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Evaluación de incidentalomas tiroideos mediante PET/CT con 18F-FDG

Authors: Muñoz López, Jaczibe Yajaira; Arroyo Castelán, Claudia; Rodríguez Palomares, Luis Alfonso; Padilla-Santamaría, Fernando;

Evaluación de incidentalomas tiroideos mediante PET/CT con 18F-FDG

Abstract

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Clinical Significance of Diffusely Increased 18F-FDG Uptake in the Thyroid Gland. J Nucl Med. 2007; 48(6): 896-901. DOI: 10.2967/jnumed.106.039024", "Nakadate M, Yoshida K, Ishii A, Koizumi M, Tochigi N, Suzuki Y, et al. Is 18F-FDG PET/CT Useful for Distinguishing Between Primary Thyroid Lymphoma and Chronic Thyroiditis? Clin Nucl Med. 2013; 38(9): 709-14. DOI: 10.1097/RLU.0b013e31829b2686", "Choi JY, Lee KS, Kim H-J, Shim YM, Kwon OJ, Park K, et al. Focal Thyroid Lesions Incidentally Identified by Integrated 18F-FDG PET/CT: Clinical Significance and Improved Characterization. J Nucl Med. 2006; 47(4): 609-15. Disponible en: https://jnm.snmjournals.org/content/47/4/609.long", "Larg M-I, Apostu D, Pe\u0219tean C, Gabora K, B\u0103dulescu IC, Olariu E, et al. Evaluation of Malignancy Risk in 18F-FDG PET/CT Thyroid Incidentalomas. Diagnostics (Basel). 2019; 9(3): 92. DOI: 10.3390/diagnostics9030092", "Soelberg KK, Bonnema SJ, Brix TH, Heged\u00fcs L. 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DOI: 10.1097/MNM.0b013e32832ee09d", "Sager S, Vatankulu B, Sahin OE, C\u0131naral F, Uslu L, Baran A, et al. Clinical significance of standardized uptake values in thyroid incidentaloma discovered by F-18 fluorodeoxyglucose positron emission tomography/computed tomography. J Cancer Res Ther. 2018; 14(5): 989-93. DOI: 10.4103/0973-1482.187247", "De Guevara DL, Munizaga C, Garc\u00eda N, Letelier C, Wash A. Frecuencia de malignidad en incidentalomas tiroideos detectados con tomograf\u00eda por emisi\u00f3n de positrones/tomograf\u00eda computada (PET/CT) con F18-FDG de cuerpo entero. Rev Med Chile. 2020; 148(1): 10-6. DOI: 10.4067/S0034-98872020000100010", "Adams MC, Turkington TG, Wilson JM, Wong TZ. A Systematic Review of the Factors Affecting Accuracy of SUV Measurements. AJR Am J Roentgenol. 2010; 195(2): 310-20. DOI: 10.2214/AJR.10.4923", "Gama-Moreno MG, Mercado M, Padilla-Rodr\u00edguez AL, Garc\u00eda-Ortiz JR, Schalch-Ponce de Le\u00f3n JM, G\u00f3mez-M\u00e9ndez M. Captaci\u00f3n tiroidea incidental en estudios de 18F-FDG PET/CT: Correlaci\u00f3n con hallazgos patol\u00f3gicos e implicaciones cl\u00ednicas. Rev Endocrinol Nutr. 2010; 18(2): 84-9. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=26041", "Demir \u00d6, K\u00f6se N, \u00d6zkan E, \u00dcnl\u00fct\u00fcrk U, Aras G, Erdo\u011fan MF. Clinical significance of thyroid incidentalomas identified by 18F-FDG PET/CT. Nucl Med Commun. 2016; 37(7): 715-20. DOI: 10.1097/MNM.0000000000000495", "Gupta M, Gupta S, Gupta VB. Correlation of Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Solitary Thyroid Nodule. J Thyroid Res. 2010; 2010: 379051. DOI: 10.4061/2010/379051", "Brites CA, Balsimelli LBS, Coelho KMPA, Fronza-J\u00fanior H, Stall J, Fran\u00e7a PHC. Investigation of correlation between cytological and histological findings in suspected carcinoma of thyroid. J Bras Patol Med Lab. 2018; 54(6): 407-11. DOI: 10.5935/1676-2444.20180061"]}

RESUMEN Introducción: La tomografía por emisión de positrones/tomografía computada (PET/CT) con Fluor18-fluorodeoxiglucosa (18F-FDG) posee un amplio uso, específicamente en pacientes oncológicos para: estadificar la patología neoplásica, vigilar la aparición de recurrencias, valorar la respuesta al tratamiento y predecir pronóstico. La glándula tiroides es uno de los órganos que más hallazgos incidentales imagenológicos presenta. Por ello, el objetivo de este estudio fue explorar las captaciones y el valor máximo estandarizado de captación (SUVmáx) en incidentalomas tiroideos mediante PET/CT con 18F-FDG y evaluar su utilidad diagnóstica comparado con estudios citológicos (biopsia por aspiración con aguja fina, BAAF). Metodología: Estudio transversal retrospectivo analítico. Se revisó el archivo histórico del departamento de Imagenología del Centro Médico Dalinde de enero de 2016 a marzo de 2020. Se incluyeron pacientes con incidentalomas tiroideos detectados por PET/CT con 18F-FDG; el muestreo empleado fue por conveniencia. Resultados: Se revisaron 1,283 expedientes; 102 correspondieron a incidentalomas tiroideos: 83 mujeres (81.37%) y 19 hombres (18.63%). Se encontró captación focal en 66 pacientes (64.7%) y difusa en 36 (35.3%). La media de SUVmax fue 7.9±9.1653, mediana 4.6 (2-55); no se encontraron diferencias entre SUVmax y el tipo de captación (p=0.6). Del total de la muestra, únicamente 35 casos contaron con reporte de BAAF; se observaron mayores cifras de SUVmáx en neoplasias malignas (p=0.028). Conclusiones: Los valores altos de SUVmáx se relacionaron con neoplasias tiroideas malignas; es necesario que cada institución de salud determine los parámetros de SUVmáx con base en su población. ABSTRACT Introduction: Positron emission tomography/computed tomography (PET/CT) with Fluor18-fluorodeoxyglucose (18F-FDG) is widely used, specifically in cancer patients to: stage neoplastic pathology, monitor the appearance of recurrences, assess the response to treatment and predict prognosis. The thyroid gland is one of the organs with the most incidental imaging findings. Therefore, the objective of this study was to explore the uptakes and the standardized maximum uptake value (SUVmax) in thyroid incidentalomas by PET/CT with 18F-FDG and to evaluate its diagnostic utility compared with cytological studies (fine needle aspiration biopsy, FNAB). Methodology: Analytical retrospective cross-sectional study. The historical archive of the Centro Médico Dalinde Imaging department was reviewed from January 2016 to March 2020. Patients with thyroid incidentalomas detected by PET/CT with 18F-FDG were included; the sampling used was for convenience. Results: 1,283 files were reviewed; 102 corresponded to thyroid incidentalomas: 83 women (81.37%) and 19 men (18.63%). Focal uptake was found in 66 patients (64.7%) and diffuse in 36 (35.3%). The mean of SUVmax was 7.9 ± 9.1653, median 4.6 (2-55); no differences were found between SUVmax and the type of uptake (p=0.6). Only 35 cases had a FNAB report; higher SUVmax were observed in malignant neoplasms (p=0.028). Conclusions: High SUVmax values were related to thyroid malignancies; It is necessary for each health institution to determine the SUVmax parameters based on its population.

Keywords

Oncology, Diagnóstico, Biopsia por aspiración con aguja fina, Diagnosis, Neoplasias tiroideas, Thyroid Neoplasms, Fine-needle aspiration biopsy, Oncología

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