Systematic review: Prevalence of malignant incidental thyroid nodules identified on fluorine-18 fluorodeoxyglucose positron emission tomography

Philip Shie, Roberto Cardarelli, Kelly Sprawls, Kimberly G. Fulda, Alan Taur

Research output: Contribution to journalArticlepeer-review

116 Scopus citations


PURPOSE: To review current literature and determine the prevalence of malignant incidental focal hypermetabolic thyroid lesions detected by fluorine-18 fluorodeoxyglucose positron emission tomography (F-FDG-PET). MATERIALS AND METHODS: Studies evaluating thyroid carcinomas discovered incidentally on F-FDG-PET were systematically searched in the MEDLINE, CINAHL, and Evidence-Based Medicine (EBM) Reviews from 1998 to 2007. Studies were eligible for inclusion with the following criteria: F-FDG-PET studies carried out on humans, long-term clinical follow-up or presence of histological confirmation of thyroid disease, and if studies reported the prevalence of abnormal F-FDG-PET scans with thyroid lesions and confirmed pathological thyroid disease. Studies were excluded if (1) there was no confirmed diagnosis, (2) there was a history of thyroid cancer, (3) they were carried out for diagnoses of thyroid abnormalities, or (4) they were case series. Two reviewers independently reviewed each study's eligibility and abstracted the data. RESULTS: Eighteen articles met criteria resulting in a total of 55 160 patients with 571 patients (1%) having an unexpected focal abnormality in the thyroid gland. Diagnostic confirmations were obtained in 322 patients. Among the confirmed diagnoses, 200 (62.1%) were benign, 107 (33.2%) were malignant, and 15 (4.7%) were indeterminate or a patient without a clear diagnosis. Papillary thyroid carcinoma was the most prevalent thyroid malignancy (82.2%). Eight studies reporting individual maximum standard uptake values were included in a subanalysis. The mean maximum standard uptake value for 73 benign lesions was 4.6±2.1, and for the 52 malignant lesions was 6.8±4.6 (P<0.001). CONCLUSION: The high prevalence of malignancy associated with focal hypermetabolic thyroid nodules found on F-FDG-PET warrants further evaluation when detected.

Original languageEnglish
Pages (from-to)742-748
Number of pages7
JournalNuclear Medicine Communications
Issue number9
StatePublished - 1 Sep 2009


  • Fluorodeoxyglucose
  • Incidental findings
  • Positron emission tomography
  • Thyroid carcinoma


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