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Lee H, Hwang KH. Unexpected focal fluorodeoxyglucose uptake in main organs; pass through or pass by? World J Clin Cases 2024; 12:1885-1899. [PMID: 38660550 PMCID: PMC11036514 DOI: 10.12998/wjcc.v12.i11.1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Since the inception of fluorine-18 fluorodeoxyglucose (F-18 FDG), positron emission tomography/computed tomography (PET/CT) utilizing F-18 FDG has become widely accepted as a valuable imaging modality in the field of oncology, with global prevalence in clinical practice. Given that a single Torso PET/CT scan encompasses the anatomical region from the skull base to the upper thigh, the detection of incidental abnormal focal hypermetabolism in areas of limited clinical interest is both feasible and not uncommon. Numerous investigations have been undertaken to delineate the distinctive features of these findings, yet the outcomes have proven inconclusive. The incongruent results of these studies present a challenge for physicians, leaving them uncertain about the appropriate course of action. This article provides a succinct overview of the characteristics of fluorodeoxyglucose, followed by a comprehensive discussion of the imaging findings and clinical significance associated with incidental focal abnormal F-18 FDG activity in several representative organs. In conclusion, while the prevalence of unrecognized malignancy varies across organs, malignancies account for a substantial proportion, ranging from approximately one-third to over half, of incidental focal uptake. In light of these rates, physicians are urged to exercise vigilance in not disregarding unexpected uptake, facilitating more assured clinical decisions, and advocating for further active evaluation.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Chandekar KR, Satapathy S, Bal C. Positron Emission Tomography/Computed Tomography in Thyroid Cancer: An Updated Review. PET Clin 2024; 19:131-145. [PMID: 38212213 DOI: 10.1016/j.cpet.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
PET/computed tomography (CT) is a valuable hybrid imaging modality for the evaluation of thyroid cancer, potentially impacting management decisions. 18F-fluorodeoxyglucose (FDG) PET/CT has proven utility for recurrence evaluation in differentiated thyroid cancer (DTC) patients having thyroglobulin elevation with negative iodine scintigraphy. Aggressive histologic subtypes such as anaplastic thyroid cancer shower higher FDG uptake. 18F-FDOPA is the preferred PET tracer for medullary thyroid cancer. Fibroblast activation protein inhibitor and arginylglycylaspartic acid -based radiotracers have emerged as promising PET agents for radioiodine refractory DTC patients with the potential for theranostic application.
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Geng D, Zhou Y, Su GY, Si Y, Shen MP, Xu XQ, Wu FY. Influence of sex, age and thyroid function indices on dual-energy computed tomography-derived quantitative parameters of thyroid in patients with or without Hashimoto's thyroiditis. BMC Med Imaging 2023; 23:25. [PMID: 36740672 PMCID: PMC9901076 DOI: 10.1186/s12880-023-00983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/01/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To study the influence of sex, age and thyroid function indices on dual-energy computed tomography (DECT)-derived quantitative parameters of thyroid in patients with or without Hashimoto's thyroiditis (HT). MATERIAL AND METHODS A total of 198 consecutive patients who underwent DECT scan of neck due to unilateral thyroid lesions were retrospectively enrolled. Iodine concentration (IC), total iodine content (TIC) and volume of normal thyroid lobe were calculated. Influences of sex, age and thyroid function indices on DECT-derived parameters in overall study population, subgroup patients with, and those without HT were assessed using Mann-Whitney U test, Student's T-test, and Spearman correlation analyses, respectively, as appropriate. RESULTS HT group showed significantly lower IC and TIC, while higher volume than No-HT group (all p < 0.001). The volume was larger in male than that in female in overall study population and No-HT group (p = 0.047 and 0.010, respectively). There was no significant difference in any DECT-derived parameters between low (≤ 35 years) and high (> 35 years) age group in all three groups (all p > 0.05). TPOAb and TgAb correlated positively with IC and TIC, and negatively with volume in overall study population (all p < 0.05). TPOAb and TgAb also correlated positively with IC in HT group (p = 0.002 and 0.007, respectively). CONCLUSION DECT-derived parameters of thyroid differed significantly between patients with and without HT. Sex and thyroid function indices could affect the DECT-derived parameters. Aforementioned physiological factors should be considered when analyzing the DECT-derived parameters of thyroid.
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Affiliation(s)
- Di Geng
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, People’s Republic of China
| | - Yan Zhou
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, People’s Republic of China
| | - Guo-Yi Su
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, People’s Republic of China
| | - Yan Si
- grid.412676.00000 0004 1799 0784Department of Thyroid Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Mei-Ping Shen
- grid.412676.00000 0004 1799 0784Department of Thyroid Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, People's Republic of China.
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, People's Republic of China.
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Dercle L, Sun S, Seban RD, Mekki A, Sun R, Tselikas L, Hans S, Bernard-Tessier A, Mihoubi Bouvier F, Aide N, Vercellino L, Rivas A, Girard A, Mokrane FZ, Manson G, Houot R, Lopci E, Yeh R, Ammari S, Schwartz LH. Emerging and Evolving Concepts in Cancer Immunotherapy Imaging. Radiology 2023; 306:32-46. [PMID: 36472538 DOI: 10.1148/radiol.210518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Criteria based on measurements of lesion diameter at CT have guided treatment with historical therapies due to the strong association between tumor size and survival. Clinical experience with immune checkpoint modulators shows that editing immune system function can be effective in various solid tumors. Equally, novel immune-related phenomena accompany this novel therapeutic paradigm. These effects of immunotherapy challenge the association of tumor size with response or progression and include risks and adverse events that present new demands for imaging to guide treatment decisions. Emerging and evolving approaches to immunotherapy highlight further key issues for imaging evaluation, such as dissociated response following local administration of immune checkpoint modulators, pseudoprogression due to immune infiltration in the tumor environment, and premature death due to hyperprogression. Research that may offer tools for radiologists to meet these challenges is reviewed. Different modalities are discussed, including immuno-PET, as well as new applications of CT, MRI, and fluorodeoxyglucose PET, such as radiomics and imaging of hematopoietic tissues or anthropometric characteristics. Multilevel integration of imaging and other biomarkers may improve clinical guidance for immunotherapies and provide theranostic opportunities.
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Affiliation(s)
- Laurent Dercle
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Shawn Sun
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Romain-David Seban
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Ahmed Mekki
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Roger Sun
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Lambros Tselikas
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Sophie Hans
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Alice Bernard-Tessier
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Fadila Mihoubi Bouvier
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Nicolas Aide
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Laetitia Vercellino
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Alexia Rivas
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Antoine Girard
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Fatima-Zohra Mokrane
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Guillaume Manson
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Roch Houot
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Egesta Lopci
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Randy Yeh
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Samy Ammari
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
| | - Lawrence H Schwartz
- From the Department of Radiology, New York Presbyterian Hospital-Columbia University Medical Center, 630 W 168th St, New York, NY 10032 (L.D., S.S., L.H.S.); Department of Nuclear Medicine, Institut Curie, Paris, France (R.D.S.); DMU Smart Imaging, Department of Medical Imaging, Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Teaching Hospital, Garches, France (A.M.); Gustave Roussy-Centrale Supélec-Therapanacea Centre of Artificial Intelligence in Radiation Therapy and Oncology, Gustave Roussy Cancer Campus, Villejuif, France (R.S.); Radiomics Team, Molecular Radiation Therapy INSERM U1030, Paris-Sud University, Gustave Roussy Cancer Campus, and University of Paris-Saclay, Villejuif, France (R.S.); Departments of Radiation Oncology (R.S.) and Interventional Radiology (L.T.), Gustave Roussy Cancer Campus, Villejuif, France; Department of Oncology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France (S.H.); Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France (A.B.T.); Department of Radiology, Cochin Hospital, APHP, France (F.M.B.); Department of Nuclear Medicine, University Hospital, INSERM 1199 ANTICIPE, Normandy University, Caen, France (N.A.); Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France (L.V., A.R.); Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, Rennes, France (A.G.); Department of Radiology, Rangueil University Hospital, Toulouse, France (F.Z.M.); Department of Hematology, University Hospital of Rennes, U1236, INSERM, Rennes, France (G.M., R.H.); EANM Oncology Committee, Vienna, Austria (E.L.); Department of Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy (E.L.); Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY (R.Y.); and Department of Medical Imaging, Diagnostic Imaging Service, Gustave Roussy, Université Paris Saclay, Villejuif, France (S.A.)
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Charoenngam N, Marangoz MS, Lamothe S, James BC. Thyroid Mucosa-associated Lymphoid Tissue Lymphoma Presenting as Intermediate-risk Thyroid Nodule with Positive KRAS Mutation. AACE Clin Case Rep 2023; 9:44-47. [PMID: 37056419 PMCID: PMC10086600 DOI: 10.1016/j.aace.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Background /Objective: Little is known about the epidemiology, clinical presentation, and diagnosis of thyroid mucosa-associated lymphoid tissue (MALT) lymphoma. Case Report We report the case of a 67-year-old woman who presented with an intermediate-risk thyroid nodule 8 years after diagnosis of hypothyroidism due to Hashimoto's. She was found to have a well-circumscribed hypoechoic 2.6-cm right-sided thyroid nodule lobe, which was biopsied and returned atypia of undetermined significance with positive KRAS mutation on the Thyroseq V3 Genomic Classifier. She subsequently underwent right thyroid lobectomy and was found to have thyroid MALT lymphoma on histopathological sections. After the surgery, she was referred to oncology for further management of the thyroid MALT lymphoma. A positron emission tomography/computed tomography scan was performed for complete staging and revealed diffuse fluorodeoxyglucose uptake in the residual left thyroid lobe without evidence of extrathyroidal involvement. Her case was discussed in a multidisciplinary fashion among oncology, endocrine surgery, and endocrinology. Given the positron emission tomography scan findings, she ultimately underwent completion thyroidectomy 4 months after the initial surgery to rule out residual disease. The patient tolerated the operation well without complication. Discussion Our report adds to the literature that Hashimoto's thyroiditis may be a risk factor of thyroid MALT lymphoma. Localized thyroid MALT lymphoma may be managed with total thyroidectomy. Conclusion We report a patient with localized thyroid MALT lymphoma who presented with an intermediate-risk nodule with positive KRAS mutation and was treated with total thyroidectomy.
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Affiliation(s)
- Nipith Charoenngam
- Department of Medicine, Mount Auburn Hospital and Harvard Medical School, Cambridge, Massachusetts
| | - Mehmet Sercan Marangoz
- Department of Endocrinology and Metabolism, Mount Auburn Hospital and Harvard Medical School, Cambridge, Massachusetts
| | - Simon Lamothe
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Benjamin C. James
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Address correspondence to Dr Benjamin C. James, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215.
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Sonavane SN, Basu S. Role of PET/Computed Tomography in Elderly Thyroid Cancer: Tumor Biology and Clinical Management. PET Clin 2023; 18:81-101. [PMID: 36718717 DOI: 10.1016/j.cpet.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PET/computed tomography (CT) studies can be potentially useful in elderly thyroid carcinoma patients for exploring the disease biology, especially in metastatic setting and thereby directing appropriate therapeutic management on case-to-case basis, adopting nuclear theranostics, and disease prognostication. With the availability of multiple PET radiopharmaceuticals, it would be worthwhile to evolve and optimally use FDG and the other non-fluorodeoxyglucose and investigational PET/CT tracers as per the clinical situation and need and thereby define their utilities in a given case scenario. In this regard, (I) differentiated thyroid carcinoma (DTC) including radioiodine refractory disease, poorly differentiated thyroid cancer (PDTC) and TENIS, (II) medullary thyroid carcinoma (MTC), (III) anaplastic carcinoma and (IV) Primary thyroid lymphoma (PTL) should be viewed and dealt separately.
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Lee H, Hwang KH. Significance of incidental focal fluorine-18 fluorodeoxyglucose uptake in colon/rectum, thyroid, and prostate: With a brief literature review. World J Clin Cases 2022; 10:12532-12542. [PMID: 36579086 PMCID: PMC9791515 DOI: 10.12998/wjcc.v10.i34.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/10/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT), a functional imaging method, is usually performed on the entire torso, and regions of unexpected suspicious focal hypermetabolism are not infrequently observed. Among the regions, colon, thyroid, and prostate were found to be the common organs in a recent umbrella review. Some studies reported that a high rate of malignancy was shown in incidentally identified focal hypermetabolic regions and suggested that further examinations should not be ignored.
AIM To investigate the malignancy rate of incidental focal FDG uptake, useful PET parameters and their cutoffs in discrimination between malignant and benign lesions.
METHODS Retrospectively, the final reports of 16510 F-18 FDG PET/CT scans performed at our hospital between January 2016 and March 2022 were reviewed to identify incidentally observed FDG uptake in the colon/rectum, thyroid, and prostate. The scans of patients with current or prior malignancies at each corresponding location, without the final reports of histopathology or colonoscopy (for colon and rectum) for the corresponding hypermetabolic regions, or with diffuse (not focal) hypermetabolism were excluded. Finally, 88 regions of focal colorectal hypermetabolism in 85 patients (48 men and 37 women with mean age 67.0 ± 13.4 years and 63.4 ± 15.8 years, respectively), 48 focal thyroid uptakes in 48 patients (12 men and 36 women with mean age 62.2 ± 13.1 years and 60.8 ± 12.4 years, respectively), and 39 focal prostate uptakes in 39 patients (mean age 71.8 ± 7.5 years) were eligible for this study. For those unexpected focal hypermetabolic regions, rates of malignancy were calculated, PET parameters, such as standardized uptake value (SUV), capable of distinguishing between malignant and benign lesions were investigated, and the cutoffs of those PET parameters were determined by plotting receiver operating characteristic curves.
RESULTS In the colon and rectum, 29.5% (26/88) were malignant and 33.0% (29/88) were premalignant lesions. Both SUVmax and SUVpeak differentiated malignant/premalignant from benign lesions, however, no parameters could distinguish malignant from premalignant lesions. Higher area under the curve was shown with SUVmax (0.752, 95%CI: 0.649-0.856, P < 0.001) and the cutoff was 7.6. In the thyroid, 60.4% (29/48) were malignant. The majority were well-differentiated thyroid cancers (89.7%, 26/29). The results of BRAF mutation tests were available for 20 of the 26 well-differentiated thyroid cancers and all 20 had the mutation. Solely SUVmax differentiated malignant from benign lesions and the cutoff was 6.9. In the prostate, 56.4% (22/39) were malignant. Only SUVmax differentiated malignant from benign lesions and the cutoff was 3.8. Overall, among the 175 focal hypermetabolic regions, 60.6% (106/175) were proven to be malignant and premalignant (in colon and rectum) lesions.
CONCLUSION Approximately 60% of the incidentally observed focal F-18 FDG uptake in the colon/rectum, thyroid, and prostate were found to be malignant. Of the several PET parameters, SUVmax was superior to others in distinguishing between malignant/premalignant and benign lesions. Based on these findings, incidental focal hypermetabolism should not be ignored and lead physicians to conduct further investigations with greater confidence.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Lu HH, Chiu NT, Tsai MH. Early post-treatment 18F-FDG PET/CT for predicting radiation-induced hypothyroidism in head and neck cancer. Cancer Imaging 2022; 22:59. [PMID: 36217182 PMCID: PMC9552508 DOI: 10.1186/s40644-022-00494-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiation-induced hypothyroidism (RIHT) is a common, but underestimated, late adverse effect in head and neck cancer. We investigated the value of early post-treatment 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting RIHT. METHODS We searched our institutional database for patients aged ≥ 20 years who had undergone definitive radiotherapy for nasopharyngeal or oropharyngeal cancer between 2005 and 2017, followed by 18F-FDG PET/CT within 180 days of radiotherapy completion. We visually assessed and compared PET/CT and baseline characteristics in patients with and without RIHT using the chi-square test for categorical variables and the t-test for continuous variables. Variable predictive ability was evaluated by measuring the area under receiver operating characteristic curves. RESULTS Fifty-two patients were included; 22 (42%) developed RIHT and 30 (58%) did not. Two patients presented with diffuse thyroid uptake on PET/CT via visual assessment, and both developed RIHT later. Among the PET/CT variables, thyroid functioning volume was significantly higher in patients without RIHT than in patients with RIHT (16.30 ± 6.03 cm3 vs. 10.61 ± 3.81 cm3, p < 0.001). The maximum standard uptake values of the thyroid and pituitary glands did not differ significantly between the groups. Two patient characteristics, pretreatment thyroid volume and mean radiotherapy dose to the thyroid, also showed significant differences between the groups. An algorithmic approach combining visual grading of thyroid 18F-FDG uptake and thyroid functioning volume cutoff of 14.01 yielded an area under curve of 0.89 (95% confidence interval, 0.80-0.98); the sensitivity, specificity, positive predictive value, and negative predictive value were 87.0%, 82.3%, 80.0%, and 88.9%, respectively. CONCLUSION Early post-treatment PET/CT-derived thyroid functioning volume was a good predictor of RIHT development. Diffusely increased thyroid 18F-FDG uptake on PET/CT may indicate impending RIHT. Routine surveillance of thyroid function is warranted in patients at high risk of developing RIHT.
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Affiliation(s)
- Hsi-Huei Lu
- Division of Nuclear Medicine, Department of Medical Imaging, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Tsing Chiu
- Division of Nuclear Medicine, Department of Medical Imaging, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Mu-Hung Tsai
- Department of Radiation Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138 Sheng Li Rd, Tainan, Taiwan.
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Abstract
Autoimmune thyroid diseases (AITD) are a heterogeneous group of disorders. They include, in particular, Graves' disease and Hashimoto's thyroiditis with a wide range of different functional status ranging from subclinical biochemical abnormalities to severe hyperthyroidism or severe hypothyroidism respectively. Furthermore, other conditions more frequently infectious or drug related can cause an immune reaction in the thyroid tissue. In AITDs, positron emission tomography/computed tomography (PET/CT) does not play a primary role for disease diagnosis or management, but accidental findings can occur in both symptomatic and asymptomatic patients, and they should be recognized and well interpreted. A comprehensive literature search of the PubMed databases was conducted to identify papers (systematic review, prospective and retrospective study, case report) evaluating the role of PET/CT in thyroid autoimmune diseases. Thyroid diffuse uptake of 18F-fluoro-2-deoxy-2-d-glucose ([18F]FDG) has been shown to be frequently associated with AITDs, but also with immune-induced thyroid disorders related to SARS-CoV-2 or immunotherapy, while malignant lesions more often have a focal aspect. Other radiopharmaceuticals as [68Ga]-DOTA-peptides, [68Ga]-fibroblast activation protein inhibitors (FAPIs) and [68Ga]-prostate specific membrane antigen ([68Ga]-PSMA) showed similar findings. In conclusion, PET/CT scan in AITDs does not play a primary role in the diagnosis, but the occasional finding of a thyroid uptake must always be described in the report and possibly investigated for a better patient's management.
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Affiliation(s)
- Elena Califaretti
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sara Dall'armellina
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guido Rovera
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Monica Finessi
- Unit of Nuclear Medicine, Department of Diagnostic Imaging and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy -
| | - Désirée Deandreis
- Unit of Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
- Unit of Nuclear Medicine, Department of Diagnostic Imaging and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
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Ciappuccini R, Saguet-Rysanek V, Dorbeau M, Lequesne J, Linard C, Lefevre-Arbogast S, Clarisse B, Bardet S. Thyroid 18F-fluorocholine uptake in patients with chronic autoimmune thyroiditis. Eur Thyroid J 2022; 11:e220025. [PMID: 35583185 PMCID: PMC9254274 DOI: 10.1530/etj-22-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective 18F-Fluorocholine (18FCH) PET/CT has high sensitivity for parathyroid adenoma detection and can reliably exclude malignancy in thyroid nodules with indeterminate cytology. Data regarding 18FCH uptake in chronic autoimmune thyroiditis (CAT) are scarce. We aimed to assess thyroid 18FCH uptake in CAT with biological and histological correlation. Methods This is an ancillary study from the Chocolate trial (NCT02784223) that prospectively enrolled 107 patients planned for thyroid surgery. 18FCH PET/CT acquisitions were performed 20 and 60 min after injection. 18FCH uptake in the thyroid gland was assessed by measuring maximum (SUVmax) and mean (SUVmean) standardized uptake values. Thyrotropin, free thyroxine (FT4), thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies were collected. The intensity of thyroiditis and the degree of fibrosis were assessed on pathology. Results CAT was evidenced in 19/107 (18%) patients. Of these, 13 (68%) displayed an increased and diffuse 18FCH thyroid uptake. This uptake pattern was not observed in patients without CAT. SUVmax and SUVmean were higher in patients with CAT than in those without (P < 0.001). At both acquisition times, SUVmax showed a monotonic relationship with the intensity of thyroiditis (Spearman ρ = 0.44 and 0.51, respectively, P < 0.001) and with the degree of fibrosis (Spearman ρ = 0.55 and 0.62, respectively, P < 0.001). SUVmax showed a linear relationship with TPOAb titers at 20 min (Pearson r = 0.54, P < 0.05; Spearman ρ = 0.59, P = 0.03). Conclusions More than two-thirds of the patients with CAT present high and diffuse thyroid 18FCH uptake. This uptake pattern is highly specific to CAT and is correlated with pathology and TPOAb titers.
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Affiliation(s)
- Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
- INSERM 1086 ANTICIPE, Caen University, Caen, France
| | | | - Marine Dorbeau
- Department of Pathology, François Baclesse Cancer Centre, Caen, France
| | - Justine Lequesne
- Department of Clinical Research, François Baclesse Cancer Centre, Caen, France
| | - Camille Linard
- Department of Pathology, François Baclesse Cancer Centre, Caen, France
| | | | - Bénédicte Clarisse
- Department of Clinical Research, François Baclesse Cancer Centre, Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer Centre, Caen, France
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12
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Peckham M, Spencer HJ, Syed S, Armstrong WB, Farwell DG, Gal TJ, Goldenberg D, Russell MD, Solis RN, King D, Stack BC. Breast and thyroid cancer: A multicenter study with Accrual to Clinical Trials Network. J Surg Oncol 2022; 125:1211-1217. [PMID: 35195923 DOI: 10.1002/jso.26825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/06/2022] [Accepted: 02/03/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate a possible link between breast and thyroid cancer. METHODS A multicenter retrospective review of patients in the electronic medical records of six Accrual to Clinical Trial (ACT) institutions with both breast cancer and thyroid carcinoma. Each center queried its data using a predefined data dictionary. Information on thyroid and breast cancer included dates of diagnosis, histology, and patient demographics. RESULTS A random-effects model was used. There were 4.24 million women's records screened, 44 605 with breast cancer and 11 846 with thyroid cancer. The relative risks observed at each institution ranged from 0.49 to 13.47. The combined risk ratio (RR) estimate was 1.77 (95% confidence interval: 0.50-5.18). CONCLUSION There was no association between the risk of developing thyroid cancer and being a breast cancer survivor compared to no history of breast cancer, but the range of relative risks among the participating institutions was wide. Our findings warrant further study of more institutions with larger sample size. Additionally, further analysis of the significance of regional RR differences may be enlightening.
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Affiliation(s)
- Merry Peckham
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Horace J Spencer
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Shorabuddin Syed
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - William B Armstrong
- Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA
| | - Donald Gregory Farwell
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas J Gal
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - David Goldenberg
- Department of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Marika D Russell
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Roberto N Solis
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Davis, California, USA
| | - Deanne King
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brendan C Stack
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Otolaryngology - Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Piek MW, de Vries LH, Donswijk ML, de Keizer B, de Boer JP, Lodewijk L, van Leeuwaarde RS, Vriens MR, Hartemink KJ, van der Ploeg IMC. Retrospective analysis of PSMA PET/CT thyroid incidental uptake in adults: incidence, diagnosis, and treatment/outcome in a tertiary cancer referral center and University Medical Center. Eur J Nucl Med Mol Imaging 2022; 49:2392-2400. [PMID: 35031811 DOI: 10.1007/s00259-022-05679-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/09/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE A prostate-specific membrane antigen (PSMA) thyroid incidentaloma (PTI) is an unexpected, PSMA-avid thyroid lesion, newly detected during the investigation of an unrelated condition using PSMA PET/CT. The aim of this study is to examine the incidence and clinical significance of PTI and the associated management strategies since the implementation of the PSMA PET/CT scan. METHODS This study involves a retrospective cohort study of 61 PTI cases depicted on PSMA PET/CT scans performed between January 2016 and July 2021, almost exclusively for (re)staging prostate cancer. The medical records of the included cases were retrospectively reviewed and data of the PSMA PET/CT scans, primary malignancy, thyroid diagnostics, treatment, and follow-up were collected. RESULTS PTI was reported in 1.1% of the patients who underwent oncologic PSMA PET/CT scans included in this study. Two PTI cases had a histologically proven thyroid cancer: one a benign thyroid lesion and one a metastasis of a renal cell carcinoma. In none of the cases in whom any form of further thyroid workup was withheld, the PTI became clinically relevant during follow-up (median 1.8 years (1.1-3.3)). Six patients (10%) died due to their primary cancer. CONCLUSION The incidence of thyroid incidentalomas on PSMA PET/CT was low (1.1%) in this large, two-center experience. Less than half of the PTI cases were analyzed and the risk of malignancy, despite being low, was not negligible. The clinical outcome was good using a standard diagnostic workup for PTI, while the prognosis of the patient was determined by the primary malignancy. The consideration to analyze and treat PTI cases should be part of the shared decision-making in cancer patients.
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Affiliation(s)
- Marceline W Piek
- Departments of Surgical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Lisa H de Vries
- Departments of Surgery, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten L Donswijk
- Departments of Nuclear Medicine, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Bart de Keizer
- Departments of Nuclear Medicine, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Paul de Boer
- Departments of Internal Medicine, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Lutske Lodewijk
- Departments of Surgery, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rachel S van Leeuwaarde
- Departments of Endocrine Oncology, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Menno R Vriens
- Departments of Surgery, University Medical Center of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Koen J Hartemink
- Departments of Surgical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Departments of Surgical Oncology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands.
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Lee H, Chung YS, Lee JH, Lee KY, Hwang KH. Characterization of focal hypermetabolic thyroid incidentaloma: An analysis with F-18 fluorodeoxyglucose positron emission tomography/computed tomography parameters. World J Clin Cases 2022; 10:155-165. [PMID: 35071515 PMCID: PMC8727242 DOI: 10.12998/wjcc.v10.i1.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/09/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidentally found thyroid tumor (thyroid incidentaloma, TI) on F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is reported in 2.5%-5% of patients being investigated for non-thyroid purposes. Up to 50% of these cases have been diagnosed to be malignant by cytological/histological results. Ultrasonography (US) and fine-needle aspiration cytology are recommended for thyroid nodules with high FDG uptake (hypermetabolism) that are 1 cm or greater in size. It is important to accurately determine whether a suspicious hypermetabolic TI is malignant or benign.
AIM To distinguish malignant hypermetabolic TIs from benign disease by analyzing F-18 FDG PET-CT parameters and to identify a cut-off value.
METHODS Totally, 12761 images of patients who underwent F-18 FDG PET-CT for non-thyroid purposes at our hospital between January 2016 and December 2020 were retrospectively reviewed, and 339 patients [185 men (mean age: 68 ± 11.2) and 154 women (mean age: 63 ± 15.0)] were found to have abnormal, either focal or diffuse, thyroid FDG uptake. After a thorough review of their medical records, US, and cytological/histological reports, 46 eligible patients with focal hypermetabolic TI were included in this study. The TIs were categorized as malignant and benign according to the cytological/histological reports, and four PET parameters [standardized uptake value (SUV)max, SUVpeak, SUVmean, and metabolic tumor volume (MTV)] were measured on FDG PET-CT. Total lesion glycolysis (TLG) was calculated by multiplying the SUVmean by MTV. Both parametric and non-parametric methods were used to compare the five parameters between malignant and benign lesions. Receiver operating characteristic (ROC) curve analysis was performed to identify a cut-off value.
RESULTS Each of the 46 patients [12 men (26.1%; mean age: 62 ± 13.1 years) and 34 women (73.9%; mean age: 60 ± 12.0 years)] with focal hypermetabolic TIs had one focal hypermetabolic TI. Among them, 26 (56.5%) were malignant and 20 (43.5%) were benign. SUVmax, SUVpeak, SUVmean, and TLG were all higher in malignant lesions than benign ones, but the difference was statistically significant (P = 0.012) only for SUVmax. There was a positive linear correlation (r = 0.339) between SUVmax and the diagnosis of malignancy. ROC curve analysis for SUVmax revealed an area under the curve of 0.702 (P < 0.05, 95% confidence interval: 0.550-0.855) and SUVmax cut-off of 8.5 with a sensitivity of 0.615 and a specificity of 0.789.
CONCLUSION More than half of focal hypermetabolic TIs on F-18 FDG PET-CT were revealed as malignant lesions, and SUVmax was the best parameter for discriminating between malignant and benign disease. Unexpected focal hypermetabolic TIs with the SUVmax above the cut-off value of 8.5 may have a greater than 70% chance of malignancy; therefore, further active assessment is required.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Yoo Seung Chung
- Department of Endocrine Surgery, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Joon-Hyop Lee
- Department of Endocrine Surgery, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Ki-Young Lee
- Department of Endocrinology and Metabolism, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Pongas GN, Alderuccio JP, Chapman JR, Lossos IS. Mantle cell lymphoma involving the thyroid gland. Clin Case Rep 2021; 9:e04104. [PMID: 34484740 PMCID: PMC8405369 DOI: 10.1002/ccr3.4104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/04/2021] [Accepted: 03/15/2021] [Indexed: 11/27/2022] Open
Abstract
Mantle cell lymphoma (MCL) rarely involves thyroid gland. Positron emission tomography-computed tomography (PET-CT) may be critical in identifying thyroid involvement by MCL and pursuing further work up of the suspicious thyroid lesions, irrespective of the thyroid function tests.
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Affiliation(s)
- Georgios N Pongas
- Department of MedicineDivision of HematologySylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Juan Pablo Alderuccio
- Department of MedicineDivision of HematologySylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Jennifer R. Chapman
- Department of Pathology and Laboratory MedicineDivision of HematopathologySylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - Izidore S Lossos
- Department of MedicineDivision of HematologySylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFLUSA
- Department of Molecular and Cellular PharmacologySylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFLUSA
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Nasr H, Farghaly H, Alqarni A, Al-Salem S, Sayed M. Characteristics of malignant thyroid lesions on [ 18F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT). Eur J Radiol Open 2021; 8:100373. [PMID: 34458507 DOI: 10.1016/j.ejro.2021.100373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To determine the imaging variables that can best differentiate malignant from benign thyroid lesions incidentally found on F-18 FDG PET/CT scans. Methods All F-18 FDG PET/CT studies starting from 2011 to end of 2016 were reviewed for incidental thyroid lesions or metabolic abnormalities. Only patients who were found to have FNAB or histopathology were included. Patients with known thyroid malignancy were excluded. Patients were analyzed for age, sex, SUVmax, non-enhanced CT tissue density in mean Hounsfield units (HU), uptake pattern (focal or diffuse) and gland morphology (MNG or diffuse). A control group of 15 patients with normal thyroid glands were used to assess the tissue density in HU for normal thyroid tissue. Sensitivity, specificity, PPV, NPV and accuracy to detect malignancy were calculated. Pearson Chi-square test was used to compare categorical variables while unpaired T-test and one way ANOVA test were used to compare means of continuous variables. ROC analysis was used to assess the best cut off points for SUVmax and HU. Regression analysis was used to detect the independent predictors for malignant lesions. Results Biopsy was unsatisfactory or indeterminate in 4/48 patients (8%). Only 44 patients (mean age 55.2 ± 14.7; 30 females (68 %)) with unequivocal FNAB or histopathology were included for further analysis. MNG was noted in 17/44 patients (38.6 %). Thyroid malignancy was found in 16/44 (36.4 %), benign thyroid lesions in 28/44 (63.6 %). Thyroid malignancies were 12 papillary, 1 follicular, 1 Hurthle cell neoplasm and 2 lymphoma. Benign lesions were 23 benign follicular or colloid nodules and 5 autoimmune thyroiditis. Focal FDG uptake pattern was more frequently associated with malignant lesions compared to benign lesions (75 % vs. 43 %; p = 0.039). The mean SUVmax and tissue density (HU) were both higher in malignant than benign lesions (8.8 ± 8.3 vs. 3.6 ± 1.9, p = 0.024) and (48.9 ± 12.7 vs. 32.9 ± 17.5, p = 0.003) respectively. The mean HU in the control group with normal thyroid tissue was 90 ± 7.4 significantly higher than in both the benign and malignant lesions (p < 0.001). ROC analysis revealed SUVmax cutoff of >4.7 and HU cutoff of >42 to best differentiate malignant from benign lesions. The sensitivity, specificity, PPV, NPV and accuracy to detect malignancy for SUVmax>4.7 were 68.8 %, 78.6 %, 64.8 %, 81.5 & 75.0 % (p = 0.002), for HU > 42 were 81.3.0 %, 75.0 %, 65.0 %, 87.5 & 77.3 % (p = 0.0003) and for both parameters combined were 87.5 %, 60.7 %, 56.0 %, 89.5 % and accuracy of 70.5 % (p = 0.002) respectively. Only HU > 42 and SUVmax>4.7 were independent predictors for malignancy with odd ratios 8.98 and 4.93 respectively. Conclusion A higher tissue density (HU > 42) and SUVmax>4.7 as well as tendency for focal uptake pattern are the most significant characteristics associated with malignant thyroid lesions occasionally detected on PET/CT.
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Petranović Ovčariček P, Deandreis D, Giovanella L. Thyroid dysfunctions induced by molecular cancer therapies: a synopsis for nuclear medicine thyroidologists. Eur J Nucl Med Mol Imaging 2021; 48:3355-3360. [PMID: 33970289 DOI: 10.1007/s00259-021-05394-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Petra Petranović Ovčariček
- EANM Thyroid Committee, Vienna, Austria. .,Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre milosrdnice", Vinogradska 29, 10 000, Zagreb, Croatia.
| | - Desiree Deandreis
- EANM Thyroid Committee, Vienna, Austria.,Department of Medical Sciences, Nuclear Medicine Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luca Giovanella
- EANM Thyroid Committee, Vienna, Austria.,Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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18
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Abstract
PET/CT imaging is a dual-modality diagnostic technology that merges metabolic and structural imaging. There are several currently available radiotracers, but 18F-FDG is the most commonly utilized due to its widespread availability. 18F-FDG PET/CT is a cornerstone of head and neck squamous cell carcinoma imaging. 68Ga-DOTA-TOC is another widely used radiotracer. It allows for whole-body imaging of cellular somatostatin receptors, commonly expressed by neuroendocrine tumors and is the standard of reference for the characterization and staging of neuroendocrine tumors. The normal biodistribution of these PET radiotracers as well as the technical aspects of image acquisition and inadequate patient preparation affect the quality of PET/CT imaging. In addition, normal variants, artifacts and incidental findings may impede accurate image interpretation and can potentially lead to misdiagnosis. In order to correctly interpret PET/CT imaging, it is necessary to have a comprehensive knowledge of the normal anatomy of the head and neck and to be cognizant of potential imaging pitfalls. The interpreter must be familiar with benign conditions which may accumulate radiotracer potentially mimicking neoplastic processes and also be aware of malignancies which can demonstrate low radiotracer uptake. Appropriate use of structural imaging with either CT, MR or ultrasound can serve a complimentary role in several head and neck pathologies including local tumor staging, detection of bone marrow involvement or perineural spread, and classification of thyroid nodules. It is important to be aware of the role of these complementary modalities to maximize diagnostic accuracy and patient outcomes. The purpose of this article is to outline the basic principles of PET/CT imaging, with a focus on 18F-FDG PET/CT and 68Ga-DOTA PET/CT. Basic physiology, variant imaging appearances and potential pitfalls of image interpretation are presented within the context of common use cases of PET technology in patients with head and neck cancers and other pathologies, benign and malignant.
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Affiliation(s)
- Jasna Mihailovic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia; Centre of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia.
| | - Ronan P Killeen
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John A Duignan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland; UCD - SVUH PET CT Research Centre, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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19
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Costa LB, Queiroz MA, Barbosa FG, Nunes RF, Zaniboni EC, Ruiz MM, Jardim D, Gomes Marin JF, Cerri GG, Buchpiguel CA. Reassessing Patterns of Response to Immunotherapy with PET: From Morphology to Metabolism. Radiographics 2020; 41:120-143. [PMID: 33275541 DOI: 10.1148/rg.2021200093] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cancer demands precise evaluation and accurate and timely assessment of response to treatment. Imaging must be performed early during therapy to allow adjustments to the course of treatment. For decades, cross-sectional imaging provided these answers, showing responses to the treatment through changes in tumor size. However, with the emergence of immune checkpoint inhibitors, complex immune response patterns were revealed that have quickly highlighted the limitations of this approach. Patterns of response beyond tumor size have been recognized and include cystic degeneration, necrosis, hemorrhage, and cavitation. Furthermore, new unique patterns of response have surfaced, like pseudoprogression and hyperprogression, while other patterns were shown to be deceptive, such as unconfirmed progressive disease. This evolution led to new therapeutic evaluation criteria adapted specifically for immunotherapy. Moreover, inflammatory adverse effects of the immune checkpoint blockade were identified, many of which were life threatening and requiring prompt intervention. Given complex concepts like tumor microenvironment and novel therapeutic modalities in the era of personalized medicine, increasingly sophisticated imaging techniques are required to address the intricate patterns of behavior of different neoplasms. Fluorine 18-fluorodeoxyglucose PET/CT has rapidly emerged as one such technique that spans both molecular biology and immunology. This imaging technique is potentially capable of identifying and tracking prognostic biomarkers owing to its combined use of anatomic and metabolic imaging, which enables it to characterize biologic processes in vivo. This tailored approach may provide whole-body quantification of the metabolic burden of disease, providing enhanced prediction of treatment response and improved detection of adverse events. ©RSNA, 2020.
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Affiliation(s)
- Larissa B Costa
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Marcelo A Queiroz
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Felipe G Barbosa
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Rafael F Nunes
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Elaine C Zaniboni
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Mariana Mazo Ruiz
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Denis Jardim
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Jose Flavio Gomes Marin
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Giovanni G Cerri
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
| | - Carlos A Buchpiguel
- From the Departments of Radiology (L.B.C., M.A.Q., F.G.B., R.F.N., E.C.Z., M.M.R., J.F.G.M., G.G.C., C.A.B.) and Oncology (D.J.), Hospital Sírio-Libanês, Rua Dona Adma Jafet 115, 01308-060 São Paulo, SP, Brazil; and Department of Radiology and Oncology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil (M.A.Q., J.F.G.M., G.G.C., C.A.B.)
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Albano D, Treglia G, Giovanella L, Giubbini R, Bertagna F. Detection of thyroiditis on PET/CT imaging: a systematic review. Hormones (Athens) 2020; 19:341-349. [PMID: 32037486 DOI: 10.1007/s42000-020-00178-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The incidence and clinical significance of thyroiditis detected by molecular imaging methods is a clinical challenge that is not widely investigated in the literature. The aim of this systematic review was to analyze published data about the detection of thyroiditis on PET or PET/CT using different tracers. METHODS A comprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase, and Cochrane library databases was conducted up to November 2019 to find relevant papers on the detection of thyroiditis by PET/CT, the metabolic appearance, and the clinical significance. RESULTS Twenty-six articles were selected and retrieved in full-text version. From the analyses of these studies, the following main findings have been found. Diffuse thyroid uptake of PET tracers is a relatively frequent event, ranging from 0.4 to 46.2%, and it is commonly related to benign disease. Thyroiditis is the most frequent reason for diffuse increased thyroid 18F-FDG uptake. Cases of malignant disease with a pattern of diffuse 18F-FDG thyroid uptake are less frequent. Preliminary studies show a possible role of thyroiditis detected by 18F-FDG PET/CT in evaluating treatment response and as a prognostic marker in oncological patients treated with immunotherapy. However, further studies are needed. CONCLUSIONS Diffuse 18F-FDG thyroid uptake is a relatively rare event commonly due to benign diseases, among which thyroiditis is the most common. The rate of neoplastic disease with diffuse 18F-FDG thyroid uptake is very low. Diffuse 18F-FDG thyroid uptake requires further investigation and clinical evaluation for the correct diagnosis. Currently, cases of diffuse thyroid uptake with non-18F-FDG radiotracer are only anecdotal.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy.
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luca Giovanella
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zürich, Zürich, Switzerland
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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21
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Yamauchi I, Yasoda A, Matsumoto S, Sakamori Y, Kim YH, Nomura M, Otsuka A, Yamasaki T, Saito R, Kitamura M, Kitawaki T, Hishizawa M, Kawaguchi-Sakita N, Fujii T, Taura D, Sone M, Inagaki N. Incidence, features, and prognosis of immune-related adverse events involving the thyroid gland induced by nivolumab. PLoS One 2019; 14:e0216954. [PMID: 31086392 PMCID: PMC6516638 DOI: 10.1371/journal.pone.0216954] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Blocking the PD-1 pathway induces immune-related adverse events (irAEs) which often involve the thyroid gland (thyroid irAEs). Clinical features of a thyroid irAE including its predictability and relationship to prognosis remain to be elucidated. METHODS Two hundred consecutive patients treated with nivolumab at Kyoto University Hospital between September 1, 2014 and August 31, 2017 were included in a retrospective cohort study. We systematically determined and classified subclinical and overt thyroid irAEs based on data collected of serum free T4 and TSH levels. Baseline characteristics and detailed clinical data were analyzed, and analyses of overall survival (OS) excluded patients censored within 1 month from the first administration of nivolumab. RESULTS Sixty-seven patients (33.5%) developed thyroid irAEs and these were divided into a subclinical thyroid irAE group (n = 40, 20.0%) and an overt thyroid irAE group (n = 27, 13.5%). Patients with thyroid uptake of FDG-PET before treatment showed high incidences of overt thyroid irAE (adjusted odds ratio 14.48; 95% confidence interval [CI] 3.12-67.19), while the same relationship was not seen with subclinical thyroid irAE. Regarding the total cohort, the thyroid irAE (+) group had a significantly longer median OS than the thyroid irAE (-) group (16.1 versus 13.6 months, hazard ratio [HR] 0.61; 95% CI 0.39-0.93). In 112 non-excluded patients with lung cancer, the thyroid irAE (+) group similarly had a longer median OS than the thyroid irAE (-) group (not reached versus 14.2 months, HR 0.51; 95% CI 0.27-0.92). However, this observation was not seen in 41 non-excluded patients with malignant melanoma (12.0 versus 18.3 months, HR 1.54; 95% CI 0.67-3.43). CONCLUSIONS By thyroid uptake of FDG-PET, overt thyroid irAEs could be predicted before nivolumab therapy. Thyroid irAEs related to good prognosis in lung cancer but might be inconclusive in malignant melanoma.
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Affiliation(s)
- Ichiro Yamauchi
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Yasoda
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigemi Matsumoto
- Department of Medical Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichi Sakamori
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Motoo Nomura
- Department of Medical Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsushi Otsuka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshinari Yamasaki
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryoichi Saito
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Morimasa Kitamura
- Department of Otolaryngology, Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshio Kitawaki
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakatsu Hishizawa
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Toshihito Fujii
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daisuke Taura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
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22
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Kim YH, Chang Y, Kim Y, Kim SJ, Rhee EJ, Kwon H, Ahn J, Ryu S. Diffusely Increased 18F-FDG Uptake in the Thyroid Gland and Risk of Thyroid Dysfunction: A Cohort Study. J Clin Med 2019; 8:jcm8040443. [PMID: 30987005 PMCID: PMC6517876 DOI: 10.3390/jcm8040443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 01/21/2023] Open
Abstract
The impact of incidentally identified diffuse thyroid FDG uptake on 18F-FDG PET/CT scan on the incidence of thyroid dysfunction remains unclear. We examined the association of diffuse thyroid FDG uptake with the development of thyroid dysfunction. This cohort study involved 39,098 Korean adults who were free of malignancy and thyroid disease at baseline and underwent regular health checkup examinations including an 18F-FDG whole body PET/CT scan, thyroid-stimulating hormone and free thyroxine. The participants were annually or biennially followed for up to 5 years. A parametric proportional hazard model was used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (CI). Diffuse thyroid uptake was positively associated with increased risk of thyroid dysfunction in both the cross-sectional and cohort studies. During 104,261.4 person-years of follow-up, 102 incident hypothyroidism cases and 172 hyperthyroidism cases were identified. Multivariable-adjusted HR (95% CI) for incident hypothyroidism or hyperthyroidism comparing diffuse thyroid uptake to no uptake were 15.72 (9.23–26.77) and 7.38 (4.23–12.87), respectively. In this large cohort, incidentally, identified diffuse thyroid uptake on 18F-FDG PET/CT was associated with increased risk of both prevalent and incident thyroid dysfunction. Therefore, baseline and follow-up evaluations in individuals with diffuse thyroid uptake may help identify individuals with thyroid dysfunction.
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Affiliation(s)
- Young Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Korea.
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 04514 Seoul, Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 06351 Seoul, Korea.
| | - Yejin Kim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 04514 Seoul, Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 06351 Seoul, Korea.
| | - Soo Jeong Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Korea.
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Korea.
| | - Hyemi Kwon
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Korea.
| | - Jiin Ahn
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 04514 Seoul, Korea.
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 04514 Seoul, Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Korea.
- Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, 06351 Seoul, Korea.
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Tatlıdil S, Akgün A. FDG PET/BT görüntülemede tiroid bezinde rastlantısal saptanan fokal artmış FDG tutulumunun klinik önemi. Ege Tıp Dergisi 2019. [DOI: 10.19161/etd.417340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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24
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Edo N, Morita K, Sakamoto M, Kaminaga T, Edo H, Okamura E, Ogawa M, Tsukamoto K, Okinaga H, Ishikawa T. Correlation between anti-thyroid peroxidase antibody levels and diffuse thyroid uptake of 18F-fluorodeoxyglucose in Hashimoto's thyroiditis: a retrospective study. Thyroid Res 2018; 11:14. [PMID: 30349584 PMCID: PMC6192302 DOI: 10.1186/s13044-018-0058-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background On 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET), diffuse uptake in the thyroid gland is often observed in patients with Hashimoto’s thyroiditis. In this study, we evaluated the factors associated with diffuse uptake by comparing Hashimoto’s thyroiditis patients with or without diffuse uptake in the thyroid. Methods A retrospective study was conducted of 18 patients with Hashimoto’s thyroiditis who underwent blood tests, thyroid ultrasonography, and FDG-PET during the period from 2014 to 2015. The patients were divided into two groups: one with diffuse thyroid uptake (group 1, n = 13) and one without diffuse thyroid uptake (group 2, n = 5). Clinical and laboratory parameters, including maximum standardized uptake in the thyroid (SUVmax), which was defined as the higher value obtained in either the right or left thyroid lobe, were compared in the two groups. Results The frequency of abnormal findings, such as a rough or heterogeneous pattern, was significantly higher in group 1 (p < 0.01), as were anti-thyroid peroxidase (TPO) antibody titers, anti-thyroglobulin (Tg) antibody titers, and SUVmax (p < 0.01). The frequency of hypothyroidism did not differ significantly in the two groups. Anti-TPO and anti-Tg titers were positively correlated with SUVmax (r = 0.856, p < 0.01 and r = 0.821, p < 0.01, respectively); in univariate analysis, anti-TPO titer was predictive of SUVmax (p < 0.01). Conclusions The results of the current study suggest that Hashimoto’s thyroiditis patients with high titers of anti-thyroid antibodies are likely to exhibit intense diffuse FDG uptake in the thyroid, and that thyroid function may be clearly impaired, even in the presence of mild FDG uptake in the thyroid.
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Affiliation(s)
- Naoki Edo
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Koji Morita
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Miki Sakamoto
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Tatsuro Kaminaga
- 2Department of Radiology, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Hiromi Edo
- 3Department of Radiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro, Tokyo, Japan
| | - Erina Okamura
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Masumi Ogawa
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Kazuhisa Tsukamoto
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Hiroko Okinaga
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
| | - Toshio Ishikawa
- 1Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-0003 Japan
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Isik U, Gokcay S, Simsek M, Paydas S, Buyukdereli G, Uguz A. Lymphocytic thyroiditis simulating thyroid cancer biochemically, radiologically and pathologically. Journal of Oncological Sciences 2018; 4:114-5. [DOI: 10.1016/j.jons.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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van Lierop ZY, Jentjens S, Anten MH, Wierts R, Stumpel CT, Havekes B, van Kroonenburgh MJ. Thyroid Gland 18F-FDG Uptake in Neurofibromatosis Type 1. Eur Thyroid J 2018; 7:155-161. [PMID: 30023349 PMCID: PMC6047496 DOI: 10.1159/000488706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/19/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate thyroid gland characteristics on 18F-FDG positron emission tomography/computed tomography (PET/CT) imaging in patients with neurofibromatosis type 1 (NF1). SUBJECTS AND METHODS Thyroid gland characteristics of patients with a clinical diagnosis of NF1 who underwent 18F-FDG PET/CT imaging for the first time to distinguish benign neurofibroma from malignant peripheral nerve sheath tumor (MPNST) at our institution (n = 69) were compared to PET/CT imaging of sarcoidosis (n = 25) and early stage lung cancer (T1N0M0 tumors, n = 15) patients. RESULTS Two NF1 patients (3%) showed a diffuse 18F-FDG uptake in the thyroid gland, 2 patients (3%) had an irregular uptake, and 7 patients (10%) had a focal uptake. Among the sarcoidosis patients, 1 showed a diffuse uptake (4%) and 1 had an irregular uptake (4%). In the early stage lung cancer group, 1 patient showed a diffuse uptake (7%) and 1 had a focal uptake (7%). NF1 patients had larger mean thyroid volume and mean SUVmax compared to sarcoidosis patients but not compared to early stage lung cancer patients. Four NF1 patients were diagnosed with multinodular goiter, 2 patients were diagnosed with benign chronic lymphocytic thyroiditis, 1 patient had metastasis to the thyroid, and 1 patient had medullary thyroid cancer. CONCLUSION Even though NF1 patients did not show an increased risk of thyroid incidentaloma on PET/CT compared to previous studies on non-thyroid cancer patients, the incidence shows that awareness of possible thyroid disease is important.
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Affiliation(s)
- Zoë Y.G.J. van Lierop
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- **Zoë Y.G.J. van Lierop, MD, Department of Neurology, Maastricht University Medical Centre, PO Box 5800, NL-6202 AZ Maastricht (The Netherlands), E-Mail
| | - Sander Jentjens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Monique H.M.E. Anten
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roel Wierts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Connie T. Stumpel
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marinus J.P.G. van Kroonenburgh
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- *Marinus J.P.G. van Kroonenburgh, MD, PhD, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, NL-6202 AZ Maastricht (The Netherlands), E-Mail
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Jaafar J, Fernandez E, Alwan H, Philippe J. Programmed cell death-1 and programmed cell death ligand-1 antibodies-induced dysthyroidism. Endocr Connect 2018; 7:R196-R211. [PMID: 29739808 PMCID: PMC5937198 DOI: 10.1530/ec-18-0079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Monoclonal antibodies blocking the programmed cell death-1 (PD-1) or its ligand (PD-L1) are a group of immune checkpoints inhibitors (ICIs) with proven antitumor efficacy. However, their use is complicated by immune-related adverse events (irAEs), including endocrine adverse events (eAEs). PURPOSE We review the incidence, time to onset and resolution rate of dysthyroidism induced by PD-1/PD-L1 Ab, and the clinical, biological and radiological findings. We aim to discuss the potential mechanisms of PD-1/PD-L1 Ab-induced dysthyroidism, and to propose a management algorithm. METHODS We performed a literature search of available clinical trials regarding PD-1/PD-L1 Ab in the PubMed database. We selected all English language clinical trials that included at least 100 patients. We also present selected case series or reports, retrospective studies and reviews related to this issue. FINDINGS In patients treated with PD-1 Ab, hypothyroidism occurred in 2-10.1% and hyperthyroidism occurred in 0.9-7.8%. When thyroiditis was reported separately, it occurred in 0.34-2.6%. Higher rates were reported when PD-1 Ab were associated with other ICI or chemotherapy. The median time to onset of hyperthyroidism and hypothyroidism after PD-1 Ab initiation was 23-45 days and 2-3.5 months, respectively. Regarding PD-L1 Ab, hypothyroidism occurred in 0-10% and hyperthyroidism in 0.5-2% of treated patients. The average time to onset of dysthyroidism after PD-L1 Ab was variable and ranged from 1 day after treatment initiation to 31 months. CONCLUSION Dysthyroidism occurs in up to 10% of patients treated with PD-1/PD-L1 Ab. Hypothyroidism and reversible destructive thyroiditis are the most frequent endocrine adverse events (eAE) in PD-1/PD-L1 treated patients. Immune and non-immune mechanisms are potentially involved, independently of the presence of thyroid antibodies.
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Affiliation(s)
- Jaafar Jaafar
- Division of Endocrinology and DiabetologyGeneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Eugenio Fernandez
- Department of OncologyGeneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Heba Alwan
- Division of Endocrinology and DiabetologyGeneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jacques Philippe
- Division of Endocrinology and DiabetologyGeneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Shi H, Yuan Z, Yuan Z, Yang C, Zhang J, Shou Y, Zhang W, Ping Z, Gao X, Liu S. Diagnostic Value of Volume-Based Fluorine-18-Fluorodeoxyglucose PET/CT Parameters for Characterizing Thyroid Incidentaloma. Korean J Radiol 2018. [PMID: 29520193 PMCID: PMC5840064 DOI: 10.3348/kjr.2018.19.2.342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective To assess clinical value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for differentiation of malignant from benign focal thyroid incidentaloma. Materials and Methods This retrospective study included 99 patients with focal thyroid incidentaloma of 5216 non-thyroid cancer patients that had undergone PET/CT. PET/CT semi-quantitative parameters, volume-based functional parameters, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of thyroid incidentaloma were assessed. Receiver-operating characteristic (ROC) analysis was conducted and areas under the curve (AUC) were compared by Hanley and McNeil test to evaluate usefulness of maximum standardized uptake value (SUVmax), MTV and TLG, as markers for differentiating malignant from benign thyroid incidentalomas. Results Of 99 thyroid incidentalomas, 64 (64.6%) were malignant and 35 (35.4%) were benign. Malignant thyroid incidentalomas were larger (1.8 cm vs. 1.3 cm, p = 0.006), and had higher SUVmax (11.3 vs. 4.8, p < 0.001), MTV (all p < 0.001) and TLG (all p < 0.001) than benign. TLG 4.0 had the highest performance for differentiation of malignant from benign thyroid incidentaloma in all semi-quantitative parameters with AUC 0.895 by ROC curve analysis. AUC (TLG 4.0) was significantly larger than AUC (SUVmean), AUC (MTV 2.5), AUC (MTV 3.0), AUC (MTV 3.5), AUC (TLG 2.5), and AUC (TLG 3.0), respectively (all, p < 0.05). There was no statistical difference between AUC (TLG 4.0) and AUC (SUVmax) (p > 0.05). A threshold TLG 4.0 of 2.475 had 81.3% sensitivity and 94.3% specificity for identifying malignant thyroid incidentalomas. Conclusion Volume-based PET/CT parameters could potentially have clinical value in differential diagnosis of thyroid incidentaloma along with SUVmax.
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Affiliation(s)
- Huazheng Shi
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China.,Department of Radiology, affiliated Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
| | - Zuguo Yuan
- Department of Chemoradiotherapy, Yinzhou People's Hospital, Ningbo 315100, China
| | - Zheng Yuan
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Chunshan Yang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Jian Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Yi Shou
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Wenrui Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Zhaofu Ping
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai 200233, China.,Department of Radiology, PET/CT Center, Shanghai 85 Hospital, Shanghai 200052, China
| | - Shiyuan Liu
- Department of Radiology, affiliated Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China
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Treglia G, Bertagna F, Sadeghi R, Verburg FA, Ceriani L, Giovanella L. Focal thyroid incidental uptake detected by 18F-fluorodeoxyglucose positron emission tomography. Nuklearmedizin 2017; 52:130-6. [DOI: 10.3413/nukmed-0568-13-03] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/08/2013] [Indexed: 01/08/2023]
Abstract
SummaryAim: To perform a meta-analysis of published data on the prevalence and risk of malignancy of focal thyroid incidental uptake (FTIs) detected by Fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/CT. Methods: A comprehensive literature search of studies published up to and including December 2012 was performed. Pooled prevalence and malignancy risk of FTIs were calculated, including a sub-analysis for the geographic areas of origin of the studies. Results: 34 studies including 215 057 patients were selected. Pooled prevalence of FTIs was 1.92% (95% confidence interval [95%CI]: 1.87–1.99%). Overall, 1522 FTIs underwent histopathology evaluation. Pooled risk of malignancy was 36.2% (95%CI: 33.8–38.6%), without significant differences among various geographic areas. Conclusions: FTIs are observed in about 2% of 18F-FDG-PET or PET/CT scans and carry a significant risk of malignancy. Therefore, further investigation is warranted whenever FTIs are detected by 18F-FDG-PET or PET/CT.
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30
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Bakhshayesh Karam M, Doroudinia A, Joukar F, Nadi K, Dorudinia A, Mehrian P, Yousefikoma A. Hypermetabolic Thyroid Incidentaloma on Positron Emission Tomography: Review of Laboratory, Radiologic, and Pathologic Characteristics. J Thyroid Res 2017; 2017:7176934. [PMID: 28913004 DOI: 10.1155/2017/7176934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/18/2017] [Indexed: 12/05/2022] Open
Abstract
Introduction Incidental hypermetabolic thyroid lesions on Positron Emission Tomography have significant clinical value and may harbor malignancy. In this study we evaluated laboratory, radiologic, and pathologic characteristics of incidental hypermetabolic thyroid lesions. Materials and Methods We evaluated 18 patients prospectively with various malignancies and hypermetabolic thyroid incidentaloma. The thyroid function tests, ultrasound assessment, and guided FNA biopsy were performed on all cases. Results We included 9 male and 9 female patients with mean age of 51 years. Most common malignancy was colon cancer. Metabolic activity quantification using maximum standard uptake value demonstrated range between 1.4 and 65.4 with mean value of 9.4. We found highest metabolic activity in patients with lung adenocarcinoma, B-cell lymphoma, and colon adenocarcinoma. On ultrasound exam most thyroid lesions were of solid, hypoechoic, noncalcified nature with either normal or peripheral increased vascularity. FNA biopsy report was benign in 15 cases and malignant or highly suggestive for malignancy in 3 other cases. Two of the three malignant cases demonstrated metabolic activity higher than average SUV max. Conclusion Most thyroid hypermetabolic incidentalomas are benign lesions, while higher values of SUV max are in favor of malignancy. This mandates further evaluation of incidentally found thyroid hypermetabolic lesions on routine PET/CT scans.
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Delivanis DA, Gustafson MP, Bornschlegl S, Merten MM, Kottschade L, Withers S, Dietz AB, Ryder M. Pembrolizumab-Induced Thyroiditis: Comprehensive Clinical Review and Insights Into Underlying Involved Mechanisms. J Clin Endocrinol Metab 2017; 102:2770-2780. [PMID: 28609832 PMCID: PMC5546861 DOI: 10.1210/jc.2017-00448] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/02/2017] [Indexed: 12/21/2022]
Abstract
CONTEXT Thyroid immune-related adverse events (irAEs) in patients treated with programmed death receptor-1 (PD-1) blockade are increasingly recognized as one of the most common adverse effects. Our aim was to determine the incidence and examine the potential mechanisms of anti-PD-1-induced thyroid irAEs. DESIGN Single-center, retrospective cohort study. PATIENTS AND MEASUREMENTS We studied 93 patients with advanced cancer (ages 24 to 82 years; 60% males) who received at least one infusion of pembrolizumab. Thyroid test results and thyroid imaging modalities were reviewed. Comprehensive 10-color flow cytometry of peripheral blood was performed. RESULTS Thirteen (14%) thyroid irAEs were observed. Thyroiditis occurred in seven patients (54%), from which four recovered. New onset of hypothyroidism overt/subclinical developed in three patients. Levothyroxine dosing required doubling in three patients with a known history of hypothyroidism. Thyroperoxidase antibodies were positive in the minority of the patients [4/13 (31%)] and diffuse increased 18fludeoxyglucose uptake of the thyroid gland was observed in the majority [7/11 (64%)] of patients. We observed more circulating CD56+CD16+ natural killer (NK) cells and an elevated HLA-DR surface expression in the inflammatory intermediate CD14+CD16+ monocytes in anti-PD-1-treated patients. CONCLUSIONS Thyroid dysfunction is common in cancer patients treated with pembrolizumab. Reversible destructive thyroiditis and overt hypothyroidism are the most common clinical presentations. The mechanism of thyroid destruction appears independent of thyroid autoantibodies and may include T cell, NK cell, and/or monocyte-mediated pathways. Because the thyroid is a frequent target of anti-PD-1 therapies, patients with therapeutically refractory thyroid cancer may be ideal candidates for this treatment.
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Affiliation(s)
- Danae A. Delivanis
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Michael P. Gustafson
- Human Cell Therapy Laboratory, Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905
| | - Svetlana Bornschlegl
- Department of Laboratory Medicine & Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Michele M. Merten
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Lisa Kottschade
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
| | - Sarah Withers
- Department of Laboratory Medicine & Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Allan B. Dietz
- Human Cell Therapy Laboratory, Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905
| | - Mabel Ryder
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota 55905
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Algin E, Uner A, Akdemir UO, Gumusay O, Kapucu O, Ozet A. The assessment of incidental thyroid lesions on 18F-fluorodeoxyglucose positron emission tomography/computed tomogrophy: A single centre experience. Journal of Oncological Sciences 2017. [DOI: 10.1016/j.jons.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Millare GG, Kwon M, Edeiken-Monroe BS, Debnam JM. 18F-PET/CT imaging of metastasis to the thyroid gland: Imaging findings and effect on patient management. ACTA ACUST UNITED AC 2017; 7:7-13. [PMID: 30405862 DOI: 10.5430/jst.v7n2p7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose While metastasis to the thyroid from a primary cancer remote to the thyroid is uncommon, current imaging techniques have improved detection of these intrathyroid metastases. The purpose of this study was to evaluate the 18F-PET/CT appearance of intrathyroid metastases and assess the impact of detection on patient management. Methods The 18F-PET/CT appearance of intrathyroid metastasis, including standardized uptake value (SUV), disease extent, and the effect on patient management following diagnosis were retrospectively reviewed. Inclusion criteria included 18F-PET/CT imaging and diagnosis of the intrathyroid metastasis matching the remote primary tumor. Results Intrathyroid metastasis were detected in 24 patients. The intrathyroid metastases presented on 18F-PET/CT as focal nodular uptake (n = 21), multiple nodular uptake (n = 2), or diffuse uptake/infiltration of the thyroid gland (n = 1). The SUV ranged between 3.9 and 42 (median 12.5 ± 7.5); in 2 patients, the FDG-avidity was minimal. On 18F-PET/CT, distant metastases were present outside the neck (n = 18), or limited to the neck (n = 6). In 2 of these 6 patients, the thyroid was the only site of metastatic disease. Due to the metastatic disease, the therapy was changed in 23 of 24 patients; 1 patient was lost to follow-up. Conclusion In any patient with a previous or current history of an extrathyroid malignancy, an 18FDG-avid thyroid mass or diffuse infiltration of the thyroid on 18F-PET/CT should be considered a potential intrathyoid metastasis until proven otherwise. Knowledge of an intrathyroid metastasis may impact patient management, especially if the thyroid or neck are the only sites of metastatic disease.
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Affiliation(s)
- Giovanni G Millare
- Department of Diagnostic Radiology, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas, United States
| | - Michael Kwon
- Department of Diagnostic Radiology, Section of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Beth S Edeiken-Monroe
- Department of Diagnostic Radiology, Section of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - J Matthew Debnam
- Department of Diagnostic Radiology, Section of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Li Y, Cui M, Azar N, Nakamoto D, Michael CW. Cytological evaluation by fine needle aspiration biopsy of incidental focal increased fluorodeoxyglucose uptake in thyroid on positron emission tomography scan. Diagn Cytopathol 2017; 45:501-506. [PMID: 28261999 DOI: 10.1002/dc.23695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/23/2017] [Accepted: 02/15/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND With the increased use of whole body fluorodeoxyglucose positron emission tomography (PET) scan for staging/restaging or primary diagnosis of neoplasia, thyroid incidentalomas have become more common. The limited reports of PET-positive thyroid incidentalomas showed incidence of malignancy ranging from 14 to 66%, and there is discrepancy in terms of the diagnostic significance of the standard uptake value (SUV) value. METHODS This is a retrospective study of 20 PET incidentalomas which had cytological evaluation from October 2009 to February 2015 at a tertiary care university medical center, M:F = 8:12. RESULTS Of the 20 cases, 14 (70%) had a cytological diagnosis of atypia or suspicious for neoplasia. Eleven of those (55%) underwent surgical resection with final diagnosis of PTC in 8 cases, follicular carcinoma in one case (5%), follicular adenoma in one case (5%), and Hurthle cell adenoma in one case (5%). There was good correlation between cytological and histological diagnosis. For two cases with cytological diagnosis of suspicious for follicular neoplasm, no further histological diagnosis was obtained. One patient had direct cytological diagnosis of PTC also did not undergo surgical resection/diagnosis due to the advanced primary pancreatic adenocarcinoma. The remaining 6 (30%) cases had a cytological diagnosis of benign follicular nodule. Furthermore, no significant difference between malignant SUV and benign SUV was observed. CONCLUSIONS Malignancy was identified in 50% of the PET-positive incidentalomas in our series. PTC constitutes the major malignant diagnosis. No diagnostic value of SUV was observed to differentiate malignant from benign lesions. Diagn. Cytopathol. 2017;45:501-506. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yanchun Li
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Min Cui
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Dean Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Claire W Michael
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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de Filette J, Jansen Y, Schreuer M, Everaert H, Velkeniers B, Neyns B, Bravenboer B. Incidence of Thyroid-Related Adverse Events in Melanoma Patients Treated With Pembrolizumab. J Clin Endocrinol Metab 2016; 101:4431-4439. [PMID: 27571185 PMCID: PMC5095250 DOI: 10.1210/jc.2016-2300] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/19/2016] [Indexed: 12/26/2022]
Abstract
CONTEXT Immune checkpoint blockade is associated with endocrine-related adverse events. Thyroid dysfunction during pembrolizumab therapy, an anti-programmed cell death 1 (PD-1) receptor monoclonal antibody, remains to be fully characterized. OBJECTIVE To assess the incidence and characteristics of pembrolizumab-associated thyroid dysfunction. DESIGN AND SETTING Thyroid function was monitored prospectively in melanoma patients who initiated pembrolizumab within an expanded access program at a referral oncology center. 18Fluorodeoxyglucose uptake on positron emission tomography/computed tomography (18FDG-PET/CT) was reviewed in cases compatible with inflammatory thyroiditis. PATIENTS Ninety-nine patients with advanced melanoma (age, 26.3-93.6 years; 63.6% females) who received at least one administration of pembrolizumab. MAIN OUTCOME MEASURES Patient characteristics, thyroid function (TSH, free T4), thyroid autoantibodies, and 18FDG-PET/CT. RESULTS Eighteen adverse events of thyroid dysfunction were observed in 17 patients. Thyrotoxicosis occurred in 12 patients, of which nine evolved to hypothyroidism. Isolated hypothyroidism was present in six patients. Levothyroxine therapy was required in 10 of 15 hypothyroid patients. Thyroid autoantibodies were elevated during thyroid dysfunction in four of 10 cases. Diffuse increased 18FDG uptake by the thyroid gland was observed in all seven thyrotoxic patients who progressed to hypothyroidism. CONCLUSIONS Thyroid dysfunction is common in melanoma patients treated with pembrolizumab. Hypothyroidism and thyrotoxicosis related to inflammatory thyroiditis are the most frequent presentations. Serial measurements of thyroid function tests are indicated during anti-PD-1 monoclonal antibody therapy. Thyrotoxicosis compatible with inflammatory thyroiditis was associated with diffuse increased 18FDG uptake by the thyroid gland. The prospective role of thyroid autoantibodies should be further investigated, together with the histopathological correlates.
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Affiliation(s)
- Jeroen de Filette
- Departments of Endocrinology (J.d.F., B.V., B.B.), Medical Oncology (Y.J., M.S., B.N.), and Nuclear Medicine (H.E.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Yanina Jansen
- Departments of Endocrinology (J.d.F., B.V., B.B.), Medical Oncology (Y.J., M.S., B.N.), and Nuclear Medicine (H.E.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Max Schreuer
- Departments of Endocrinology (J.d.F., B.V., B.B.), Medical Oncology (Y.J., M.S., B.N.), and Nuclear Medicine (H.E.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Hendrik Everaert
- Departments of Endocrinology (J.d.F., B.V., B.B.), Medical Oncology (Y.J., M.S., B.N.), and Nuclear Medicine (H.E.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Brigitte Velkeniers
- Departments of Endocrinology (J.d.F., B.V., B.B.), Medical Oncology (Y.J., M.S., B.N.), and Nuclear Medicine (H.E.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Bart Neyns
- Departments of Endocrinology (J.d.F., B.V., B.B.), Medical Oncology (Y.J., M.S., B.N.), and Nuclear Medicine (H.E.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Bert Bravenboer
- Departments of Endocrinology (J.d.F., B.V., B.B.), Medical Oncology (Y.J., M.S., B.N.), and Nuclear Medicine (H.E.), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium
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Sharma A, Jasim S, Reading CC, Ristow KM, Villasboas Bisneto JC, Habermann TM, Fatourechi V, Stan M. Clinical Presentation and Diagnostic Challenges of Thyroid Lymphoma: A Cohort Study. Thyroid 2016; 26:1061-7. [PMID: 27256107 DOI: 10.1089/thy.2016.0095] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Thyroid lymphoma is a relatively rare disease often posing a diagnostic challenge. Reaching the final diagnosis can be delayed if insufficient biopsy material is obtained for immunohistochemistry analysis. The aim of this study was to evaluate the clinical, biochemical, and radiological features of thyroid lymphoma. METHODS A retrospective analysis was conducted of all Mayo Clinic patients evaluated between 2000 and 2014 who had a tissue biopsy positive for thyroid lymphoma. RESULTS Seventy-five subjects had biopsy-proven thyroid lymphoma, and 62.7% were primary thyroid lymphomas. The median age at diagnosis was 67 years (range 20-90 years). A total of 50.7% were male, and 54.7% had a history of Hashimoto's thyroiditis. Presenting symptoms included neck mass (88%), dysphagia (45.3%), and hoarseness (37.3%). The typical ultrasound appearance consisted of a solid, hypoechoic mass with increased vascularity and variable edge characteristics. Fine-needle aspiration (FNA) biopsies were abnormal in 70.7% of cases, and 42% indicated a specific lymphoma subtype. The diagnosis was confirmed in 53.3% by core biopsy, in 21.3% by thyroidectomy (partial or total), in 12% through incisional biopsy, and in 12% by lymph node biopsy. Core biopsy had a higher sensitivity compared with FNA (93% vs. 71%, p = 0.006). CONCLUSION A rapidly enlarging neck mass in the setting of Hashimoto's thyroiditis should raise suspicion for thyroid lymphoma. Radiologically, this usually presents as a large, unilateral, thyroid-centered mass, hypoechoic by ultrasound, and expanding into adjacent soft tissues. Core-needle biopsy should be the first diagnostic test to expedite reaching the final diagnosis and decrease patient burden of additional tests and interventions.
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Affiliation(s)
- Anu Sharma
- 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Sina Jasim
- 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Carl C Reading
- 2 Department of Radiology, Mayo Clinic , Rochester, Minnesota
| | - Kay M Ristow
- 3 Department of Oncology, Mayo Clinic , Rochester, Minnesota
| | | | | | - Vahab Fatourechi
- 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Marius Stan
- 1 Department of Endocrinology, Mayo Clinic , Rochester, Minnesota
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Beech P, Lavender I, Jong I, Soo G, Ramdave S, Chong A, Nandurkar D. Ultrasound stratification of the FDG-avid thyroid nodule. Clin Radiol 2016; 71:164-9. [DOI: 10.1016/j.crad.2015.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 10/01/2015] [Accepted: 10/21/2015] [Indexed: 01/01/2023]
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Abstract
A 39 year old female presented with rapidly enlarging goitre, minimal obstructive symptoms and no constitutional symptoms. Clinical examination revealed diffusely enlarged, firm, non-tender thyroid gland. Biochemical investigations showed subclinical hypothyroidism, positive thyroid antibodies and unremarkable inflammatory markers. Ultrasound examination and CT scan of the neck were suspicious of Riedels thyroiditis. The patient was referred for a FDG PET scan to evaluate for systemic fibro-inflammatory process or lymphoma. Subsequent core biopsy of the thyroid gland demonstrated a chronic inflammatory process with fibrosis consistent with Riedels thyroiditis. A FDG PET/CT study showed diffuse FDG uptake in the thyroid gland and no abnormal retroperitoneal FDG uptake elsewhere to suggest active retroperitoneal fibrosis. The goitre reduced in size with thyroid hormone replacement and steroids, however the patient was lost to follow up.
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Affiliation(s)
- Robert Mansberg
- Nepean Hospital, Clinic of PET and Nuclear Medicine, Penrith, Australia. E-mail:
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39
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Jeong YH, Kim D, Lee JW, Rhee Y, Nam KH, Yun M, Kim CK. Pituitary 18F-FDG Uptake Correlates With Serum TSH Levels in Subjects With Diffuse Thyroid 18F-FDG Uptake. Clin Nucl Med 2015; 40:632-6. [PMID: 26018720 DOI: 10.1097/RLU.0000000000000793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study was to evaluate the relationship among FDG uptake in the pituitary gland (FDGp), FDG uptake in the thyroid gland (FDGt), and serum thyroid-stimulating hormone (TSH) levels in patients with diffuse FDGt incidentally noted on positron emission tomography/computed tomography (PET/CT). PATIENTS AND METHODS We retrospectively reviewed FDG PET/CT scans of 2,945 subjects who underwent health screening. Of these, 44 subjects had diffuse FDGt and available thyroid function tests. FDGt and FDGp were correlated with serum TSH. FDGp in 44 paired control subjects without FDGt and 15 thyroid cancer patients undergoing thyroid hormone withdrawal were additionally measured, and compared with FDGp in the 44 subjects with FDGt divided into 3 groups according to serum TSH levels. RESULTS In the 44 subjects, there was a strong correlation found between FDGp and TSH (P < 0.001, r = 0.618). As well, there were statistically significant differences in FDGp between the low, normal, and high TSH groups (P < 0.001). FDGp in the paired control subjects was not different from that in the normal TSH group (P = 0.384), and FDGp in the TSH-stimulated thyroid cancer patients was not different from that in the high TSH group (P = 0.463). CONCLUSION We found a strong positive correlation between pituitary FDG uptake and serum TSH. Pituitary FDG uptake seems to hold an important clue to the functional status of the thyroid in subjects with diffuse thyroid FDG uptake. Furthermore, physiologic FDG uptake in the pituitary gland caused by hypothyroidism should not be confused with pathologic conditions such as macroadenoma or metastases.
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40
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Ciarallo A, Marcus C, Taghipour M, Subramaniam RM. Value of Fluorodeoxyglucose PET/Computed Tomography Patient Management and Outcomes in Thyroid Cancer. PET Clin 2015; 10:265-78. [DOI: 10.1016/j.cpet.2014.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Jamsek J, Zagar I, Gaberscek S, Grmek M. Thyroid lesions incidentally detected by (18)F-FDG PET-CT - a two centre retrospective study. Radiol Oncol 2015; 49:121-7. [PMID: 26029022 DOI: 10.2478/raon-2014-0039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/22/2014] [Indexed: 11/20/2022] Open
Abstract
Background. Incidental 18F-FDG uptake in the thyroid on PET-CT examinations represents a diagnostic challenge. The maximal standardized uptake value (SUVmax) is one possible parameter that can help in distinguishing between benign and malignant thyroid PET lesions. Patients and methods. We retrospectively evaluated 18F-FDG PET-CT examinations of 5,911 patients performed at two different medical centres from 2010 to 2011. If pathologically increased activity was accidentally detected in the thyroid, the SUVmax of the thyroid lesion was calculated. Patients with incidental 18F-FDG uptake in the thyroid were instructed to visit a thyroidologist, who performed further investigation including fine needle aspiration cytology (FNAC) if needed. Lesions deemed suspicious after FNAC were referred for surgery. Results. Incidental 18F-FDG uptake in the thyroid was found in 3.89% — in 230 out of 5,911 patients investigated on PET-CT. Malignant thyroid lesions (represented with focal thyroid uptake) were detected in 10 of 66 patients (in 15.2%). In the first medical centre the SUVmax of 36 benign lesions was 5.6 ± 2.8 compared to 15.8 ± 9.2 of 5 malignant lesions (p < 0.001). In the second centre the SUVmax of 20 benign lesions was 3.7 ± 2.2 compared to 5.1 ± 2.3 of 5 malignant lesions (p = 0.217). All 29 further investigated diffuse thyroid lesions were benign. Conclusions. Incidental 18F-FDG uptake in the thyroid was found in 3.89% of patients who had a PET-CT examination. Only focal thyroid uptake represented a malignant lesion in our study — in 15.2% of all focal thyroid lesions. SUVmax should only serve as one of several parameters that alert the clinician on the possibility of thyroid malignancy.
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42
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Song MK, Chung JS, Kim SJ, Kim SS, Shin HJ. Diffuse thyroid 18F-FDG uptake after R-CHOP therapy predicts favorable outcome in patients with DLBCL. Ann Hematol 2015; 94:995-1001. [DOI: 10.1007/s00277-015-2311-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/28/2015] [Indexed: 11/28/2022]
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43
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Agrawal K, Weaver J, Ngu R, Krishnamurthy Mohan H. Clinical significance of patterns of incidental thyroid uptake at (18)F-FDG PET/CT. Clin Radiol 2015; 70:536-43. [PMID: 25687827 DOI: 10.1016/j.crad.2014.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
Incidental uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) in the thyroid gland is not uncommonly encountered in day-to-day practice of oncological (18)F-FDG positron-emission tomography/computed tomography (PET/CT). These are often felt to be "nuisance lesions" by referring clinicians and radiologists alike. However, recognition of the importance of different patterns of FDG uptake in the thyroid gland and knowledge of the possible underlying aetiologies are crucial in ensuring that patients are managed appropriately in the clinical context of their primary diagnosis, as the underlying pathological condition may be clinically important in a significant minority of such cases. This review describes the various patterns of (18)F-FDG uptake within the thyroid and discusses the clinical significance and possible impact on patient management. Incidental low-grade homogeneous diffuse increased thyroid (18)F-FDG uptake is usually seen in the patients with chronic thyroiditis, Grave's disease, and hypothyroidism. Thyroid function tests and antibody profiling are advised in these patients. Incidental focal (18)F-FDG thyroid uptake should raise the possibility of underlying malignancy. Ultrasound with or without fine-needle aspiration cytology is usually recommended for the evaluation of these lesions. Heterogeneous uptake with prominent focal uptake in the thyroid should be further evaluated to exclude malignancy.
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Affiliation(s)
- K Agrawal
- Dept of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - J Weaver
- School of medicine, King's College London, London, UK
| | - R Ngu
- Department of Dental Maxillofacial Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Krishnamurthy Mohan
- Dept of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Clinical PET Centre, St Thomas' Hospital, London, UK
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44
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Pruthi A, Choudhury PS, Gupta M, Taywade S. Does the intensity of diffuse thyroid gland uptake on F-18 fluorodeoxyglucose positron emission tomography/computed tomography scan predict the severity of hypothyroidism? Correlation between maximal standardized uptake value and serum thyroid stimulating hormone levels. Indian J Nucl Med 2015; 30:16-20. [PMID: 25589800 PMCID: PMC4290060 DOI: 10.4103/0972-3919.147528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Context: F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) scan and hypothyroidism. Aims: The aim was to determine whether the intensity of diffuse thyroid gland uptake on F-18 FDG PET/CT scans predicts the severity of hypothyroidism. Materials and Methods: A retrospective analysis of 3868 patients who underwent F-18 FDG PET/CT scans, between October 2012 and June 2013 in our institution for various oncological indications was done. Out of them, 106 (2.7%) patients (79 females, 27 males) presented with bilateral diffuse thyroid gland uptake as an incidental finding. These patients were investigated retrospectively and various parameters such as age, sex, primary cancer site, maximal standardized uptake value (SUVmax), results of thyroid function tests (TFTs) and fine-needle aspiration cytology results were noted. The SUVmax values were correlated with serum thyroid stimulating hormone (S. TSH) levels using Pearson's correlation analysis. Statistical Analysis Used: Pearson's correlation analysis. Results: Clinical information and TFT (serum FT3, FT4 and TSH levels) results were available for 31 of the 106 patients (27 females, 4 males; mean age 51.5 years). Twenty-six out of 31 patients (84%) were having abnormal TFTs with abnormal TSH levels in 24/31 patients (mean S. TSH: 22.35 μIU/ml, median: 7.37 μIU/ml, range: 0.074-211 μIU/ml). Among 7 patients with normal TSH levels, 2 patients demonstrated low FT3 and FT4 levels. No significant correlation was found between maximum standardized uptake value and TSH levels (r = 0.115, P > 0.05). Conclusions: Incidentally detected diffuse thyroid gland uptake on F-18 FDG PET/CT scan was usually associated with hypothyroidism probably caused by autoimmune thyroiditis. Patients should be investigated promptly irrespective of the intensity of FDG uptake with TFTs to initiate replacement therapy and a USG examination to look for any suspicious nodules.
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Affiliation(s)
- Ankur Pruthi
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha Sarathi Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sameer Taywade
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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45
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Abstract
OBJECTIVE Thyroid cancer is the most common endocrine cancer. This review evaluates the established use of (18)F-FDG PET/CT in papillary, follicular, Hürthle cell, anaplastic, and medullary thyroid cancers. The significance of incidental diffuse and focal thyroid FDG uptake is discussed. The evolving value of non-FDG radiotracers, including (124)I, (18)F-dihydroxyphenylalanine, and (68)Ga somatostatin analogs, is summarized. CONCLUSION PET/CT is a valuable imaging test, in the appropriate clinical context, for the management of thyroid cancers.
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46
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Achury C, Estorch M, Domènech A, Camacho V, Flotats A, Jaller R, Geraldo L, Deportós J, Montes A, Carrió I. Interpretation of thyroid incidentalomas in 18F-FDG PET/CT studies. Rev Esp Med Nucl Imagen Mol 2014; 33:205-209. [DOI: 10.1016/j.remnie.2014.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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47
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Nayan S, Ramakrishna J, Gupta MK. The Proportion of Malignancy in Incidental Thyroid Lesions on 18-FDG PET Study: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2014; 151:190-200. [DOI: 10.1177/0194599814530861] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/18/2014] [Indexed: 01/21/2023]
Abstract
Objective To evaluate through a systematic review and meta-analysis the malignancy rates of thyroid incidentalomas identified in adults by 18-fluorodeoxyglucose positron emission tomography, computed tomography (18-FDG PET-CT) imaging studies. Data Sources The literature search was conducted using OVID Medline, EMBASE, the Cochrane Library, Google Scholar, Pubmed, and reference list review (inception to April 2013) by 2 independent review authors. Review Methods Studies with adults undergoing 18-FDG PET scan identifying a thyroid incidentaloma with definitive histological or cytological results reported were included. Results Thirty-one studies with a total of 197,296 PET studies and 3659 focal thyroid incidentalomas were identified with 1341 having definitive cytopathology or histopathology. The pooled proportion of malignancy was calculated as 19.8% (95% confidence interval [CI], 15.3%-24.7%) with 15.4% (95% CI, 11.4%-20.0%) of the total cases being papillary thyroid cancer. Distant metastases represented 1.1% (95% CI, 0.6%-1.8%) of the total cases. Conclusions Our systematic review and meta-analysis suggests that the incidence of malignancy is high in thyroid incidentalomas identified through 18-FDG PET imaging studies. Thyroid incidentalomas identified through 18-FDG PET require thorough investigation.
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48
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Mane M, O'Neill AC, Tirumani SH, Shi M, Shinagare AB, Fisher DC. Thyroid lymphoma on a background of Hashimoto's thyroiditis: PET/CT appearances. Clin Imaging 2014; 38:864-7. [PMID: 24679651 DOI: 10.1016/j.clinimag.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/27/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
Primary thyroid lymphoma is a rare thyroid tumor accounting for only 5% of all thyroid malignancies. It is more common in patients with a background history of chronic thyroiditis. PET/CT is helpful in the initial staging and for follow up to assess treatment response.
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Affiliation(s)
- Mayuresh Mane
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
| | - Ailbhe C O'Neill
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215.
| | - Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
| | - Min Shi
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Atul B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
| | - David C Fisher
- Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215
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49
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Achury C, Estorch M, Domènech A, Camacho V, Flotats A, Jaller R, Geraldo L, Deportós J, Montes A, Carrió I. [Interpretation of thyroid incidentalomas in (18)F-FDG PET/CT studies]. Rev Esp Med Nucl Imagen Mol 2014; 33:205-9. [PMID: 24560597 DOI: 10.1016/j.remn.2013.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/23/2013] [Accepted: 12/05/2013] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Thyroid findings or incidentalomas in (18)F-FDG PET/CT studies are relatively frequent, being its clinical significance subject of controversy. The aim of this study was to show our experience in the detection of thyroid incidentalomas by PET/CT studies as well as its follow up. MATERIAL AND METHODS A retrospective and descriptive review was conducted on patients who had thyroid incidentalomas detected in (18)F-FDG PET/CT studies between June 2010 and March 2013. Patient's medical records were reviewed for age, genre, maximum standardized uptake value (SUVmax), thyroid diseases, TSH and antithyroid antibodies levels, ultrasound, fine-needle aspiration (FNA) and cytology. RESULTS 4085 PET/CT studies for several purposes were performed. Eighty-three of these studies (2.03%) showed thyroid incidentalomas. Thirty-seven patients showed a diffuse increase of glucose metabolism in the thyroid gland and 46 showed a focal increase of glucose metabolism. Five out of 46 patients with focal uptake were diagnosed of a neoplastic disease by cytology (11%). The SUVmax of malignant pathology did not differ from that of benign thyroid diseases (Mean: 10,26 and 5,92 respectively). CONCLUSION In our experience, focal thyroid incidentalomas detected in (18)F-FDG PET/CT studies are related to a significant risk of malignancy (11%). Therefore, in these situations, an ultrasound study with fine needle biopsy should be recommended. Moreover, a diffuse increase of glucose metabolism in the thyroid gland is often associated with benign thyroid pathology.
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Affiliation(s)
- C Achury
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - M Estorch
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A Domènech
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - V Camacho
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A Flotats
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - R Jaller
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - L Geraldo
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Deportós
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A Montes
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - I Carrió
- Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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50
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Lee S, Park T, Park S, Pahk K, Rhee S, Cho J, Jeong E, Kim S, Choe JG. The Clinical Role of Dual-Time-Point (18)F-FDG PET/CT in Differential Diagnosis of the Thyroid Incidentaloma. Nucl Med Mol Imaging 2013; 48:121-9. [PMID: 24900152 PMCID: PMC4028480 DOI: 10.1007/s13139-013-0247-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/10/2013] [Accepted: 10/21/2013] [Indexed: 11/26/2022] Open
Abstract
Thyroid incidentalomas are common findings during imaging studies including 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for cancer evaluation. Although the overall incidence of incidental thyroid uptake detected on PET imaging is low, clinical attention should be warranted owing to the high incidence of harboring primary thyroid malignancy. We retrospectively reviewed 2,368 dual-time-point 18F-FDG PET/CT cases that were undertaken for cancer evaluation from November 2007 to February 2009, to determine the clinical impact of dual-time-point imaging in the differential diagnosis of thyroid incidentalomas. Focal thyroid uptake was identified in 64 PET cases and final diagnosis was clarified with cytology/histology in a total of 27 patients with 18F-FDG-avid incidental thyroid lesion. The maximum standardized uptake value (SUVmax) of the initial image (SUV1) and SUVmax of the delayed image (SUV2) were determined, and the retention index (RI) was calculated by dividing the difference between SUV2 and SUV1 by SUV1 (i.e., RI = [SUV2 - SUV1]/SUV1 × 100). These indices were compared between patient groups that were proven to have pathologically benign or malignant thyroid lesions. There was no statistically significant difference in SUV1 between benign and malignant lesions. SUV2 and RI of the malignant lesions were significantly higher than the benign lesions. The areas under the ROC curves showed that SUV2 and RI have the ability to discriminate between benign and malignant thyroid lesions. The predictability of dual-time-point PET parameters for thyroid malignancy was assessed by ROC curve analyses. When SUV2 of 3.9 was used as cut-off threshold, malignancy on the pathology could be predicted with a sensitivity of 87.5 % and specificity of 75 %. A thyroid lesion that shows RI greater than 12.5 % could be expected to be malignant (sensitivity 88.9 %, specificity 66.3 %). All malignant lesions showed an increase in SUVmax on the delayed images compared with the initial images. But in the group of benign lesions, 37.5 % (6/16) showed a decrease or no change in SUVmax. Dual-time-point 18F-FDG PET/CT, obtaining additional images 2 h after injection, seems to be a complementary method for the differentiation between malignancy and benignity of incidental thyroid lesions.
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Affiliation(s)
- Sinae Lee
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Taegyu Park
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Soyeon Park
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Kisoo Pahk
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seunghong Rhee
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jaehyuk Cho
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Eugene Jeong
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sungeun Kim
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Jae Gol Choe
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
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