Outcome of multi-disciplinary management of patients with FDG-PET avid thyroid incidentaloma – should we adopt a more conservative approach?. (1st March 2022)

• Record Type: Journal Article
• Authors: Matthews, Emily; Patel, Neil; Khan, Shahab; Mihai, Radu; Stechman, Michael; Scott-Coombes, David
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 2
• Publication Date: 2022-03-01
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac055.002
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Optimum surgical management of incidental focal thyroid tracer uptake on FDG-PET scanning remains unclear. We examined outcomes of patients with FDG-PET thyroid incidentalomas. Methods: Retrospective analysis of patients referred to two regional thyroid multidisciplinary teams (MDTs). Appropriate statistical analyses were performed. Results: Between 2010 and 2020, 108 patients with PET-avid thyroid incidentaloma were managed. Seventy-two patients (42 women; median age 66years, range 17–82) underwent surgery (Group A), whilst 36 patients (22 women, median age 68y, range 42–86) underwent surveillance (Group B). FDG-PET was performed for malignancy in 70% of cases. The proportion of patients with FNAC of Thy3+ was 89% (Group A) and 93% (Group B), but the incidence of Thy4/5 was higher in Group A (44% vs. 25%). In Group A, histology was benign in 33 (46%) patients, primary thyroid malignancy in 37 (51%) and two (3%) metastases to the thyroid. SUVmax was higher in malignant lesions (P <0.05). Primary thyroid cancers were papillary (n=31, 84%), follicular (n=3, 8%) and medullary (n=3, 8%). MACIS score <6 was recorded in 19 (56%) patients with DTC. No patient in either group died of thyroid cancer, whilst 25 patients (23%) died from other causes. Conclusion: Management of PET thyroid incidentaloma requires careful consideration because just under half of our patients had unnecessary surgery and over half of those operated with thyroid cancer had low risk DTC. A conservative approach requires closer dialogue with non-thyroid cancer MDTs regarding how these incidentalomas should sit within the patients' management algorithm.