The Clinical Relevance of Thyroid Incidentalomad Detected by 18F-Fluorodeoxyglucose Positron Emission Tomography

氟—18—FDG正子電腦斷層造影偵測甲狀腺偶發瘤之臨床相關研究

謝宏仁(Hung-Jen Hsieh) ； 林聖翔(Sheng-Hsiang Lin) ； 楊邦宏(Bang-Hung Yang) ； 朱任公(Yum-Kung Chu) ； 張承培(Cheng-pei Chang) ； 劉仁賢(Ren-Shyan Liu)

《核子醫學雜誌》 16卷2期 (2003/06) Pp. 53-58

https://doi.org/10.6332/ANMS.1602.001

摘要

背景：氟-18-FDG正子電腦斷層造影有時可意外偵測到甲狀腺局部放射活性增高。此種甲狀腺偶發瘤可能引發相當的疑慮。本研究收集癌症篩檢的健檢人士以及其它癌症（非甲状腺癌）後績追蹤的病人，進一步釐清其臨床意義。方法：檢視連續六個月間，477位做癌症篩檢或癌症追蹤而接受氟-18-FDG正子電腦斷層造影的病人資料（261位男性，216女性，年龄層10歲至90歲，平均年齡±標準差：52.4±12.9歲）。這些病人過去都没有甲狀腺疾病病史，也未曾發現頸部腫瘤。目視判讀氟-18-FDG正子電腦斷層造影影像，對甲狀腺有異常放射活性聚集的病人予以長期追蹤，比對其臨床表現、超音波檢查、細針吸取細胞學檢查及手衡標本的病理檢驗結果。對於每個甲狀腺異常活性病灶均計算其SUV値。結果：有12位病人發現單一性甲狀腺局部放射活性增高(2.5％)，其中10位可確立診斷。一位是分化良好之甲狀腺乳突癌，一位是濾泡腺瘤合併被囊侵犯，一位是出血性囊腫，其餘七位皆屬良性增生結節。甲状腺乳突癌的平均SUV値爲16，濾泡腺瘤爲17，出血性囊腫爲1.8，其餘七個良性結節分別爲1.1、1.7、1.7、2.0、1.4、2.1及1.8。結論：過去没有甲状腺疾病病史，也未曾發現頸部腫瘤的病人，氟-18-FDG正子電腦斷層造影測得甲状腺偶發瘤的發生率爲25％。本研究十位甲狀腺偶發瘤的病例只有一位證實爲甲狀腺癌。比較SUV値無法區分惡性或良性病灶。

關鍵字

甲狀腺偶發瘤 ； 甲狀腺癌 ； 正子電腦斷層造影 ； 氟—18—去氧葡萄糖

並列摘要

Backgrounds: Incidentally discovered thyroid nodules may be noted on positron emission tomography(PET)for reasons unrelated to thyroid pathology The nature of such thyroid incidentalomas can be source of considerable anxiety for individual patients. The aim of this retrospective study is to assess the clinical relevance of the thyroid incidentalomas detected by 18F-fluorodeoxyglucose (FDG)PET Methods: Four hundred and seventy-seven patients(261 male,216 female; age: mean±SD,52.4±12.9years,ranging from 10～90 years),free of thyroid disease history and palpable neck mass, were studied by FDG PET scan for the purpose of cancer screening or surveillance of recurrent malignancies. Images were analyzed by visual interpretation. Patients found to have focal thyroid uptake were subsequently correlated with thyroid ultrasonography, fine needle aspiration cytology or pathology of the specimen from surgical excision. Standard uptake value(SUV)of each focal abnormal thyroid uptake was calculated. Results: Solitary focal thyroid uptake was disclosed in twelve patients(2.5%).Final diagnosis was available in ten cases. One had well-differentiated papillary carcinoma and one had follicular adenoma with partial capsular invasion, both proved by pathology of surgical specimen. Another had a hemorrhagic cyst, and the remaining seven cases had benign nodules based on ultrasound foundlings, fine needle aspiration cytology and relative clinical evidences. The average SUVs of the ten nodules ranged from 1.1 to 2.1.The average SUVs of papillary carcinoma, follicular adenoma and hemordagic cyst were 1.6,1.7 and 1.8 respectively. The average SUVs of remaining seven benign nodules were 1.1,1.7,1.7,2.0,1.4,2.1 and 1.8.Conclusion:Thyroid incidentalomas was found by FDG PET in 2.5% of patients without known thyroid disease or palpable thyroid mass. Only one out of ten hypermetabolic incidentalomas was malignant neoplasm. SUV of FDG uptake by the solitary nodule did not differentiate benign from malignant nodule.

並列關鍵字

thyroid incidentaloma ； thyroid cancer ； positron emission tomography ； 18F-fluorodeoxyglucose