Malignancy classification of thyroid incidentalomas using 18F-fluorodeoxy-d-glucose PET/computed tomography-derived radiomics

Background Thyroid incidentalomas (TIs) are incidental thyroid lesions detected on fluorodeoxy-d-glucose ( ¹⁸F-FDG) PET/computed tomography (PET/CT) scans. This study aims to investigate the role of noninvasive PET/CT-derived radiomic features in characterizing ¹⁸F-FDG PET/CT TIs and distinguishing benign from malignant thyroid lesions in oncological patients. Materials and methods We included 46 patients with PET/CT TIs who underwent thyroid ultrasound and thyroid surgery at our oncological referral hospital. Radiomic features extracted from regions of interest (ROI) in both PET and CT images and analyzed for their association with thyroid cancer and their predictive ability. The TIs were graded using the ultrasound TIRADS classification, and histopathological results served as the reference standard. Univariate and multivariate analyses were performed using features from each modality individually and combined. The performance of radiomic features was compared to the TIRADS classification. Results Among the 46 included patients, 36 patients (78%) had malignant thyroid lesions, while 10 patients (22%) had benign lesions. The combined run length nonuniformity radiomic feature from PET and CT cubical ROIs demonstrated the highest area under the curve (AUC) of 0.88 (P < 0.05), with a negative correlation with malignancy. This performance was comparable to the TIRADS classification (AUC: 0.84, P < 0.05), which showed a positive correlation with thyroid cancer. Multivariate analysis showed higher predictive performance using CT-derived radiomics (AUC: 0.86 ± 0.13) compared to TIRADS (AUC: 0.80 ± 0.08). Conclusion This study highlights the potential of ¹⁸F-FDG PET/CT-derived radiomics to distinguish benign from malignant thyroid lesions. Further studies with larger cohorts and deep learning-based methods could obtain more robust results.