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J Korean Soc Radiol. 2014 Sep;71(3):111-119. English. Original Article.
Lee KH , Shin JH , Han BK , Ko EY , Ko ES , Hahn SY , Choi JY .
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

PURPOSE: To evaluate the clinical implications of subsequent ultrasound (US) for incidental thyroid lesions (ITLs) detected on positron emission tomography/computed tomography (PET/CT) in patients with non-thyroidal cancer. MATERIALS AND METHODS: We retrospectively searched for ITLs in 2703 patients with non-thyroidal cancer on 3226 PET/CT examinations. We divided the patients into two groups: US-performed and US-not performed groups. Diagnostic performance of US in detecting malignancy was analyzed according to the PET/CT findings. RESULTS: The incidence of ITLs on PET/CT in patients with non-thyroidal cancer was 8.4% (226/2703). Death rate from disease and stage were not significantly different between the groups. The malignant rate of ITLs that had cytopathology was 39% (22/57). All malignancies were primary thyroid cancers except for one metastasis. Overall diagnostic performance of US was 87% sensitivity, 66% specificity, 66% positive predictive value (PPV), and 89% negative predictive value (NPV). The diagnostic performance of US according to the PET/CT findings was probable benign on PET/CT (n = 9): 100% specificity, 100% NPV; suspicious malignant on PET/CT (n = 22): 75% sensitivity, 90% specificity, 90% PPV, 75% NPV; and undetermined on PET/CT (n = 26): 100% sensitivity, 94% specificity, 91% PPV, 100% NPV. CONCLUSION: ITLs did not affect the prognosis of patients with non-thyroidal cancer whether subsequent US was performed or not. Subsequent US may be unnecessary for ITLs with probable benign findings on PET/CT.

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