Prevalence of incidental thyroid malignancy on routine (18)F-fluorodeoxyglucose PET-CT in a large teaching hospital

PURPOSE: To quantify incidental thyroid pathology including malignancy on routine (18)F-FDG PET-CT scans To compare standardised uptake values (SUV(max)) in thyroid malignancy subtypes METHODS AND MATERIALS: This is a retrospective study of all (18)F-FDG PET-CT scans (n = 6179) performed in a teaching hospital between June 2010 and May 2019. RIS database search of reports for the word “thyroid” was performed. Studies with evidence of thyroid uptake were included. Patient age and gender, primary indication for PET scan (malignant or non-malignant), thyroid result on PET (diffuse or focal tracer uptake, SUV(max)), ultrasound and FNAC results were recorded. RESULTS: Incidental abnormal thyroid tracer uptake as a proportion of all (18)F-FDG PET-CT scans was 4.37% (n = 270). Out of region patients (n = 87) whose records could not be obtained were excluded leaving a study group of n = 183. Ninety-four in this group had focal uptake, and 89 had diffuse uptake. Fifty-five patients in the focal group had undergone further investigations. Of these, 30 were thought to be benign on USS alone, and 25 patients underwent USS/FNAC. Thirteen (24%) malignancies were identified (5 papillary, 6 follicular, 1 poorly differentiated thyroid cancer, 1 metastatic malignancy). Mean SUV(max) for papillary carcinoma was noted to be 8.2 g/ml, and follicular carcinoma was 12.6 g/ml. CONCLUSION: Incidental abnormal thyroid (18)F-FDG PET-CT uptake in PET-CT scans of 4.37% is in keeping with the known limited literature. Rather similar number of patients was noted in the focal and diffuse tracer uptake categories in the final study group. Around quarter of the focal lesions were identified to be malignant, implying focal lesions should always be further investigated.