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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

ReplyLetter

Reply:

E.M. Genden
American Journal of Neuroradiology February 2010, 31 (2) E31; DOI: https://doi.org/10.3174/ajnr.A1998
E.M. Genden
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The American Thyroid Association guidelines for the management of patients with thyroid nodules1 outlines the role of sonography and fine-needle aspiration for the evaluation of thyroid nodules. Our work and the work of others2–4 suggest that fluorodeoxyglucose–positron-emission tomography (FDG-PET) positivity is associated with a significant risk of malignancy, not unlike the cytologic reading of “indeterminate cytology,” which, according to the task force (R9, recommendation B), states that a “lobectomy or total thyroidectomy should be considered.”1 We support the work of the American Thyroid Association and believe that FDG-PET positivity simply represents an adjunct to sonography and cytology for the risk assessment of a patient with a thyroid nodule. We do not advocate thyroidectomy for patients with benign cytology and retract any implication of such; however, we do inform patients of the data on FDG-PET positivity—after all, the false-negative rate for fine-needle aspiration of thyroid nodules is higher than the false-positive rate. The American Thyroid Association recommends that a lobectomy or total thyroidectomy be considered for indeterminate cytology, which is associated with a 5%–10% risk of malignancy. Do we feel comfortable withholding surgical intervention when FDG-PET positivity is associated with a 25%–50% risk of malignancy?

References

  1. 1.
    1. Cooper DS,
    2. Doherty GM,
    3. Haugen BR,
    4. et al
    . Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109–42
  2. 2.
    1. Choi JY,
    2. Lee KS,
    3. Kim HJ,
    4. et al
    . Focal thyroid lesions incidentally identified by integrated 18F-FDG PET/CT: clinical significance and improved characterization. J Nucl Med 2006;47:609–15
  3. 3.
    1. Kang KW,
    2. Kim SK,
    3. Kang HS,
    4. et al
    . Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects. J Clin Endocrinol Metab 2003;88:4100–04
  4. 4.
    1. Chen YK,
    2. Ding HJ,
    3. Chen KT,
    4. et al
    . Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects. Anticancer Res 2005;25:1421–6
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