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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E31; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1998 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9565--6305324783" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E.M. Genden </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.M.%2BGenden%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Genden%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.M.%2BGenden%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><p id="p-1">The American Thyroid Association guidelines for the management of patients with thyroid nodules<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> outlines the role of sonography and fine-needle aspiration for the evaluation of thyroid nodules. Our work and the work of others<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3"></a>–<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> suggest that fluorodeoxyglucose–positron-emission tomography (FDG-PET) positivity is associated with a significant risk of malignancy, not unlike the cytologic reading of “indeterminate cytology,” which, according to the task force (R9, recommendation B), states that a “lobectomy or total thyroidectomy should be considered.”<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a></sup> We support the work of the American Thyroid Association and believe that FDG-PET positivity simply represents an adjunct to sonography and cytology for the risk assessment of a patient with a thyroid nodule. We do not advocate thyroidectomy for patients with benign cytology and retract any implication of such; however, we do inform patients of the data on FDG-PET positivity—after all, the false-negative rate for fine-needle aspiration of thyroid nodules is higher than the false-positive rate. The American Thyroid Association recommends that a lobectomy or total thyroidectomy be considered for indeterminate cytology, which is associated with a 5%–10% risk of malignancy. Do we feel comfortable withholding surgical intervention when FDG-PET positivity is associated with a 25%–50% risk of malignancy?</p><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.2.E31.1" data-doi="10.1089/thy.2006.16.109"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Cooper</span>  <span class="cit-name-given-names">DS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Doherty</span>  <span class="cit-name-given-names">GM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Haugen</span>  <span class="cit-name-given-names">BR</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Management guidelines for patients with thyroid nodules and differentiated thyroid cancer</span>. <abbr class="cit-jnl-abbrev">Thyroid</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">16</span>:<span class="cit-fpage">109</span>–<span class="cit-lpage">42</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1089/thy.2006.16.109&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=16420177&amp;link_type=MED&amp;atom=%2Fajnr%2F31%2F2%2FE31.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div>
</li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.2.E31.2"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Choi</span>  <span class="cit-name-given-names">JY</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lee</span>  <span class="cit-name-given-names">KS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kim</span>  <span class="cit-name-given-names">HJ</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Focal thyroid lesions incidentally identified by integrated 18F-FDG PET/CT: clinical significance and improved characterization</span>. <abbr class="cit-jnl-abbrev">J Nucl Med</abbr> <span class="cit-pub-date">2006</span>;<span class="cit-vol">47</span>:<span class="cit-fpage">609</span>–<span class="cit-lpage">15</span>
</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Njoiam51bWVkIjtzOjU6InJlc2lkIjtzOjg6IjQ3LzQvNjA5IjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzMxLzIvRTMxLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div>
</li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.2.E31.3" data-doi="10.1210/jc.2003-030465"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Kang</span>  <span class="cit-name-given-names">KW</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kim</span>  <span class="cit-name-given-names">SK</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kang</span>  <span class="cit-name-given-names">HS</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for metastasis evaluation and cancer screening in healthy subjects</span>. <abbr class="cit-jnl-abbrev">J Clin Endocrinol Metab</abbr> <span class="cit-pub-date">2003</span>;<span class="cit-vol">88</span>:<span class="cit-fpage">4100</span>–<span class="cit-lpage">04</span>
</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1210/jc.2003-030465&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=12970270&amp;link_type=MED&amp;atom=%2Fajnr%2F31%2F2%2FE31.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div>
</li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a>

<div class="cit ref-cit ref-journal" id="cit-31.2.E31.4"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Chen</span>  <span class="cit-name-given-names">YK</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ding</span>  <span class="cit-name-given-names">HJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Chen</span>  <span class="cit-name-given-names">KT</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Prevalence and risk of cancer of focal thyroid incidentaloma identified by 18F-fluorodeoxyglucose positron emission tomography for cancer screening in healthy subjects</span>. <abbr class="cit-jnl-abbrev">Anticancer Res</abbr> <span class="cit-pub-date">2005</span>;<span class="cit-vol">25</span>:<span class="cit-fpage">1421</span>–<span class="cit-lpage">6</span>
</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTA6ImFudGljYW5yZXMiO3M6NToicmVzaWQiO3M6MTA6IjI1LzJCLzE0MjEiO3M6NDoiYXRvbSI7czoxOToiL2FqbnIvMzEvMi9FMzEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div>
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E31; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1998 </span></div>
  
  
  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E31; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1998 </span></div>
  
  
  
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