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  • Accordingly false negative results have limited diagnostic a

    2018-10-31

    Accordingly, false-negative results have limited diagnostic accuracy to 59% to 88%. FNAB failed to diagnose thyroid lymphoma in all nine patients examined in the current study. This is likely attributable to the inadequate experience of our cytopathologists resulting from the rarity of the disease, and we believe most clinicians in low-volume centers may face similar dilemmas. In this study, all patients received a final diagnosis after a core-needle biopsy or thyroidectomy. Biopsy procedures performed to obtain an adequate specimen remain necessary for our pathologists to differentiate the histological subtypes of thyroid lymphoma. Five of our patients were diagnosed using ultrasound-guided core-needle biopsies, avoiding the need of further surgery for diagnosis. Ultrasound imaging is a valuable tool, because it tnf alpha inhibitor can identify solid tumor lesions while avoiding necrotic lesions or vessel injuries. In all thyroid malignancies, the accuracy obtained using core-needle biopsy was higher (up to 92.1%) than that obtained using FNAB. Histological sub-classification is possible, because core-needle biopsy successfully sub-classifies histological types in 89.7% of neck lymphomas. This technique provides an adequate amount of specimen for the detection of prognostic markers, such as Ki-67 and p53, through immunohistochemistry staining, enabling a reliable differentiation between Hashimoto\'s thyroiditis and anaplastic carcinoma. Considering the indeterminate results of FNAB, core-needle biopsy can be used as a complementary diagnostic tool before surgery. In core-needle biopsy, bleeding is a major concern; however, no bleeding complication related to needle biopsy was observed in this study. Studies reported the incidence of hematoma formation as being slightly higher after core-needle biopsy (0.02–2.00%) as compared with that observed after fine-needle biopsy; however, none of the patients required hospitalization. Additionally, while the ultrasound-guided core-needle biopsy typically requires fewer needle passes as compared with those required for fine-needle biopsy, the adequacy of the specimen is superior. Therefore, ultrasound-guided core biopsy is an efficient and relatively safe alternative to open biopsy for the diagnosis of thyroid lymphoma. The proposed management algorithm for primary thyroid lymphoma is presented in Figure 2. In patients with rapidly growing neck masses and a diffuse infiltrative image pattern, the differential diagnosis may include anaplastic carcinoma, poorly differentiated thyroid cancer, and thyroid lymphoma. Once initial FNAB fails to definitively diagnose the tumor type, core-needle biopsy should be considered. In patients with a diffuse infiltrative image pattern or high clinical suspicion of lymphoma, core-needle biopsy may be used instead of FNAB as an initial diagnostic test. For example, Patient 7 underwent core-needle biopsy without undergoing a prior FNAB. The results of the biopsy revealed DLBCL, precluding the need for any additional surgical biopsy. The staging work-up involves physical examination, laboratory blood tests (complete blood counts and biochemistry data, including beta-microglobulin and lactate dehydrogenase values), radiological imaging (CT/magnetic resonance imaging (MRI) scans and MRI), nuclear medicine imaging (gallium scan and PET tnf alpha inhibitor scans), and bone-marrow examination. CT or MRI scans are valuable in defining the local extent of the disease, such as a potential extrathyroid invasion, substernal extension, and lymph node involvement. In patients suitable for thyroidectomy, resectability is also ideally evaluated through CT scans to assess vascular enhancement or prevertebral fascia invasion; however, nuclear imaging is more useful for evaluating the extent of lymph node involvement and distant metastasis. PET-CT scans largely replaced gallium scans at our institute after 2008, because they provide more precise localization and provide high sensitivity and specificity for all lymphoma subtypes, especially those of an indolent nature (such as MALT and follicular). Compared with nodal non-Hodgkin\'s lymphomas, primary thyroid lymphoma tends to be less invasive. Most cases of thyroid lymphoma belong to Ann Arbor stage IE or IIE. The prognosis is poor for patients with an International Prognostic Index score ≥2 (including advanced stage and age), large B cell or follicular histology, or inadequate local tumor control by radiation or surgery. Additionally, the histological findings of vascular invasion, abundant apoptosis, high mitotic rate, and perithyroidal soft-tissue invasion are associated with poor prognosis.