RESUMEN
OBJECTIVE: Focal thyroid incidentaloma (TI) occurs in a 2% of 18F-FDG PET/CT and about one-third of TIs is cancer. Due to the lack of evidence on the optimal management of TI, current guidelines suggest performing fine-needle aspiration cytology (FNA). The study aim was to evaluate the reliability of ACR-TIRADS, EU-TIRADS, and K-TIRADS in indicating FNA in TIs. DESIGN: We retrospectively reviewed 18F-FDG PET/CT TIs recorded during the period 2016-2019. Enrolled were TIs with histologic outcome and autonomous nodules. Cases with uncertain matching between 18F-FDG PET/CT, US/scintiscan and histology were excluded. RESULTS: Eighty TIs at 18F-FDG PET/CT (median size 17 mm, median SUVmax 7.85) were included; a 26.2% was cancer. The percentage of nodules classified as high risk according to ACR-TIRADS, EU-TIRADS, and K-TIRADS was 20%, 30%, and 29.8%, respectively. The cancer prevalence in high-risk class was 56.2%, 66.7%, and 65.2% in ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively. ACR-TIRADS had the lowest number of cases with FNA indication (48%) and the K-TIRADS, the highest one (75%). Evaluating the reliability of the three systems in indicating FNA, we found a 100% sensitivity and NPV for EU-TIRADS and K-TIRADS; while all the three systems showed poor specificity and PPV. CONCLUSION: All TIRADSs were reliable to stratify the risk of cancer in focal TI. Comparing their reliability in indicating FNA, we found a good performance of EU-TIRADS and K-TIRADS. Considering the high cancer percentage expected in this setting of patients, those TIRADS with higher propensity to indicate FNA should be preferred.
Asunto(s)
Adenoma/diagnóstico , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Adenoma/patología , Adulto , Anciano , Biopsia con Aguja Fina/normas , Europa (Continente) , Femenino , Fluorodesoxiglucosa F18 , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Sociedades Médicas/normas , Neoplasias de la Tiroides/patologíaRESUMEN
This study assessed the role of 18F-FDG PET-CT (PET/CT) to detect the cartilage and paraglottic infiltration in advanced glottic cancer comparing the results with those of conventional imaging (CI) (contrast-enhanced computed tomography and/or magnetic resonance). In addition, we assessed the prognostic value of quantitative parameters, measured on baseline PET/CT, in terms of event-free survival (EFS) and overall survival (OS). We retrospectively analyzed 27 patients with glottic squamous cell carcinoma stage III and IVA, treated in our institute between 2010 and 2016, comparing PET/CT, performed for staging and radiotherapy planning, and CI findings. Cohen's K was used to compare concordance between PET/CT and CI. Imaging findings were correlated with endoscopic evaluation and histological reports (gold standard (GS)). All lesions shown by CI were also detected by PET/CT imaging, and in 5 cases, a better definition of local infiltration was achieved with PET/CT than CI (5 CT). Sensitivity, specificity, and accuracy of PET/CT and CT were 95%, 86%, and 93% and 70%, 86%, and 74% for, respectively. MRI showed sensitivity and specificity of 100%. One false-negative (FN) cases and 1 false-positive (FP) case were observed with PET/CT with no difference compared to MRI (10 cases). Six FN cases and 1 FP case were observed with CT. Cohen's K was 0.60 (PET vs. CI) and 0.80 (PET vs. GS). Patients were followed-up for at least 24 months to calculate EFS and OS. 13 local recurrence and 7 deaths were recorded. Among quantitative PET parameters, baseline MTV was the most powerful predictor of outcome. Our data suggest a reliable sensitivity and accuracy of PET/CT in the evaluation of local extension, proving a useful method for initial local staging in addition to the well-established role in lymph-node and distant sites assessment. Furthermore, pretreatment MTV provides better prognostic information than other PET/CT parameters.
Asunto(s)
Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Glotis/diagnóstico por imagen , Neoplasias Laríngeas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Cartílagos Laríngeos/diagnóstico por imagen , Cartílagos Laríngeos/patología , Neoplasias Laríngeas/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/diagnóstico por imagen , Supervivencia sin Progresión , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
No disponible
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Humanos , Masculino , Anciano , Sínfisis Pubiana/patología , Sínfisis Pubiana , Imagen Multimodal/instrumentación , Imagen Multimodal/métodos , Imagen Multimodal , Corticoesteroides/uso terapéutico , Oxigenoterapia Hiperbárica/métodos , Imagen Multimodal/tendencias , Necrosis/patología , Necrosis , Pelvis , Pelvis/patología , Osteomielitis/patología , Osteomielitis , Sínfisis Pubiana , Radioterapia/efectos adversosRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Fluorodesoxiglucosa F18 , Tumores Neuroendocrinos , Carcinoma Neuroendocrino , Neoplasias Hipofaríngeas/patología , Seno Piriforme/patología , Carcinoma de Células Pequeñas , Metástasis de la Neoplasia , Tomografía Computarizada de Emisión de Fotón Único/métodosAsunto(s)
Neoplasias Óseas/secundario , Carcinoma Neuroendocrino/diagnóstico por imagen , Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Neoplasias Hipofaríngeas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Seno Piriforme/diagnóstico por imagen , Radiofármacos , Neoplasias Óseas/diagnóstico por imagen , Carcinoma Neuroendocrino/tratamiento farmacológico , Carcinoma Neuroendocrino/secundario , Resultado Fatal , Humanos , Neoplasias Hipofaríngeas/tratamiento farmacológico , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
No disponible
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Humanos , Femenino , Adolescente , Neuritis Óptica , Receptores de Somatostatina/análisis , Somatostatina/análogos & derivados , Hallazgos IncidentalesRESUMEN
No disponible
