Check for updatesReceived:6 December 2022 Revised:27 February 2023 Accepted:28 February 2023D0t10.1111/cen.14905GUIDELINESWILEYConsensus statement on the management of incidentallydiscovered FDG avid thyroid nodules in patients beinginvestigated for other cancersJonathan Wadsley1 Sabapathy P.Balasubramanian2 Gitta Madani3Jean Munday4 Tom Roques5 Christopher W.Rowes Philip Touska?Kristien Boelaert3Weston Park Cancer Centre,Sheffield,UK2Sheffield Teaching Hospitals,Sheffield.UKAbstract3Imperial College Healthcare NHS Trust.With the widespread use of 18F-fluorodeoxyglucose positron emission tomographyLondon,UK(FDG PET/CT)in the investigation and staging of cancers,incidental discovery ofQueen Alexandra Hospital,Portsmouth,UKFDG-avid thyroid nodules is becoming increasingly common,with a reportedSNorfolk and Norwich Hospital,Norwich.UKincidence in the range 1%-4%of FDG PET/CT scans.The risk of malignancy in anUniversity of Newcastle,Newcastle,New South Wales,Australiaincidentally discovered FDG avid thyroid nodule is not clear due to selection bias in7Guy's and St Thomas'Hospital,London.UKreported retrospective series but is likely to be less than 15%.Even in cases whereUniversity of Birmingham,Bimmingham,UKthe nodule is found to be malignant,the majority will be differentiated thyroidcancers with an excellent prognosis even without treatment.If,due to index cancerCorrespondenceJonathan Wadsley,Weston Park Cancerdiagnosis,age and co-morbidities,it is unlikely that the patient will survive 5 years,Centre,Whitham Rd,Sheffield S10 2SJ,UK.further investigation of an incidental FDG avid thyroid nodule is unlikely to beEmail:jonathan.wadsley1@nhs.netwarranted.We provide a consensus statement on the circumstances in whichfurther investigation of FDG avid thyroid nodules with ultrasound and fine needleaspiration might be appropriate.KEYWORDSFDG PET,prognosis,thyroid incidentaloma1 INTRODUCTIONwhether imaging can be reduced and a less invasive approachadopted to FDG avid nodules in patients with a very poor prognosisOwing to the widespread use of 18F-fluorodeoxyglucose positrondue to another cancer.We searched the literature and based onemission tomography (FDG PET/CT)in the investigation and stagingrelevant literature and on the clinical expertise of the panel,of cancers,incidental discovery of FDG-avid thyroid nodules(thyroidformulated a consensus statement.incidentaloma [is becoming an increasingly common phenome-non.It is now typical for specialist thyroid cancer multidisciplinaryteam (MDT)meetings to receive regular referrals of such cases.2 BACKGROUNDThe following multicenter multidisciplinary consensus statementseeks to provide guidance to clinicians involved with the care of2.1 Incidence,risk of malignancy and risk ofthese patients regarding when further investigation of Tl isthyroid cancer-related deathwarranted,and,perhaps more importantly,when it is not required.A group of opinion leaders in Oncology,Endocrine Surgery,HeadThe incidence of TI on FDG
