Retrospective analysis of PSMA PET/CT thyroid incidental uptake in adults: incidence, diagnosis, and treatment/outcome in a tertiary cancer referral center and University Medical Center

Purpose A prostate-specific membrane antigen (PSMA) thyroid incidentaloma (PTI) is an unexpected, PSMA-avid thyroid lesion, newly detected during the investigation of an unrelated condition using PSMA PET/CT. The aim of this study is to examine the incidence and clinical significance of PTI and the...

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Bibliographic Details
Published in:European journal of nuclear medicine and molecular imaging 2022-06, Vol.49 (7), p.2392-2400
Main Authors: Piek, Marceline W., de Vries, Lisa H., Donswijk, Maarten L., de Keizer, Bart, de Boer, Jan Paul, Lodewijk, Lutske, van Leeuwaarde, Rachel S., Vriens, Menno R., Hartemink, Koen J., van der Ploeg, Iris M. C.
Format: Article
Language:English
Subjects:
Antigens
Cancer
Cardiology
Computed tomography
Decision making
Health care facilities
Health services
Imaging
Kidney cancer
Malignancy
Medical diagnosis
Medical imaging
Medical records
Medicine
Medicine & Public Health
Metastases
Nuclear Medicine
Oncology
Oncology – Head and Neck
Original Article
Orthopedics
Patients
Positron emission
Prostate
Prostate cancer
Radiology
Renal cell carcinoma
Thyroid cancer
Thyroid gland
Tomography
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Summary:Purpose A prostate-specific membrane antigen (PSMA) thyroid incidentaloma (PTI) is an unexpected, PSMA-avid thyroid lesion, newly detected during the investigation of an unrelated condition using PSMA PET/CT. The aim of this study is to examine the incidence and clinical significance of PTI and the associated management strategies since the implementation of the PSMA PET/CT scan. Methods This study involves a retrospective cohort study of 61 PTI cases depicted on PSMA PET/CT scans performed between January 2016 and July 2021, almost exclusively for (re)staging prostate cancer. The medical records of the included cases were retrospectively reviewed and data of the PSMA PET/CT scans, primary malignancy, thyroid diagnostics, treatment, and follow-up were collected. Results PTI was reported in 1.1% of the patients who underwent oncologic PSMA PET/CT scans included in this study. Two PTI cases had a histologically proven thyroid cancer: one a benign thyroid lesion and one a metastasis of a renal cell carcinoma. In none of the cases in whom any form of further thyroid workup was withheld, the PTI became clinically relevant during follow-up (median 1.8 years (1.1–3.3)). Six patients (10%) died due to their primary cancer. Conclusion The incidence of thyroid incidentalomas on PSMA PET/CT was low (1.1%) in this large, two-center experience. Less than half of the PTI cases were analyzed and the risk of malignancy, despite being low, was not negligible. The clinical outcome was good using a standard diagnostic workup for PTI, while the prognosis of the patient was determined by the primary malignancy. The consideration to analyze and treat PTI cases should be part of the shared decision-making in cancer patients.
ISSN:1619-7070
1619-7089
DOI:10.1007/s00259-022-05679-y