I had a combo PET/CT scan recently and had the incidental finding of 2 thyroid nodules. I understand that they were imaged solely through the CT and that they did not otherwise appear on the PET portion of the test. Subsequently, I had an ultrasound, which showed that the largest nodule was approx. 2 cm. I also had a FNB which came back with an indication of follicular neoplasm. The cytology plus the size of the nodule has led my dr. to recommend surgery. I am extremely reluctant to do this given the high probability of a benign outcome and lingering negative aftereffects of the surgery.
Isn't the PET/CT the gold standard of diagnosis? How can I better weigh the predictive value of this test versus the FNB and US?
PET scans are supposed to be the gold standard but they have their limitations. Remember the story of Tony Snow (former White House spokesperson):
(from FoxNews online:)
During regular tests last year, which include PET imaging scans, magnetic resonance imaging tests and CAT scans, a small growth was discovered in his lower right pelvic area. Blood tests and the PET scan had come back negative, but Snow and his doctors decided to have exploratory surgery, Snow said, "out of an aggressive sense of caution."
Doctors determined that the growth was cancerous, and that his cancer had metastasized, or spread, to his liver, Perino said.
FNB/FNAs are 100% conclusive *for positive tests* - however they have a huge margin of error on negative tests (i.e., they can miss the cancerous cells). So, if the FNA/FNB shows cancerous cells then you have thyroid cancer. However if the FNAFNB is negative or inconclusive it doesn't mean your thyroid is cancer free.
According to thyroid-cancer.net: It is not possible to distinguish a follicular adenoma from follicular thyroid cancer on the basis of a fine needle aspiration biopsy sample. (http://www.thyroid-cancer.net/topics/what+is+a+follicular+neoplasm)
Ultrasounds can only show the composition of the nodules (solid, complex, cystic) but cannot determine if the solid materials are cancerous or not.
The only way to determine whether or not it is cancerous is to have it removed and sent to pathology.
Sorry, no other conclusive ways to tell. You are going to have to decide if you want to take a "wait and see" approach or be aggressive and have it out.
Are the nodules on both sides or just one? You could opt for a partial if only on the one side ? What is the size and location of the others?
My two were atypical (25% chance of turning cancerous if left in and benign so out mine came) and they turned out to be benign follicular adenomas (overgrowth of thy tissue) however, when in there they found 2 very small (mm's) microcarniomas of papillary cancer .... there were two which doesn't thrill me but they were fully encapsulated and no lymph node involvement and the other nodules were non-cance on frozen path so they closed me up and 48hrs later found the other little nodules.
My docs went from no big deal, people have these all the time, to .... gee, there were two so we are a bit more concerned and here are your options .. bottom line: 3 of my 4 opinions suggested a wait and see approach on the other side as we monitor the heck out of a stable 3mm nodule on the other side.
Personally, if you had the Pet scan for cancer reasons elsewhere, I'd be more aggressive vs. conservative .... I had melanoma diagnosis 6mos after my thyroid issues .. it was VERY EARLY STAGE I and all gone now (I go ev. 3 mos for mole cks) but I often wonder what would have happened if I didn't trust my instincts on this mole which changed very quickly within 2mos' time that brought me to the dermatolgist for a look see as I have strong history of other atypical moles but none cancer.
Trust your Instincts .. They have Never Ever Let me Down,
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