Incidental Findings of Thyroid Detected by PET-CT during Cancer Follow-up

Joong Suck Kim M.D.; So-young Choi M.D.; Hyo Keun No M.D.; Sei Joong Kim M.D.; Youn Jeong Kim M.D.; Young Hyun M.D.; Young Mo Kim M.D.; Young Up Cho M.D.

doi:10.16956/kjes.2010.10.4.249

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M.D., M.D., M.D., M.D., M.D., M.D., M.D., and M.D.: Incidental Findings of Thyroid Detected by PET-CT during Cancer Follow-up

Review Article

Korean J Endocrine Surg 2010;10(4):249-255.

Published online: 18 December 2010

DOI: https://doi.org/10.16956/kjes.2010.10.4.249

Incidental Findings of Thyroid Detected by PET-CT during Cancer Follow-up

Joong Suck Kim M.D., So-young Choi M.D., Ph.D., Hyo Keun No M.D., Sei Joong Kim M.D., Ph.D., Youn Jeong Kim M.D., Ph.D.¹, Young Hyun M.D., Ph.D.², Young Mo Kim M.D., Ph.D.³, Young Up Cho M.D., Ph.D.

Departments of Surgery and Medicine, Incheon, Korea

¹Departments of Surgery and Radiology, Incheon, Korea

²Departments of Surgery and Nuclear Medicine, Incheon, Korea

³Departments of Surgery and Otorhinolaryngology, Inha University School of, Incheon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The incidence of thyroid cancer is increasing in Korea, partially owing to the development of diagnostic tools. Positron emission tomography (PET)-computed tomography (CT), in particular, has generally been used for evaluation of metastasis and follow-up of malignancy.

Methods:

We retrospectively investigated 2,833 patients with PET-CT for metastasis work-up or cancer follow-up, which was performed between January 1998 and May 2008 at Inha University Hospital. Of them, abnormal thyroid findings were discovered in 181 patients and we studied the result of further evaluation or follow-up PET-CT.

Results:

Thyroid cancer was diagnosed in 26 patients, including metastatic cancer in 3 patients, and non-operated primary cancer in 2 patients. Other 21 patients received operation, which in all histopathologically revealed papillary carcinoma. The mean age of the 21 patients was 55.4 years. Nine patients had a history of radiotherapy. The site of malignant nodule was discordant between PET-CT and histopathologic result in 6 patients. The mean size of malignant nodules was 9.45 mm (0.1∼23 mm) with micro-carcinoma in 10 patients (47.6%). The mean interval between diagnoses was 15.8 months, and in 4 patients operations for two malignancies were performed in a same day. The incidence of thyroid cancer was significantly high in female patients, but the differences of incidence among different cancer groups were not significant for female patients.

Conclusion:

Early diagnosis of synchronous or secondary thyroid cancer by PET-CT in cancer patients can make early treatment and better strategies for multiple malignancies possible. (Korean J Endocrine Surg 2010;10:249-255)

Keywords: Thyroid cancer, Positron emission tomography, Incidental findings

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Table 1.

Result of thyroid evaluation in the patients with thyroid uptake on PET-CT

Total number of patients (Number of patients who received thyroid operation)
Primary cancer	Sex Total U	Uptake in PET-CT No. US∗ N	Nodule^† No. FNA^‡	Result of FNA
Primary cancer	Sex Total U	Uptake in PET-CT No. US∗ N	Nodule^† No. FNA^‡	Unsatisfactory Thyroiditis	NH Atypia	Papillary cancer Meta. cancer
Colorectal	M 314	3 0	0 0	0 0	0 0	0 0
cancer	F 221	11 7	4 3 (2)	1 (1) 1	0 0	1 (1) 0
Breast cancer	M 4	0 0	0 0	0 0	0 0	0 0
	F 971	112 83	46 35 (20)	0 3 (1)	13 (2) 6 (6)	12 (11) 1
Lung cancer	M 386	8 4	4 4 (1)	0 0	3 0	1 (1) 0
	F 146	11 7	7 5 (3)	0 0	0 1 (1)	3 (2) 1
Cervix cancer	F 227	12 10	6 4 (1)	0 1	2 0	1 (1) 0
Stomach cancer	M 318	6 1	1 1	0 0	1 0	0 0
	F 157	18 8	6 5 (2)	0 0	3 (1) 0	1 (1) 1
HCC	M 74	0 0	0 0	0 0	0 0	0 0
	F 15	0 0	0 0	0 0	0 0	0 0
Total	2,833	181 120	74 57 (29)	1 (1) 5 (1)	22 (3) 7 (7)	19 (17) 3

HCC = hepatocellular carcinoma; M = male; F = female; US = ultrasound; FNA = fine needle aspiration cytology; NH = nodular hyper plasia; Meta = metastatic. ∗No. US = number of patients who received ultrasound examination;

^† Nodule = number of patients wh showed nodule on ultrasound examination;

^‡ No. FNA = number of patients who received fine needle aspiration cytology.

Table 2.

Result of surgical biopsy of thyroid and incidence of thyroid cancer

Number of patients
Primary cancer	Sex			Surgical biopsy		Primary PTC^†	All thyroid cancer^‡
Primary cancer	Sex	OP∗	Hashimoto's thyroiditis	NH	Papillary cancer	Primary PTC^†	All thyroid cancer^‡
Colorectal cancer	M	0	0	0	0	0	0
	F	2	0	0	2	2	2
Breast cancer	M	0	0	0	0	0	0
	F	20	1	4	15	15	16
Lung cancer	M	1	0	0	1	1	1
	F	3	1	0	2	3	4
Cervix cancer	F	1	0	0	1	1	1
Stomach cancer	M	0	0	0	0	0	0
	F	2	0	2	0	1	2
HCC	M	0	0	0	0	0	0
	F	0	0	0	0	0	0
Total		29	2	6	21	23	26

CA = cancer; HCC = hepatocellular carcinoma; M = male; F = female; NH = nodular hyperplasia. ∗OP = number of patients who received operation;

^† Primary PTC = number of patients with primary papillary thyroid cancer including those who did not receive operation;

^‡ All thyroid cancer = number of patients with thyroid cancer including those with metastatic cancer.

Table 3.

Standard uptake values of surgically removed thyroids in PET-CT

	Papillary thyroid cancer	Nodular hyperplasia	Hashimoto's thyroiditis
Number of patients	21	6	2
Mean SUVmax	4.19	4.31	1.81
(range)	(2.01∼8.45)	(1.74∼6.31)	(1.61∼2.01)

SUVmax = maximum standard uptake value.

Table 4.

Characteristics of the patients with papillary thyroid cancerwho received operation

No. Age	Sex	Site of previous CA	Site of thyroid uptake on PET-CT	SUVmax of thyroid on PET-CT	Result of FNA	Site of nodule by surgical biopsy S n	Size of thyroid nodule (mm)	Number o metastatic regional lymph node	f c es Sta T	age N	Hx of RT	OP	Interval between diagnoses (mo)
1 48	F	Breast	Right	5.03	Papillary	Right	11, 5	0/9	1	0	A	T	54
					CA
2 71	F	Breast	Left	2.29	Papillary	Left	9	X	1	X	A	T	5
					CA
3 60	F	Breast	Left	4.21	Papillary	Left	10	3/4	3	1a	P	T	27
					CA
4 40	F	Breast	Right	3.21	Papillary	Right	6	0/1	3	0	A	R	15
					CA
5 57	F	Breast	Left	2.86	Papillary	Left	11	X	3	X	P	T	7
					CA
6 32	F	Breast	Left	2.05	Papillary	Left	8	X	1	X	P	T	8
					CA
7 45	F	Breast	Left	3.31	Atypia	Left	8	X	1	X	A	L	5
8 42	F	Breast	Left	2.27	Atypia	Both 2	23, 12 (Left),	X	3	X	A	T	38
							8, 6 (Right)
9 53	F	Breast	Right	4.13	Papillary	Right	8	2/4	1	1a	A	R	36
					CA
10 50	F	Breast	Left	4.93	Atypia	Both	20 (Left),	1/1	3	1a	P	T	49
							3 (Right)
11 51	F	Breast	Left	8.45	Papillary	Both	16 (Left),	0/2	3	0	A	T	26
					CA		4 (Right)
12 73	F	Breast	Left	4.17	Papillary	Left	7	X	1	X	A	L	9
					CA
13 41	F	Breast	Left	3.88	Papillary	Left	11	0/2	3	0	P	T	7
					CA
14 48	F	Breast	Both	4.79	Papillary	Both	13 (Left),	3/5	3	1a	P	T	10
					CA	1	10, 2 (Right)
15 60	F	Breast	Both	2.76	Papillary	Both	8 (Left),	X	1	X	P	T	8
					CA		7 (Right)
16 48	F	Cervix	Right	8.15	Papillary	Both	13 (Left),	0/5	3	0	P	T	0
					CA		8 (Right)
17 75	F	Lung	Left	7.01	Papillary	Left	30	0/3	3	0	A	T	1
					CA
18 58	F	Lung	Right	3.14	Papillary	Right	4	X	3	X	P	T	26
					CA
19 72	M	Lung	Left	2.67	Papillary	Left	9, 1	1/1	3	1a	A	L	0
					CA
20 72	F	Colon	Right	6.74	Unsatis-	Left	＜0.1	X	1	X	A	T	0
					factory
21 68	F	Colon	Right	2.01	Papillary	Left	12, 4, 2	2/42	1	1b	A	T	0
					CA

CA = cancer; FNA = fine needle aspiration cytology; Hx = History; RT = radiotherapy; OP = operation; F = female; M = male; N = normal; E = elevated; D = depressed; A = absent; P = present; T = total thyroidectomy; R = right thyroid lobectomy; L = left thyroid lobectomy.

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