Hypermetabolism on 18F-FDG PET scan does not influence the interpretation of thyroid cytopathology and nodules with SUVmax

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Hypermetabolism on 18F-FDG PET scan does not influence the interpretation of thyroid cytopathology and nodules with SUVmax <2.5 are not at increased risk for malignancy.

Thyroid. 2016 Jun 21;

Authors: Valderrabano P, Montilla Soler J, Mifsud MJ, Leon ME, Centeno BA, Khazai L, Padhya T, McCaffrey TV, Russell JS, McIver B, Otto KJ

Abstract
BACKGROUND: Hypermetabolism of thyroid nodules on 18F-fluorodeoxyglucose positron emission tomography (PET) is associated with higher prevalence of malignancy. However, the definition of hypermetabolism and its impact on cytological interpretation are unclear.
METHODS: Medical records of all patients with thyroid nodules that had undergone cytological evaluation at Moffitt Cancer Center between October 2008 and May 2014 were retrospectively reviewed. Those with a PET scan performed within 1 year of the cytology composed the study group, and the rest were used as controls. The distribution of the cytological categories, percentage of resection and prevalence of malignancy among each Bethesda category was compared between both groups.
RESULTS: Fifteen percent (436) of all thyroid nodules with cytological evaluation were in the study group. Maximum standardized uptake (SUVmax) values were directly associated with the probability of having a malignant or a follicular neoplasm cytological diagnosis; and inversely associated with the probability of having a benign cytological diagnosis. However, the prevalence of cancer within each Bethesda category was not associated with SUVmax values. We found that the prevalence of malignant cytology increased above 5% with SUVmax values ≥2.5. SUVmax values were significantly higher in malignant than in benign nodules on histology (mean values 10.8 vs. 5) but with significant overlap between both groups for either the whole cohort or nodules with indeterminate cytology only limiting its use for differential diagnosis.
CONCLUSIONS: The prevalence of malignancy in thyroid nodules with SUVmax <2.5 is similar to the general population and management should not be modified in those patients. The increased prevalence of malignancy among hypermetabolic thyroid nodules (SUVmax ≥2.5) is well characterized by cytology and does not impact the interpretation of cytological categories. Therefore, SUVmax value does not add relevant information once cytology is available.

PMID: 27324615 [PubMed - as supplied by publisher]

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