The Thyroid Incidentaloma. Dimyati Achmad Department of Surgery Faculty of Medicine Padjadjaran University/ Hasan Sadikin Hospital Bandung Indonesia.
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Department of Surgery Faculty of Medicine Padjadjaran University/ HasanSadikin Hospital Bandung Indonesia
Female, 70 years old after cancer resection 6 months ago due to anal cancer, undergo positron emission tomography to determine distant metastases.
Thyroid Incidentaloma (T.I.)
Is a thyroid lesions detected during
Imaging investigation unrelated to
examination of thyroid gland
Prevalency of T.I. increased as the extent of use Ultrasonography (USG), Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and especially Positron Emission Tomography (PET).
CurrentlyPET scans with 18F flourodeoxyglucose(FDG-PET) are widely used in the management of patients with malignant conditions of various organ systems, especially to determine the extent of the primary tumor, regional nodal metastases and distant metastases.
is still dilemmatic
whether put on further investigationor not.
but again brought attention
due to development imaging technology
such as PET scans.
We review some articles about T.I. to conclude the appropriate management.
Gender : Male
Age : < 20 years or > 60 years
Prior head and neck irradiation
Family history of thyroid carcinoma
Lateral neck lymphadenophaty
Prevalence of T.I. : 9,4 % - 27 %
Characteristics of suspicious malignant :
2. Irreguler margin
3. Incomplete halo.
Prevalence of T.I. :
CT : + 11.3%
MRI : + 13%
CT or MRI examination can not be revealed the malignant form because there is no characteristic to differentiated them.
Prevalence of T.I. : 1.1% - 8.4%
Mostly of cases are benign lesions.
32.4% malignant cases : the most histopatology result is micropapillary thyroid carcinoma which is a slow growing, good prognosis and the 10-year diseases specific mortality < 1%
FDG uptake in the thyroid gland, PET interpretation which was greater than background activity in adjacent tissues and blood pool, was classifed as :
Focal Multifocal Diffuse
Focal uptake descriptionindicated is neoplastic process.
Standart Uptake Value (SUV)
The relationship betweenmalignant with SUV is still debatable.
Size of nodule
No significant different between nodule > 1 cm in diameter compared with 1 cm or lessnodule in diameter to determine malignancy.
There is no benefit to investigate T.I. in patient with widespread distant metastasis and poor overall survival from the primary tumor.
an algorithm, hopefullycan explain the related dilematic issues.
We emphasized in yellow highlight form.
Multifocal / Diffuse
Management Algorithm for T.I.
Non Suspicious Malignancy
Non Suspicious Malignancy
Regular Follow - up with USG
Malignant or Suspicious
In cases of T.I. which are male, age < 20 years or > 60 years, previous head and neck irradiation, family history of thyroid cancer and lateral neck lymphadenopathy which should be undergo further investigation.