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C-1650 - Thyroid incidentalomas diagnosed by 18-FDG PET-CT.  Is fine-needle aspiration (FNA) of all thyroid nodules justified?

C. Martínez Gamarra1, S. de Águeda Martín1, A. Linares Beltrán1, M. García Sánchez1, M. Montero2, A. Santiago Hernando1, C. Martín-Hervás1; 1 Madrid/ES 2 MADRID/ES Type: Scientific Exhibit
Area of Interests: Thyroid / Parathyroids, Interventional non-vascular
Imaging Techniques: Ultrasound, PET-CT
Procedure: Biopsy
Special Focuses: Neoplasia, Endocrine disorders
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Aims and objectives: When a focal increased FDG uptake is seen in thyroid on PET/CT there are no established criteria to differentiate benign from malignant incidentalomas, therefore further evaluation with biopsy is needed. The aim of this study is to compare the diagnostic accuracy for thyroid malignancy as an inciden[...]

Methods and materials: 38 consecutive focal thyroid lesions with high uptakes seen on FDG PET where analyzed in 35 patients with ultrasound and FNAB between November 2013 and November 2015. An experienced nuclear medicine physician interpreted the PET/CT images qualitatively by visual inspection. FDG uptake was considered[...]

Results: 30 benign nodules: 15 (39%) colloid goiter, 6 (15%) hyperplastic/Hurtle adenomas, 5 (13%) follicular lesions and 4 (10%) lymphocytic thyroiditis 7 malignant nodules:  6 (15%) papillar Ca. and 1 (0.02%) pulmonary metastasis   1 (0.02%) sample was inadequate and repeated weeks after  [...]

Conclusion: In most cases, focally high uptake of FDG in the thyroid as an incidental finding does not mean malignancy The combined assessment of US and PET/CT would help to decrease in number of unnecessary FNABs    

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References:   Nam-Goong IS, Kim HY, Gong G et al. Ultrasonography guided fine needle aspiration of thyroid incidentaloma correlation with pathological findings. Clin End (Oxf) 60 (2004) 21-28   Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiolo[...]

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