500 chapter 13 In both of these European guidelines, the promising rule-out potential of [18F]FDG-PET/CT is recognized, too, although its routine use is not recommended. Whereas the ETA guidelines presents high costs and limited availability of [18F]FDG-PET/CT as arguments [15], the French put forward the disappointing NPV in several pre-EfFECTS trial studies and the limited added value over using a combination of ultrasound (i.e., Thyroid Imaging Reporting and Data System [TIRADS]) and cytology to classify thyroid nodules [666]. It must be mentioned, though, that the French guidelines did not include the results of the EfFECTS trial, because its main results were published shortly after the literature search for the guidelines update was completed. Still, in their response to our comment that the EfFECTS trials’ results should have been included, Thuillier et al. argued that the these results would have left their recommendation not favouring the routine use of [18F]FDG-PET/CT unchanged, as the trials’ 1-year protocolled follow-up is considered insufficient to exclude malignancy and as no ultrasound classification system was included in the main analysis [726]. The ETA guidelines were recently strongly criticized by the European Association of Nuclear Medicine (EANM), as no nuclear medicine physicians were included in this guidelines’ author list and as a possible result, the established involvement and/or added value of nuclear medicine techniques in the diagnosis and treatment of thyroid nodules is greatly underexposed [727]. Altogether, even though various international guidelines aim to propose generalizable recommendations, this shows that perspectives regarding the preferred diagnostic workup of thyroid nodules may greatly differ from country to country [25].
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