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Hürthle Cells on Fine-Needle Aspiration Cytology Are Important for Risk Assessment of Focally PET/CT FDG Avid Thyroid Nodules.

Authors
  • Poller, David N1
  • Megadmi, Hakim2
  • Ward, Matthew J A3
  • Trimboli, Pierpaolo4, 5
  • 1 Departments of Cytology & Pathology, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
  • 2 Department of Nuclear Medicine, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
  • 3 Department of ENT Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
  • 4 Clinic of Endocrinology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland. , (Switzerland)
  • 5 Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland. , (Switzerland)
Type
Published Article
Journal
Cancers
Publisher
MDPI AG
Publication Date
Nov 27, 2020
Volume
12
Issue
12
Identifiers
DOI: 10.3390/cancers12123544
PMID: 33260994
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study assesses the role of [18F] FDG PET/CT, fine needle aspiration (FNA) cytology and ultrasound in the 1-2% of patients with focally positive thyroid nodules on FDG PET/CT. All FDG PET/CT scans with focally increased thyroid FDG PET/CT uptake performed over 37 months in one institution were matched to patients undergoing thyroid FNA. Diffuse FDG PET/CT uptake patients were excluded. A total of 47 patients showed focally increased thyroid uptake. Consistent with previous studies, 18 (38.2%) patients had malignancy-12 primary thyroid carcinoma, 1 parathyroid carcinoma, 3 metastatic carcinoma to the thyroid and 2 lymphoma. A total of 15 (31.9%) lesions categorized as non-malignant contained Hürthle cells/oncocytes. A total of 14 lesions (29.8%) had focally increased FDG PET/CT uptake with no specific cytological or histopathological cause identified. No focally PET avid Hürthle cell/oncocytic lesions were found to be malignant. Exclusion of oncocytic lesions increased the calculated risk of malignancy (ROM) of focally PET avid nodules from 38% to 68%. It may be useful to exclude focally FDG PET/CT avid Hürthle cell/oncocytic lesions, typically reported as follicular neoplasm or suspicious for a follicular neoplasm, Hürthle cell type (Oncocytic) type, RCPath Thy 3F: Bethesda IV or sometimes Thy 3a: Bethesda III FNAs) from ROM calculations. Oncocytic focally PET/CT FDG avid lesions appear of comparatively lower risk of malignancy and require investigation or operation but these lesions should be readily identified by FNA cytology on diagnostic work up of focally PET avid thyroid nodules.

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