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Oncology-Clinical Diagnosis: Solid TumorsMelanoma and Other Tumors |
1 Diagnostic Imaging, Kaiser Permanente Fontana Medical Center, Fontana, California; 2 Family & Community Medicine, Division of Research, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas
583
Objectives: To review literature and tabulate the prevalence of malignancy in incidental focal or focal plus diffuse hypermetabolic thyroid lesions detected by PET.
Methods: Studies evaluating the risk of thyroid malignancies incidentally found by PET were searched for in MEDLINE, including a manual search of the references lists. Search terms include thyroid disease, thyroid neoplasm, fluorodeoxyglucose F18, PET, and incidental findings. Inclusion criteria: 1) PET performed for work-up of malignancies other than thyroid cancer or in healthy volunteer subjects for cancer screening, 2) focal or focal plus diffuse hypermetabolic activity in the thyroid gland, 3) confirmation of diagnosis by histopathologic examination. Exclusion criteria: 1) case report or series, 2) only diffuse activity of the thyroid reported.
Results: Sixteen retrospective studies were included. Of the 63499 patients studied, 667 patients (1.05%, 95% CI:0.97%-1.13%) were found to have hypermetabolic thyroid lesions. In the group of 376 patients with further evaluation, thyroid malignancy was found in 125 patients (33.24%, 95% CI:28.50%-38.26%). Papillary thyroid carcinoma was found in 99 patients (79.20%, 95% CI:71.02%-85.94%). The remainder of the patients were found to have follicular variant of the papillary thyroid carcinoma, 7.20%, (95% CI:3.34%-13.23%); follicular carcinoma, 0.80% (95% CI:0.02%-4.38%); and other malignancies, 13.60% (95%, CI:8.13%-20.88%).
Conclusions: The high prevalence of thyroid malignancy associated with focal or focal plus diffuse hypermetabolic thyroid lesions found on PET warrants further evaluation when encountered incidentally.
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