479 MD and [18F]FDG-PET/CT: complementing techniques or waste of valuable resources? 12 c. non-oncocytic nodules, AUS cytology (n=51) MD [18F]FDG-PET/CT A priori ROM 16% Histopathology P value Test result Malignant or borderline Benign Malignant or borderline Benign Positive 6 10 7 20 Negative 2 33 1 23 MD on cytology (n=51), assuming nodules under active surveillance are benign, % (95% CI) Sensitivity 75 (35-97) 88 (47-100) .50 Specificity 77 (61-88) 53 (38-69) .04 PPV 38 (15-65) 26 (11-46) NPV 94 (81-99) 96 (79-100) BCR 69 (54-81) 47 (33-62) d. non-oncocytic nodules, FN cytology (n=35) MD [18F]FDG-PET/CT A priori ROM 40% Histopathology P value Test result Malignant or borderline Benign Malignant or borderline Benign Positive 11 5 13 10 Negative 3 16 1 11 MD on cytology (n=35), assuming nodules under active surveillance are benign, % (95% CI) Sensitivity 79 (49-95) 93 (66-100) .63 Specificity 76 (53-92) 52 (30-74) .13 PPV 69 (41-89) 57 (34-77) NPV 84 (60-97) 92 (62-100) BCR 54 (37-71) 34 (19-52) e. oncocytic nodules, O-FN cytology (n=29) MD [18F]FDG-PET/CT A priori ROM 28% Histopathology P value Test result Malignant or borderline Benign Malignant or borderline Benign Positive 7 11 8 20 Negative 1 10 0 1 MD on cytology (n=29), assuming nodules under active surveillance are benign, % (95% CI) Sensitivity 88 (47-100) 100 (63-100) n.a.a Specificity 48 (26-70) 5 (0-24) .004 PPV 39 (17-64) 29 (13-49) NPV 91 (59-100) 100 (3-100) BCR 38 (21-58) 3 (0-18) 95% CI, 95% confidence interval; AUS, atypia of undetermined significance; BCR, benign call rate; CI, confidence interval; [18F]FDG, 2-[18F]fluoro-2-deoxy-D-glucose; [18F]FDG-PET/CT, positron emission tomography/computed tomography using [18F]FDG; FN, follicular neoplasm; MD, molecular diagnostics; n, number; n.a., not applicable. NPV, negative predictive value; PPV, positive predictive value. ROM, rate of malignancy, including borderline tumours. a: not applicable, not able to calculate McNemar test. observed for MD (Table 4). MD and [18F]FDG-PET/CT were concordant in 63% (72/115) of cases (Table 5). [18F]FDG-PET/CT did not differentiate in nodules with O-FN cytology (Table 2e): nearly all were [18F] FDG positive (BCR 3%). MD had 88% sensitivity, 48% specificity, and 38% BCR in O-FN nodules.
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