Management for primary thyroid lymphoma: Experience from a single tertiary care centre in Taiwan

Background: Diverse treatments are available for different histological types of thyroid lymphoma: concurrent chemoradiotherapy for diffuse large B cell lymphoma (DLBCL) and radiotherapy or thyroidectomy for low-grade mucosa-associated lymphoid tissue (MALT) lymphoma. However, diagnosing lymphomas before operation is difficult, because the diagnostic yield of fine-needle biopsies is limited by the rarity of the disease. Therefore, patients may undergo unnecessary thyroidectomies. Purpose: To investigate the efficacy of various biopsy procedures and explore indications for thyroidectomy in patients with primary thyroid lymphomas. Methods: The demographics, types of biopsy procedures, treatments, and outcome data of patients diagnosed with primary thyroid lymphoma at Tri-Service General Hospital between 1992 and 2015 were retrospectively collected. Results: Ten patients received a diagnosis of primary thyroid lymphomas: eight with DLBCL and two with MALT lymphoma. None of these patients received a definitive diagnosis after fine-needle aspiration biopsies; however, six patients received their diagnosis and histological-subtype classification after core-needle biopsies. Before 2004, three patients with DLBCL underwent thyroidectomies for diagnostic purposes and one encountered vocal cord palsy. By contrast, two patients with localized MALT lymphoma underwent thyroidectomies for treatment, with both experiencing favorable outcomes and prognoses. Conclusion: Core-needle biopsy is superior to fine-needle biopsy for diagnosing primary thyroid lymphomas without increasing complications. Thyroidectomy in localized, low-grade MALT lymphoma of the thyroid can cure the disease and exclude high-grade malignancies in the remaining glands. By contrast, DLBCL should be treated with chemotherapy and radiotherapy after diagnosis through biopsy, and extensive surgery should be avoided. Copyright (C) 2016, Taiwan Surgical Association. Published by Elsevier Taiwan LLC.