Joon Young Choi

Jeong DY, et al. J Korean Med Sci. 2027 Mar;42:e63. https://doi.org/10.3346/jkms.2027.42.e63

Introduction: Focal fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) has been associated with thyroid malignancy. However, its incremental value beyond ultrasonographic risk stratification remains unclear. We evaluated whether focal FDG uptake and the maximum standardized uptake value (SUVmax) improve the prediction of malignancy when incorporated into ultrasonographic risk stratification systems. Methods: This retrospective cohort study included 464 thyroid nodules from 454 individuals who underwent ultrasonography, biopsy, and PET/CT between 2017 and 2022 at our tertiary referral hospital. PET/CT had been performed for cancer work-up in 96.6% of nodules. Nodules were classified according to the American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and the Korean Thyroid Imaging Reporting and Data System (K-TIRADS). Diagnostic performance was assessed using receiver operating characteristic analysis and the area under the curve (AUC). Incremental value was evaluated using the net reclassification improvement (NRI) and decision curve analysis. Results: Among 464 nodules, 221 (47.6%) were malignant. The malignancy rate was higher in nodules with focal FDG uptake than in those without (52.3% vs. 24.4%). Adding focal FDG uptake increased the AUC for both ACR-TIRADS and K-TIRADS; however, the overall NRI was not improved. The absence of focal FDG uptake modestly improved the reclassification of benign nodules (NRI_nonevent = 0.070 for ACR-TIRADS and 0.045 for K-TIRADS). SUVmax was positively associated with malignancy risk without a clear diagnostic cutoff. Incorporating SUVmax improved the AUC and the overall NRI (0.093 for ACR-TIRADS and 0.077 for K-TIRADS), mainly through reclassification of benign nodules (NRI_nonevent = 0.271 and 0.129), whereas reclassification of malignant nodules worsened (NRI_event = −0.178 and −0.052). Conclusions: Focal FDG uptake and SUVmax on PET/CT provided only modest incremental value beyond ultrasonographic risk stratification, largely confined to the reclassification of benign nodules. Nevertheless, the absence of focal FDG uptake did not reliably exclude malignancy in nodules with intermediate- or high-risk sonographic features, given the high malignancy rate observed in these FDG-nonavid nodules (41.4%–77.8%).

Small cell lung cancer imaging is evolving beyond conventional staging toward molecularly guided precision medicine, integrating machine learning, radiogenomics, and molecular imaging with novel radiotracers to support biomarker-driven diagnosis, risk stratification, and personalized treatment.

Purpose Aggressive breast cancer treatment increases the risk of breast cancer-related lymphedema(BCRL). However, whether all high-risk patients require equally intensive long-term management remains unclear. This study aimed to characterize the long-term manifestations of the BCRL pattern in patients who received aggressive cancer therapies yet showed favorable lymphoscintigraphy findings. Methods This retrospective study included 104 patients with BCRL with a history of mastectomy with axillary lymph node dissection and locoregional radiation therapy between 2008 and 2022, all of whom showed favorable lymphoscintigraphy findings. The patients were stratified into four groups based on their initial percentage of excessive volume(PEV). Volume changes and individualized lymphedema treatment during the first 12 months were analyzed. From months 12 to 24, the treatment intensity, including the frequency of medical compression therapy, was adjusted based on expert assessment. Results Despite similar treatment histories and lymphoscintigraphy findings, the patients showed different volume change patterns based on the initial PEV, although the overall outcomes were favorable over two years in all groups. Patients with BCRL and a low initial PEV maintained stable reduced volumes after 6 months of minimal or no compression therapy. However, the high-initial PEV group required active surveillance and long-term management despite favorable lymphoscintigraphy results. Conclusion Initial PEV effectively predicted long-term outcomes and treatment needs in patients with BCRL with an aggressive cancer treatment history and favorable lymphoscintigraphy findings. Personalized treatment planning using initial PEV and lymphoscintigraphy may provide the appropriate intensity of therapy to patients for an optimal duration to reduce time and financial burdens.