IntroductionThe increasing usage of positron emission tomography/computed tomography (PET/CT) for detection and monitoring of malignancy has led to an increase in incidental detection of thyroid nodules. Nodules that demonstrate increased avidity for 2‐[18F]‐fluoro‐2‐deoxy‐d‐glucose (FDG) have been shown to carry a high incidence of malignancy and warrant further investigation. At present, there has been limited research on the risk stratification of FDG‐avid thyroid incidentalomas. Thus, this study aims to evaluate the efficacy of the ACR TIRADS classification in the risk stratification of such nodules.MethodsData were collected retrospectively for FDG‐avid thyroid incidentalomas over a 10‐year period. Nodules were characterised using the TIRADS classification and, subsequently, underwent fine‐needle aspirate cytology. Cytological findings were classified using the Bethesda reporting system. Non‐diagnostic samples (Bethesda class I) were excluded. The remaining samples were divided into two groups: benign (Bethesda class II) or suspicious for malignancy/malignant (Bethesda class III or above).ResultsThirty‐six percent of low‐risk nodules and 45% of high‐risk nodules were malignant, respectively (P = 0.516). The sensitivity and specificity of TIRADS for detection of malignant nodules were 56% and 54%, respectively. There were no malignant TIRADS 1 or 2 nodules. The absence of any suspicious sonographic features had a 1.0 negative predictive value.ConclusionsFDG‐avid nodules classified as TIRADS 1 or 2 or have no suspicious ultrasound features have a 0% incidence of malignancy and thus may not require further assessment with fine‐needle aspirate cytology (FNA) when detected incidentally. FDG‐avid nodules that are TIRADS 3 or above should undergo FNA regardless of size due to the high risk of malignancy and poor sensitivity of the TIRADS classification system.

中文翻译：

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使用甲状腺成像报告和数据系统对富含 FDG 的甲状腺结节进行超声风险分层


简介越来越多地使用正电子发射断层扫描/计算机断层扫描 (PET/CT) 来检测和监测恶性肿瘤，导致甲状腺结节的偶然检出率增加。结节表现出对 2-[18F]-氟-2-脱氧-的亲和力增加d ‐葡萄糖（FDG）已被证明具有很高的恶性肿瘤发生率，值得进一步研究。目前，关于富含 FDG 的甲状腺偶发瘤的风险分层的研究有限。因此，本研究旨在评估 ACR TIRADS 分类在此类结节风险分层中的有效性。方法回顾性收集 10 年来 FDG 丰富的甲状腺偶发瘤的数据。使用 TIRADS 分类对结节进行表征，随后进行细针抽吸细胞学检查。使用贝塞斯达报告系统对细胞学结果进行分类。非诊断样本（贝塞斯达 I 类）被排除在外。其余样本分为两组：良性（Bethesda II 级）或可疑恶性肿瘤/恶性（Bethesda III 级或以上）。结果 36% 的低风险结节和 45% 的高风险结节是恶性的，分别(磷= 0.516）。 TIRADS 检测恶性结节的敏感性和特异性分别为 56% 和 54%。没有恶性 TIRADS 1 或 2 结节。不存在任何可疑的超声特征，阴性预测值为 1.0。 结论 FDG 活跃的结节被分类为 TIRADS 1 或 2 级或没有可疑的超声特征，其恶性肿瘤发生率为 0%，因此可能不需要通过细针抽吸细胞学进行进一步评估(FNA) 偶然检测到时。 由于恶性风险高且 TIRADS 分类系统的敏感性较差，TIRADS 3 或以上的 FDG 亲和结节无论大小都应接受 FNA。