Focal Thyroid Incidentalomas on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration.

Background: The rising demand for 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) has led to an increase of thyroid incidentalomas. Current guidelines are restricted in giving options to tailor diagnostics and to suit the individual patient. Objectives: We aimed at exploring the extent of potential overdiagnostics by performing a systematic review and meta-analysis of the literature on the prevalence, the risk of malignancy (ROM) and the risk of inconclusive FNAC (ROIF) of focal thyroid incidentalomas (FTI) on 18F-FDG PET/CT. Data Sources: A literature search in MEDLINE, Embase and Web of Science was performed to identify relevant studies. Study Selection: Studies providing information on the prevalence and/or ROM of FTI on 18F-FDG PET/CT in patients with no prior history of thyroid disease were selected by two authors independently. Sixty-one studies met the inclusion criteria. Data Analysis: A random effects meta-analysis on prevalence, ROM and ROIF with 95% confidence intervals (CIs) was performed. Heterogeneity and publication bias were tested. Risk of bias was assessed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Data Synthesis: Fifty studies were suitable for prevalence analysis. In total, 12,943 FTI were identified in 640,616 patients. The pooled prevalence was 2.22% (95% CI = 1.90% - 2.54%, I2 = 99%). 5151 FTI had cyto- or histopathology results available. The pooled ROM was 30.8% (95% CI = 28.1% - 33.4%, I2 = 57%). 1308 (83%) of malignant nodules were papillary thyroid carcinoma (PTC). The pooled ROIF was 20.8% (95% CI = 13.7% - 27.9%, I2 = 92%). Limitations: The main limitations were the low to moderate methodological quality of the studies and the moderate to high heterogeneity of the results. Conclusion: FTI are a common finding on 18F-FDG PET/CTs. Nodules are malignant in approximately one third of the cases, with the majority being PTC. Cytology results are non-diagnostic or indeterminate in one fifth of FNACs. These findings reveal the potential risk of overdiagnostics of FTI and emphasize that the workup of FTI should be performed within the context of the patient's disease and that guidelines should adopt this patient tailored approach.

[Ingested medication blister packs]. / Ingeslikte blisterverpakkingen.

BACKGROUND: Single dose blister packs (BP) are commonly used in pharmaceutical packaging. Accidental ingestion of medication BPs can cause serious harm as the sharp edges can severely damage the esophageal wall. CASE DESCRIPTIONS: We describe 2 cases of accidental BP ingestion. An 88-year-old man self-administered his medication during hospital admission. Afterwards, he started to complain about dysphagia. Endoscopic examination the next day revealed a BP stuck in the esophageal wall, which was successfully removed. A 66-year-old man presented to the emergency department with acute onset hematemesis and dysphagia for one week. Upper endoscopy showed a deep tear in the esophageal mucosa and an intact BP in the stomach. The BP was removed and the patient recovered. CONCLUSION: Patients are often not aware of the ingested BP. Urgent endoscopic intervention is needed in order to prevent further damage to the esophageal wall. Supervision during specific moments of intake could help to prevent accidental ingestion.