Dear Editor,
Thank you for your interest in our article and for your thoughtful commentary on our study regarding the utility of FDG uptake values and ultrasonographic findings of thyroid nodules in decision-making for fine-needle aspiration biopsy (FNAB) in incidentally detected thyroid nodules on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT).[1] Management of thyroid incidentalomas detected on 18F-FDG PET/CT remains an important area of research.
We share the authors' view that FDG uptake and ultrasound-based risk stratification should be regarded as complementary rather than competing tools in the evaluation of PET-positive thyroid incidentalomas. SUVmax cutoff values can help guide decision-making in patients whose thyroid nodules are detected on 18F-FDG PET/CT imaging. In our study, the SUVmax cutoff value for malignancy was reported as 5.5, and it was also reported as 5.67 in a study by Ozturk et al.[2] Evidence regarding the relationship between higher FDG uptake and malignant thyroid nodules has also been demonstrated in several recent studies.[3,4] However, due to low adherence to follow-up after the detection of thyroid incidentalomas, these results reflect only a selected group of patients.
Future prospective studies with more detailed information on thyroid nodules and histopathological verification may provide further insight into the role of 18F-FDG PET/CT in thyroid incidentalomas.
We sincerely appreciate your interest in our study.
References
- 1.Kostek M, Kostek H, Unlu MT, Caliskan O, Cakir Y, Sengul Z, et al. Deciding on fine needle aspiration biopsy in thyroid incidentalomas in FDG-PET/CT: Should ultrasonographic evaluation or FDG uptake be in the foreground? Sisli Etfal Hastan Tip Bul. 2025;59:20–7. doi: 10.14744/SEMB.2025.49140. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ozturk Y, Kocabas M, Kaya B, Karakose M. Evaluation of the performance of ultrasound risk stratification systems in predicting malignancy in incidental thyroid nodules detected on 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A single-center retrospective study. Endocrinol Res Pract. 2026;30:112–9. doi: 10.5152/erp.2026.25820. [DOI] [Google Scholar]
- 3.Kim MK, Kim H, Shin JH, Lee JH, Choi JY, Hahn SY. Thyroid incidentalomas detected on 18F-fluorodeoxyglucose positron emission tomography with computed tomography in cancer patients: imaging clues for further evaluation. Eur Radiol. 2026;36:3820–8. doi: 10.1007/s00330-025-12181-0. [DOI] [PubMed] [Google Scholar]
- 4.Abdulrezzak U, Temizer E, Tutus A. The importance of FDG avidity in incidental thyroid nodules on FDG PET/CT. Clin Imaging. 2025;128:110626. doi: 10.1016/j.clinimag.2025.110626. [DOI] [PubMed] [Google Scholar]