The malignancy risk of thyroid incidentalomas detected by [18F]FDG PET/CT lower than expected: a nationwide observational study in the Netherlands.
Background: The widespread use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has led to increased detection of thyroid incidentalomas (TIs). Current guidelines cite malignancy rates of 31–33% for [18F]FDG-positive thyroid nodules, but population-based d...
| Publicado en: | European Journal of Nuclear Medicine & Molecular Imaging Vol. 53; no. 6; pp. 3653 - 3664 |
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| Autores principales: | , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Springer Nature
May2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=193283630&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 193283630 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 16197070 NPC jtl: European Journal of Nuclear Medicine & Molecular Imaging issn: 16197070 maglogo: N pubinfo: dt: May2026 vid: 53 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 193283630 190710874 10.1007/s00259-025-07714-0 193283630 ppf: 3653 ppct: 11 formats: tig: atl: The malignancy risk of thyroid incidentalomas detected by [18F]FDG PET/CT lower than expected: a nationwide observational study in the Netherlands. aug: au: Coerts, Hannelore I. van Kemenade, Folkert J. van Ginhoven, Tessa M. Vriens, Menno R. Medici, M. Vriens, D. de Keizer, Bart Verburg, Frederik A. affil: https://ror.org/018906e22 Academic Center for Thyroid Disease, Department of Radiology and Nuclear Medicine, Erasmus Medical Centre Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands sug: ab: Background: The widespread use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has led to increased detection of thyroid incidentalomas (TIs). Current guidelines cite malignancy rates of 31–33% for [18F]FDG-positive thyroid nodules, but population-based data remain limited. This study aimed to assess the malignancy risk and cytological distribution of [18F]FDG PET TIs in a nationwide cohort. Methods: This retrospective observational study analyzed data from the Dutch nationwide pathology databank (Palga) for all patients who underwent thyroid fine-needle aspiration between January 2012 and December 2019, with follow-up until December 2022. Patients were classified as [18F]FDG PET TI based on documentation of [18F]FDG PET positivity in pathology reports. The primary outcome was malignancy risk compared between [18F]FDG PET TI and control groups. Secondary outcomes included distribution across Bethesda System categories and histological subtypes. Results: Among 64,706 patients analyzed, 3,938 (6.1%) underwent fine-needle aspiration for [18F]FDG PET thyroid incidentalomas. [18F]FDG PET TI detection increased 128% between 2012 (n = 281) and 2019 (n = 641). Patients with [18F]FDG PET TIs were older (median 64 vs. 52 years, p < 0.001) and more likely male (30.8% vs. 19.1%, p < 0.001). The overall malignancy rate was significantly higher in [18F]FDG PET TIs compared with controls (19.4% vs. 8.8%, p < 0.001). [18F]FDG PET TIs demonstrated higher proportions of suspicious cytological categories: atypia of undetermined significance (Bethesda III) (13.1% vs. 6.5%), follicular neoplasm (Bethesda IV) (10.2% vs. 4.3%), suspicious for malignancy (Bethesda V) (7.3% vs. 2.9%), and malignant cytology (Bethesda VI) (6.8% vs. 2.1%) (all p < 0.001). Among patients with indeterminate cytology, 36% of Bethesda IV and 29% of Bethesda V cases did not undergo surgery. Papillary thyroid carcinoma was the predominant malignant subtype (52.3%), with no anaplastic carcinomas observed. Conclusions: This largest population-based study demonstrates that [18F]FDG PET TIs have a malignancy rate of 19.4%, which is lower than the 31–33% cited in current guidelines. The substantial proportion of cytologically suspicious nodules that do not proceed to surgery suggests potential inefficiency in current diagnostic approaches. These findings support more selective FNA strategies and enhanced risk stratification to optimize patient care while minimizing unnecessary interventions. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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