Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan.
Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Endocr J. 2020 Nov 28;67(11):1085-1091. doi: 10.1507/endocrj.EJ20-0202. Epub 2020 Jul 9.
Research on the primary thyroid lymphoma (PTL) diagnosis is limited, with only a few large sample size studies, reported from Asian countries. The aim of the present study was to clarify the current prevalence and challenges in PTL diagnosis, and recommended ancillary studies for PTL in non-Western countries. PTL (n = 153) cases were retrieved from 10 institutions in non-Western countries and analyzed. Ultrasound examination (UE) and fine needle aspiration cytology (FNAC) were used as main preoperative diagnostic tools in all participating institutions. Flow cytometry (FCM) was performed in the 5 institutions (50%). Lobectomy was the most common histological procedure to confirm the PTL diagnosis. All institutions routinely performed immuno-histochemical analysis. PTL was 0.54% of malignant thyroid tumor cases, with mucosa-associated lymphoid tissue lymphoma (MALTL) and diffuse large B-cell lymphoma (DLBCL) being 54.9% and 38.6%, respectively. Kuma Hospital, where the frequency of MALTL was highest (83.7%), routinely performed FCM using the materials obtained by FNAC. UE and FNAC sensitivities were 62.5% and 57.8%, respectively. In both UE and FNAC, sensitivity of MALTL was lower than of DLBCL. The study elucidated that the prevalence of PTL in non-Western countries was lower than previously reported. We propose that FCM should be more actively used to improve the preoperative diagnosis of MALTL. Our data predicted that the MALTL proportion will increase with improved diagnostic tools, while observation of PTL-suspected nodules without histological examination remains a viable option.
原发性甲状腺淋巴瘤（PTL）的研究有限，仅有少数来自亚洲国家的大型样本量研究报告。本研究旨在阐明 PTL 诊断的当前流行情况和挑战，并为非西方国家的 PTL 推荐辅助研究。从非西方国家的 10 个机构中检索到 153 例 PTL 病例并进行分析。所有参与机构均将超声检查（UE）和细针穿刺细胞学（FNAC）作为主要术前诊断工具。有 5 个机构（50%）进行流式细胞术（FCM）。大部分机构（93.3%）采用甲状腺叶切除术作为确认 PTL 诊断的主要组织学程序。所有机构均常规进行免疫组织化学分析。PTL 占恶性甲状腺肿瘤病例的 0.54%，其中黏膜相关淋巴组织淋巴瘤（MALTL）和弥漫性大 B 细胞淋巴瘤（DLBCL）分别占 54.9%和 38.6%。Kuma 医院（日本）MALTL 的发病率最高（83.7%），常规使用 FNAC 获得的材料进行 FCM。UE 和 FNAC 的敏感性分别为 62.5%和 57.8%。在 UE 和 FNAC 中，MALTL 的敏感性均低于 DLBCL。该研究表明，非西方国家的 PTL 患病率低于先前报告。我们建议更积极地使用 FCM 以改善 MALTL 的术前诊断。我们的数据预测，随着诊断工具的改进，MALTL 的比例将会增加，而不进行组织学检查观察 PTL 疑似结节仍然是一种可行的选择。
