Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study
Por:
Gonzalez-Sanchez C, Salvador-Egea M, Gluckmann-Maldonado E, Rios A, Martin-Fernandez J, Perez-Garcia J, Garcia-Lorenzo F, Flores-Pastor B, Gomez-Ramirez J, Ortega-Serrano J, Ros-Lopez S, Villar-del-Moral J, Morales-Garcia D, Gutierrez-Rodriguez M, Domenech-Calvet J, Nuno-Vazquez-Garza J, Franch-Arcas G
Publicada:
24 may 2023
Ahead of Print:
24 may 2023
Resumen:
PurposeSurgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role.MethodsThis was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated.ResultsSome 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172).ConclusionIncidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.
Filiaciones:
Gonzalez-Sanchez C:
Complejo Asistencial Univ Salamanca, Dept Surg, Paseo San Vicente,88-132, Salamanca 37007, Spain
Inst Invest Biomed Salamanca IBSAL, Salamanca, Spain
Salvador-Egea M:
Complejo Hosp Navarra B, Dept Surg, Pamplona, Spain
Gluckmann-Maldonado E:
Hosp Univ Virgen Victoria, Dept Surg, Malaga, Spain
Rios A:
Hosp Clin Univ Arrixaca, Dept Surg, Murcia, Spain
Martin-Fernandez J:
Complejo Hosp Ciudad Real, Dept Surg, Ciudad Real, Spain
Perez-Garcia J:
Hosp Santa Creu i St Pau, Dept Surg, Barcelona, Spain
Garcia-Lorenzo F:
Hosp Alvaro Cunqueiro Vigo, Dept Surg, Vigo, Spain
Flores-Pastor B:
Hosp Gen Univ Morales Meseguer, Dept Surg, Murcia, Spain
Gomez-Ramirez J:
Hosp Univ La Paz, Dept Surg, Madrid, Spain
Ortega-Serrano J:
Hosp Clin Univ Valencia, Dept Surg, Valencia, Spain
Ros-Lopez S:
Hosp Clin Univ Lozano Blesa, Dept Surg, Zaragoza, Spain
Villar-del-Moral J:
Hosp Univ Virgen Nieves, Dept Surg, Granada, Spain
Inst Invest Biosanit IBS Granada, Granada, Spain
Morales-Garcia D:
Hosp Univ Virgen Victoria, Dept Surg, Malaga, Spain
Gutierrez-Rodriguez M:
Hosp Univ Basurto, Dept Surg, Bilbao, Spain
Domenech-Calvet J:
Hosp Univ St Joan De Reus, Dept Surg, Reus, Spain
Nuno-Vazquez-Garza J:
Hosp Hosp Meixoeiro, Dept Surg, Vigo, Spain
Franch-Arcas G:
Complejo Asistencial Univ Salamanca, Dept Surg, Paseo San Vicente,88-132, Salamanca 37007, Spain
Inst Invest Biomed Salamanca IBSAL, Salamanca, Spain
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