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18 F-Fluorocholine Positron Emission Tomography/Computed Tomography is a Highly Sensitive but Poorly Specific Tool for Identifying Malignancy in Thyroid Nodules with Indeterminate Cytology: The Chocolate Study.
- Source :
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Thyroid : official journal of the American Thyroid Association [Thyroid] 2021 May; Vol. 31 (5), pp. 800-809. Date of Electronic Publication: 2020 Dec 23. - Publication Year :
- 2021
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Abstract
- Background: Refining the risk of malignancy in patients presenting with thyroid nodules with indeterminate cytology (IC) is a critical challenge. We investigated the performances of <superscript>18</superscript> F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) to predict malignancy. Methods: Between May 2016 and March 2019, 107 patients presenting with a thyroid nodule ≥15 mm with IC and eligible for surgery were included in this prospective study. Head-and-neck PET/CT acquisitions were performed 20 and 60 minutes after injection of 1.5 MBq/kg of FCH. PET/CT acquisition was scored positive when maximal standardized uptake value in the IC nodule was higher than in the thyroid background. Pathology was the gold standard for diagnosis. Results: At pathology, 19 (18%) nodules were malignant, 87 were benign, and one was a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Sensitivity, specificity, accuracy, positive-predictive value (PPV), and negative-predictive value (NPV) of FCH PET/CT in detecting cancer or NIFTP were 90%, 50%, 55%, 29%, and 96% at 20 minutes and 85%, 49%, 67%, 28%, and 94% at 60 minutes, respectively. Higher specificity (58% vs. 33%, p = 0.01) was observed in nononcocytic ( n = 72) than in oncocytic IC nodules ( n = 35). The pre-PET/CT probability of cancer or NIFTP in Bethesda III-IV nodules was 11% and the post-PET/CT probability was 19% in PET-positives and 0% in PET-negatives. In retrospective analysis, 42% of surgeries would have been unnecessary after PET/CT and 81% before ( p < 0.001), resulting in a hypothetical 48% reduction (95% confidence interval [32-64]). Conclusions: FCH PET/CT offers high NPV to reliably exclude cancer in PET-negative IC nodules, but suffers from low PPV, particularly in those with oncocytic cytology. ClinicalTrials.gov identifier: NCT02784223.
- Subjects :
- Adenocarcinoma, Follicular pathology
Adenocarcinoma, Follicular surgery
Adenoma, Oxyphilic pathology
Adenoma, Oxyphilic surgery
Adult
Aged
Choline analogs & derivatives
Female
Fluorine Radioisotopes
Humans
Male
Middle Aged
Positron Emission Tomography Computed Tomography
Predictive Value of Tests
Sensitivity and Specificity
Thyroid Cancer, Papillary pathology
Thyroid Cancer, Papillary surgery
Thyroid Neoplasms pathology
Thyroid Neoplasms surgery
Thyroid Nodule pathology
Thyroid Nodule surgery
Thyroidectomy
Adenocarcinoma, Follicular diagnostic imaging
Adenoma, Oxyphilic diagnostic imaging
Thyroid Cancer, Papillary diagnostic imaging
Thyroid Neoplasms diagnostic imaging
Thyroid Nodule diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1557-9077
- Volume :
- 31
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Thyroid : official journal of the American Thyroid Association
- Publication Type :
- Academic Journal
- Accession number :
- 33183159
- Full Text :
- https://doi.org/10.1089/thy.2020.0555