloma identified by 18F‐fluorodeoxyglucose positron emission tomography with CT (FDG‐PET/CT): clinical and pathological relevance , 2011, Clinical endocrinology.

[13]  M. Hier,et al.  Head and neck incidentalomas on positron emission tomographic scanning: ignore or investigate? , 2011, Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale.

[14]  M. Lin,et al.  The clinical significance and management of incidental focal FDG uptake in the thyroid gland on positron emission tomography/computed tomography (PET/CT) in patients with non-thyroidal malignancy , 2011, Acta radiologica.

[15]  P. Lin,et al.  The prevalence and clinical significance of 18F–2‐fluoro‐2‐deoxy‐D‐glucose (FDG) uptake in the thyroid gland on PET or PET‐CT in patients with lymphoma , 2011, Hematological oncology.

[16]  M. Cotter,et al.  Focal thyroid incidentalomas identified with whole-body FDG-PET warrant further investigation. , 2011, Irish medical journal.

[17]  T. Yen,et al.  Prevalence and significance of thyroid uptake detected by 18F-FDG PET , 2011, Endocrine.

[18]  J. How,et al.  Incidental thyroid "PETomas": clinical significance and novel description of the self-resolving variant of focal FDG-PET thyroid uptake. , 2011, Canadian journal of surgery. Journal canadien de chirurgie.

[19]  Bo Hyun Kim,et al.  Risk stratification and prediction of cancer of focal thyroid fluorodeoxyglucose uptake during cancer evaluation , 2010, Annals of nuclear medicine.

[20]  Seong-Jang Kim,et al.  Relationship between biological marker expression and fluorine-18 fluorodeoxyglucose uptake in incidentally detected thyroid cancer. , 2010, Cancer biotherapy & radiopharmaceuticals.

[21]  S. Nishizawa,et al.  High incidence of thyroid cancer in focal thyroid incidentaloma detected by 18F-fluorodeoxyglucose [corrected] positron emission tomography in relatively young healthy subjects: results of 3-year follow-up. , 2010, Endocrine journal.

[22]  Young Ha Park,et al.  Incidental thyroid uptake on F-18 FDG PET/CT: correlation with ultrasonography and pathology , 2009, Annals of nuclear medicine.

[23]  B. Song,et al.  Incidental thyroid lesions detected by FDG-PET/CT: prevalence and risk of thyroid cancer , 2009, World journal of surgical oncology.

[24]  E. Genden,et al.  The Significance and Management of Incidental [18F]Fluorodeoxyglucose–Positron-Emission Tomography Uptake in the Thyroid Gland in Patients with Cancer , 2009, American Journal of Neuroradiology.

[25]  Ricardo Rossi,et al.  An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. , 2009, The Journal of clinical endocrinology and metabolism.

[26]  A. Alavi,et al.  Evaluation of thyroid FDG uptake incidentally identified on FDG-PET/CT imaging , 2009, Nuclear medicine communications.

[27]  P. Castaldi,et al.  Clinical significance of focal and diffuse thyroid diseases identified by (18)F-fluorodeoxyglucose positron emission tomography. , 2007, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[28]  B. Stack,et al.  Incidence of Thyroid Carcinoma in Fluorodeoxyglucose Positron Emission Tomography-Positive Thyroid Incidentalomas , 2007, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[29]  J. Shah,et al.  Histological Aggressiveness of Fluorodeoxyglucose Positron-Emission Tomogram (FDG-PET)-Detected Incidental Thyroid Carcinomas , 2007, Annals of Surgical Oncology.

[30]  Jeong Hyun Lee,et al.  Focal uptake of 18F‐fluorodeoxyglucose by thyroid in patients with nonthyroidal head and neck cancers , 2007 .

[31]  V. Lowe,et al.  Clinical Significance of Diffusely Increased 18F-FDG Uptake in the Thyroid Gland , 2007, Journal of Nuclear Medicine.

[32]  V. Lowe,et al.  The value of quantifying 18F-FDG uptake in thyroid nodules found incidentally on whole-body PET–CT , 2007, Nuclear medicine communications.

[33]  S. Larson,et al.  FDG-PET Detected Thyroid Incidentalomas: Need for Further Investigation? , 2006, Annals of Surgical Oncology.

[34]  Kyung-Han Lee,et al.  Focal thyroid lesions incidentally identified by integrated 18F-FDG PET/CT: clinical significance and improved characterization. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[35]  Q. Chu,et al.  Positron Emission Tomography (PET) Positive Thyroid Incidentaloma: The Risk of Malignancy Observed in a Tertiary Referral Center , 2006, The American surgeon.

[36]  M. Inbar,et al.  The presentation of malignant tumours and pre-malignant lesions incidentally found on PET-CT , 2006, European Journal of Nuclear Medicine and Molecular Imaging.

[37]  G. Gladish,et al.  Focal uptake of fluorodeoxyglucose by the thyroid in patients undergoing initial disease staging with combined PET/CT for non-small cell lung cancer. , 2005, Radiology.

[38]  Tae Yong Kim,et al.  18F‐Fluorodeoxyglucose Uptake in Thyroid from Positron Emission Tomogram (PET) for Evaluation in Cancer Patients: High Prevalence of Malignancy in Thyroid PET Incidentaloma , 2005, The Laryngoscope.

[39]  R. Wahl,et al.  Detection of unexpected additional primary malignancies with PET/CT. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[40]  Yen-Ling Chen,et al.  Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects. , 2005, Anticancer research.

[41]  Seung-Yong Jeong,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. , 2003, The Journal of clinical endocrinology and metabolism.

[42]  M. Cohen,et al.  Risk of malignancy in thyroid incidentalomas identified by fluorodeoxyglucose-positron emission tomography. , 2001, Surgery.

[43]  A. Czarnywojtek,et al.  Incidental ¹⁸F-FDG uptake in the thyroid in patients diagnosed with PET/CT for other malignancies. , 2011, Nuclear medicine review. Central & Eastern Europe.

[44]  G. Zhai,et al.  The role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography whole body imaging in the evaluation of focal thyroid incidentaloma , 2010, Journal of endocrinological investigation.