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    Prevalence and diagnostic challenges of thyroid lymphoma: a multi-institutional study in non-Western countries
    (JAPAN ENDOCRINE SOC, 2020-01-01) Hirokawa, Mitsuyoshi; Suzuki, Ayana; Hashimoto, Yuko; Satoh, Shinya; Canberk, Sule; Jhuang, Jie Yang; Jung, Chan Kwon; Tangnuntachai, Nichthida; Kovacevic, Bozidar; Zhu, Yun; Agarwal, Shipra; Kakudo, Kennichi
    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 mucosaassociated 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.
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    Ultrasound-Guided Fine Needle Aspiration (USFNA) of Thyroid Nodules
    (KOWSAR PUBL, 2015-01-01) Ozcan, Umit Aksoy; Atahan, Safak
    Background: The goal of ultrasound guided fine-needle aspiration (USFNA) is to obtain most cellular specimen that represents the nodule. However, there is substantial variability in specimen cellularity depending on the obtaining techniques. While performing USFNA, it is not clear whether the needle tip should be placed at hypovascular or hypervascular site of the nodule to obtain more cells for cytological analysis. Objectives: The aim of the study was to assess whether USFNA of the hypovascular or hypervascular site of a thyroid nodule would reveal more cells for cytological analysis. Patients and Methods: Twenty-three consecutive patients with solid thyroid nodules larger than 2 cm were aspirated under color Doppler sonography guidance. First pass was from the hypovascular site and the second pass from the hypervascular site. The aspirates were scored from 1-3 by cytologist according to number of cell groups. Results: When only hypervascular site was used, adequate sampling was limited to 65\% of the cases. When both sites were evaluated together, overall adequate sampling was 91\%. Adding a sample from the hypervascular site to hypovascular aspirate increased the adequate sampling by 8\%. The highest pathological score was achieved when both hypo-and hypervascular site aspirates were evaluated together. Conclusions: The aspirates from the hypovascular and hypervascular sites of solid nodules are complementary and should be performed consecutively.