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Updated: Feb 27, 2026
Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis
Published on: February 9, 2024
Preoperative diagnostic algorithm of primary thyroid lymphoma using ultrasound, aspiration cytology, and flow
Mitsuyoshi Hirokawa1, Takumi Kudo2, Hisashi Ota3
1Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 650-0011, Japan.
Insights
This study evaluates ultrasound, fine needle aspiration cytology, and flow cytometry for diagnosing primary thyroid lymphoma. A combined scoring system can guide surgical decisions for accurate diagnosis.
Area of Science:
- Endocrinology
- Oncology
- Diagnostic Imaging
Background:
- Primary thyroid lymphoma is rare but requires accurate preoperative diagnosis.
- Distinguishing lymphoma from benign thyroid conditions is clinically significant.
Purpose of the Study:
- To assess the diagnostic value of ultrasound (US), fine needle aspiration cytology (FNAC), and flow cytometry for primary thyroid lymphoma.
- To develop a preoperative diagnostic algorithm for primary thyroid lymphoma.
Main Methods:
- Retrospective analysis of 32 primary thyroid lymphoma and 43 benign lymphoproliferative lesion cases.
- Evaluation of US, FNAC, and flow cytometry data collected between May 2012 and December 2015.
- Development of a scoring system integrating US, FNAC, and flow cytometry results.
Main Results:
- Flow cytometry demonstrated the highest specificity (88.4%) and sensitivity (75.0%).
- FNAC showed the highest positive (90.5%) and negative (94.7%) predictive values.
- A proposed scoring system (US + FNAC + flow cytometry) with a threshold of ≥4 suggests thyroid resection for diagnosis.
Conclusions:
- A combined diagnostic approach using US, FNAC, and flow cytometry can improve the preoperative diagnosis of primary thyroid lymphoma.
- The proposed algorithm aids in identifying patients who may benefit from surgical intervention.
- While aggressive lymphomas are identified, indolent types like MALT lymphoma may require careful follow-up.
Abstract:
The aims of this report were to clarify the diagnostic significance of ultrasound (US), fine needle aspiration cytology (FNAC), and flow cytometry for primary thyroid lymphoma, and to establish a preoperative diagnostic algorithm of primary thyroid lymphoma. We retrospectively examined US, FNAC, and flow cytometry in 43 patients with benign lymphoproliferative lesions and 32 patients with primary thyroid lymphoma, who underwent US, FNAC, and flow cytometry at Kuma Hospital between May 2012 and December 2015. Primary thyroid lymphomas included 27 mucosa-associated lymphoid tissue lymphomas, 4 diffuse large B-cell lymphomas, and 1 follicular lymphoma. Flow cytometry had the highest specificity (88.4%) and sensitivity (75.0%). The specificity of US was the lowest (32.6%). Both the positive predictive value (90.5%) and negative predictive value (94.7%) were the highest for FNAC. A scoring system was defined as follows: US, low suspicion 0, intermediate suspicion 1, and high suspicion 2; FNAC, benign 0, undetermined 1, malignant 2; and flow cytometry, 0.33< κ/λ ratio <3 0, κ/λ ratio ≤0.33 2, and κ/λ ratio ≥3 2. We propose that a score ≥4 indicates the need for thyroid resection for diagnosing primary thyroid lymphoma. In such a situation, the case of diffuse large B-cell lymphoma, which was aggressive, was not excluded. Approximately one-fifth of mucosa-associated lymphoid tissue lymphomas may be overlooked, but the patients could be followed up with because of an indolent course.
