334 chapter 4 of ionizing radiation (~4 mSv), and the diagnostic and therapeutic consequences (including costs) of incidental findings. Our study showed that incidental findings caused overtreatment in 4 of 132 (3%) patients, even though treatment was compliant with the current guidelines (Table 11). These individual cases underpin that careful exploration of further diagnostic options should be considered, especially when drastic management changes are the consequence. In conclusion, this randomised controlled trial shows that an [18F]FDG-PET/CT-driven diagnostic workup of indeterminate thyroid nodules leads to practice changing patient management, accurately and oncologically safely ruling out malignancy, reducing futile surgeries by 40%, and saving approximately €6,900 per patient. Its use should be limited to nodules with non-Hürthle cell cytology only to further optimise its therapeutic yield to 48%, as [18F]FDG-PET/CT does not contribute to the management of patients with Hürthle cell nodules.
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