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1483: Application of 2D and 3D Ultrasonography in the Diagnosis of Thyroid Nodules
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Ultrasound in Medicine and Biology
1480 The Reproducibility of the VOCAL Program for Evaluating 3D Power Doppler Ultrasonography of Thyroid Nodules Shyh-Ching Chiou, Da Chien General Hospital; China Medical University Hospital, Taiwan Pao-Tsai Yeh, Da Chien General Hospital, Taiwan Jen-Der Lin, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Wu-Huei Hsu, China Medical University Hospital, Taiwan Ching-Chu Chen, China Medical University Hospital, Taiwan Min-Huang Hsieh, China Medical University Hospital, Taiwan Wei-Lun Haung, China Medical University Hospital, Taiwan Long-Bin Jeng, China Medical University Hospital, Taiwan Aim: The aim of this study was to evaluate the inter-examinational, intra-observer and inter-observer reproducibility of three dimensional (3D) power Doppler ultrasonography (US) with the virtual organ computer-aided analysis (VOCAL) program for measuring thyroid volume, mean gray value (MG) and vascular indices in patients with thyroid nodules. Patients and Methods: Patients had thyroid nodules with diameters range form 0.5 to 3 cm, clear margin and scanty cystic part, without history of thyroidectomy, were examined by 3DUS (V730, GE) from March 2008 to June 2008. The thyroid volume, MG and vascular indices: vascularization index (VI), flow index (FI), vascularization– flow index (VFI) were obtained from the VOCAL program. Interexaminational reproducibility intra-observer and inter-observer reproducibility were presented as inter-examinational-class correlation coefficient (inter-examin-CC), intra-class correlation coefficient (intraCC) and inter-class correlation coefficient (inter-CC). Values greater than 0.70 were considered as acceptable. Results: Totally 38 patients with 44 nodules were included. Twenty nodules were examined with two times’ 3DUS examination. The values of inter-examin-CC of volume, MG, VI, VFI were larger than 0.9323; otherwise, FI was 0.8162 with wide 95% CI 0.5984-0.9224. For evaluating total 44 thyroid nodules, thyroid volume showed excellent intra-observer and inter-observer reproducibility (intra-CC⬎ 0.9677 and inter-CC: 0.8533). MG, VI and VFI also showed excellent reproducibility (intra-CC ⬎ 0.9921 and inter-CC ⬎ 0.9592). The values of intra-CC of FI were larger than 0.8983 but small inter-CC value (0.5112). Conclusion: Base on this study, 3DUS with the VOCAL program is a reproducible tool, except FI, for evaluating thyroid nodules. 1481 Clinical Evaluation of Elastography for the Differential Diagnosis of Thyroid Follicular Tumors Nobuhiro Fukunari, Showa University Yokohama Northern Hospital, Japan Kazushige Arai, Showa University Yokohama Northern Hospital, Japan Akio Naakamura, Showa University Yokohama Northern Hospital, Japan Tomomi Yamazaki, Showa University Yokohama Northern Hospital, Japan Satoshi Sakaue, Showa University Yokohama Northern Hospital, Japan Kenji Nakano, Showa University Yokohama Northern Hospital, Japan Purpose: The diagnosis and management of follicular cancer of the thyroid gland remains a controversial topic. The aim of this study was to evaluate the clinical usefulness of Elastography imaging for the differential diagnosis of thyroid follicular lesions.
Volume 35, Number 8S, 2009 Methods and Materials: 133 follicular tumors were examined by Elastography. Papillary cancers, other types thyroid malignancies or hot nodules were excluded from this study. The images of thyroid follicular lesions were recognized as four typical patterns as follows: Pattern 1(P1): nodule is relatively homogenous and colored with light green. Pattern 2(P2): the center of nodule is colored with green and its periphery is colored with blue. Pattern 3(P3): nodule is mixed-colored with light green and red. Pattern 4(P4): the whole tumor is displayed in blue. Results: All the follicular tumors were surgically and histopathologically diagnosed finally. In this series, 58 hyperplastic nodules, 33 follicular adenomas and 42 follicular cancers (28 Minimally invasive, 14 Widely invasive) were found. Of the 42 follicular cancers, 31 cases were P2, which was occupied 73.8%. Assuming Pattern 2 to be malignant and others to be benign, 87 of 91 benign tumors and 31 of 42 follicular cancers were accurately diagnosed, yielding a sensitivity of 78.8%, a specificity of 95.6%, and an accuracy of 90.2%. Conclusion: Elastography can provide new useful information for the differential diagnosis of thyroid follicular tumors and has a capability to improve the diagnostic specificity and accuracy than that of our former studies of color-Doppler examination. 1482 Clinical Application of 3D Color Energy Mapping in Thyroid Nodules Quan Jiang, Pudong New District Hospital, China Ye Ning Bai, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Hua Yu Zhao, Pudong New District Hospital, China Yuan Zhang, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Objective: To explore the clinical application of 3-D color energy(3CDE)mapping in the diagnosis of the thyroid nodules. Methods: A total of 62 thyroid nodules in 56 patients were detected on 3 CDE mapping.The ultrasonic data were compared with results of surgery and pathology. Results: The mapping of thyroid nodules had high reproducibility.Benign and malignant thyroid nodules has their own characteristics.About 73.3%(11/15)of malignant thyroid nodules displayed dilatated,distorted and irregular distributed vessels.In benign nodules the cyst or cystic solid noudles showed that the vessels distributed surrounding the mass,and the substantial nodules showed thin,regular vessels arranged from outside toward the inner.All the two types counted to 87.2%(41/ 47).Therefor,significant difference was present as benign nodules VS malignant(P⬍0.05). Conclusions: 3CDE provided directviewing and thyroid nodular morphology,and 3CDE nodular mapping can display the vessel structure. The relationship with adjacent tissue and distribution of vessels may also help confirm new vessels of thyroid nodules.3CDE mapping is a new method for analysing tumor characterisitcs. 1483 Application of 2D and 3D Ultrasonography in the Diagnosis of Thyroid Nodules Quan Jiang, Pudong New District Hospital, China Yuan Zhang, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Ying Wan Zhang, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Objective: To apply two-dimensional and 3D ultrasonography were performed in 56 patients with 62 thyroid nodules. The results were compared with those of operation and pathology.
Abstracts Results: Images of 3D ultrasonography provided relationship between nodules and adjacent tissue rapidly. Benign solid nodules of thyroid showed a complete hyperechogenic interface, and 88.9% nodules showed regular halo. There were nodules extending to carotid presented to be malignancy. Solid cystic nodules in thyroid were benign mostly (92.6%), and malignant mixed echogenic nodules presented irregular surface. Conclusion: Three-dimensional ultrasonography extends the view of two-dimensional ultrasonography and provides direct stereo morphologic features and is a new imaging modality for thyroid diseases. 1484 Application of 2D Color Doppler Ultrasonography in Diagnosis of Thyroid Diseases Quan Jiang, Pudong New District Hospital, China Cheng Yu Xu, Department of Ultrasound, Pudong New District Hospital, Shanghai 201200, China, China Objective: To explore the diagnosis and differential diagnosis value of ultrasongraphy in patients with thyroid diseases. Methods: Twenty cases with normal thyroid and ninety-eight cases with thyroid diseases were examined with two dimensional color Doppler ultrasonography. Results: Different thyroid diseases have their own some unique characteristics. Conclusion: Comprehensive evaluation of different available sonarographical methods can increase greatly accuracy in diagnosing thyroid diseases. 1485 Which Study is More Accurate, FDG PET/CT or Ultrasonography? Detection of Metastasis or Recurrence After Surgical Treatment in Patients with Differentiated Thyroid Carcinoma Jae-Hwan Kim, Korea Cancer Center Hospital, Korea Tae-Hyun Lee, Korea Cancer Center Hospital, Korea Young-Joo Chung, Korea Cancer Center Hospital, Korea Kie-Hwan Kim, Korea Cancer Center Hospital, Korea Purpose: To compare the accuracy of FDG PET/CT and ultrasonography (US) for detection of recurrence or metastasis after surgical treatment in patients with differentiated thyroid carcinoma. Materials and Methods: One hundred and twenty-eight patients with differentiated thyroid carcinoma, who had previously undergone neck operation, were evaluated with FDG PET/CT and US. The two studies were performed within 3 months of each other. Diagnosis of recurrence or metastasis was based on histological results. The results of FDG PET/CT and US were analyzed and sensitivity and specificity values were calculated statistically. Results: Recurrence or metastasis occurred in 40 out of 128 patients. Thirty-one patients were detected in both FDG PET/CT and US. Eight patients were detected only in US. One patient who had high SUV on FDG PET/CT was not detected by US due to its location which was just posterior to thyroid cartilage. The sensitivity, specificity, accuracy, positive, and negative predictive values of FDG PET/CT were 80%, 82%, 82%, 68%, and 90%, respectively. Whereas, those of US were 97%, 85%, 89%, 75%, and 99%. US-guided percutaneous needle aspiration was performed in 57 recurrent or metastatic lesions of 37 patients. Twenty-eight lesions of 57 recurrences or metastasis occurred in level VI. Conclusion: In our study, US of neck proved to be more accurate than FDG PET/CT. To detect recurrent or metastatic disease after surgical treatment in patients with differentiated thyroid carcinoma, US of neck is a better screening modality.
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1486 Evaluation of the Role of Thyroid Ultrasonography and Fine Needle Aspiration Cytology for the Diagnosis of Thyroid Cancers in 38,848 Patients at a Single Medical Center Jen-Der Lin, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Bie Yu Bie Yu, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Chuen Hsuen, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Jeng-Yeou Chen, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Miaw-Jene Liou, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Tzu-Chieh Chao, Chang Gung Memorial Hospital, Chang Gung University, Taiwan The combined use of thyroid ultrasonography with fine-needle aspiration cytology (FNAC) is an effective and economical tool for the diagnosis of thyroid nodules. Objective: To realize the contribution of thyroid ultrasound with FNAC including decreased thyroid cancer tumor size underwent surgical treatment, increasing ratio of papillary thyroid microcarcinoma. Methods: Retrospectively review the data during the period between 1986 and 2007, a total of 38,848 patients underwent thyroid ultrasonography with FNAC in the Chang Gung Medical Center, Linkou, Taiwan. At the end of 2007, approximately 6,754 patients including 5,552 women (mean age 43.39 ⫾ 14.03 years) and 1,202 men (mean age 46.59 ⫾ 15.23 years) developed thyroid nodules (17.39%) underwent surgery. Results: The percentage of patients who underwent surgical treatment decreased from 23.8% to 11.5%. Of the 6,754 operative cases, lesions in the case of 1,549 patients (22.93%) were histologically proved to be thyroid cancer. The percentage of thyroid cancers in surgically treated cases increased from 18.52% to 27.51%. Among the thyroid cancer patients, follicular thyroid cancers were detected in 157 patients (10.14%). The incidence of follicular thyroid cancer among all the thyroid cancer patients decreased from 15.79% to 7.30%. The mean tumor size of thyroid cancer decreased from 3.60⫾2.38 cm to 2.37⫾1.69 cm, and the percentage of papillary thyroid microcarcinomas in thyroid cancer increased from 8.06% to 22.94%. Conclusions: This study illustrated that the application of thyroid ultrasound with FNAC could decrease number of patients who underwent unnecessary surgery by facilitating the early detection of thyroid cancers. 1487 Ultrasound Appearances of Malignant Lymphoma of the Thyroid Tsukasa Murakami, Noguchi Thyroid Clinic and Hospital Foundation, Japan Hitoshi Noguchi, Noguchi Thyroid Clinic and Hospital Foundation, Japan Nobuhiro Nakatake, Noguchi Thyroid Clinic and Hospital Foundation, Japan Seigo Tachibana, Noguchi Thyroid Clinic and Hospital Foundation, Japan Shiro Noguchi, Noguchi Thyroid Clinic and Hospital Foundation, Japan Objectives: Ultrasound findings of primary malignant lymphoma of the thyroid were investigated among consecutive patients in a single thyroid disease center.
Ultrasound in Medicine and Biology
1480 The Reproducibility of the VOCAL Program for Evaluating 3D Power Doppler Ultrasonography of Thyroid Nodules Shyh-Ching Chiou, Da Chien General Hospital; China Medical University Hospital, Taiwan Pao-Tsai Yeh, Da Chien General Hospital, Taiwan Jen-Der Lin, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Wu-Huei Hsu, China Medical University Hospital, Taiwan Ching-Chu Chen, China Medical University Hospital, Taiwan Min-Huang Hsieh, China Medical University Hospital, Taiwan Wei-Lun Haung, China Medical University Hospital, Taiwan Long-Bin Jeng, China Medical University Hospital, Taiwan Aim: The aim of this study was to evaluate the inter-examinational, intra-observer and inter-observer reproducibility of three dimensional (3D) power Doppler ultrasonography (US) with the virtual organ computer-aided analysis (VOCAL) program for measuring thyroid volume, mean gray value (MG) and vascular indices in patients with thyroid nodules. Patients and Methods: Patients had thyroid nodules with diameters range form 0.5 to 3 cm, clear margin and scanty cystic part, without history of thyroidectomy, were examined by 3DUS (V730, GE) from March 2008 to June 2008. The thyroid volume, MG and vascular indices: vascularization index (VI), flow index (FI), vascularization– flow index (VFI) were obtained from the VOCAL program. Interexaminational reproducibility intra-observer and inter-observer reproducibility were presented as inter-examinational-class correlation coefficient (inter-examin-CC), intra-class correlation coefficient (intraCC) and inter-class correlation coefficient (inter-CC). Values greater than 0.70 were considered as acceptable. Results: Totally 38 patients with 44 nodules were included. Twenty nodules were examined with two times’ 3DUS examination. The values of inter-examin-CC of volume, MG, VI, VFI were larger than 0.9323; otherwise, FI was 0.8162 with wide 95% CI 0.5984-0.9224. For evaluating total 44 thyroid nodules, thyroid volume showed excellent intra-observer and inter-observer reproducibility (intra-CC⬎ 0.9677 and inter-CC: 0.8533). MG, VI and VFI also showed excellent reproducibility (intra-CC ⬎ 0.9921 and inter-CC ⬎ 0.9592). The values of intra-CC of FI were larger than 0.8983 but small inter-CC value (0.5112). Conclusion: Base on this study, 3DUS with the VOCAL program is a reproducible tool, except FI, for evaluating thyroid nodules. 1481 Clinical Evaluation of Elastography for the Differential Diagnosis of Thyroid Follicular Tumors Nobuhiro Fukunari, Showa University Yokohama Northern Hospital, Japan Kazushige Arai, Showa University Yokohama Northern Hospital, Japan Akio Naakamura, Showa University Yokohama Northern Hospital, Japan Tomomi Yamazaki, Showa University Yokohama Northern Hospital, Japan Satoshi Sakaue, Showa University Yokohama Northern Hospital, Japan Kenji Nakano, Showa University Yokohama Northern Hospital, Japan Purpose: The diagnosis and management of follicular cancer of the thyroid gland remains a controversial topic. The aim of this study was to evaluate the clinical usefulness of Elastography imaging for the differential diagnosis of thyroid follicular lesions.
Volume 35, Number 8S, 2009 Methods and Materials: 133 follicular tumors were examined by Elastography. Papillary cancers, other types thyroid malignancies or hot nodules were excluded from this study. The images of thyroid follicular lesions were recognized as four typical patterns as follows: Pattern 1(P1): nodule is relatively homogenous and colored with light green. Pattern 2(P2): the center of nodule is colored with green and its periphery is colored with blue. Pattern 3(P3): nodule is mixed-colored with light green and red. Pattern 4(P4): the whole tumor is displayed in blue. Results: All the follicular tumors were surgically and histopathologically diagnosed finally. In this series, 58 hyperplastic nodules, 33 follicular adenomas and 42 follicular cancers (28 Minimally invasive, 14 Widely invasive) were found. Of the 42 follicular cancers, 31 cases were P2, which was occupied 73.8%. Assuming Pattern 2 to be malignant and others to be benign, 87 of 91 benign tumors and 31 of 42 follicular cancers were accurately diagnosed, yielding a sensitivity of 78.8%, a specificity of 95.6%, and an accuracy of 90.2%. Conclusion: Elastography can provide new useful information for the differential diagnosis of thyroid follicular tumors and has a capability to improve the diagnostic specificity and accuracy than that of our former studies of color-Doppler examination. 1482 Clinical Application of 3D Color Energy Mapping in Thyroid Nodules Quan Jiang, Pudong New District Hospital, China Ye Ning Bai, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Hua Yu Zhao, Pudong New District Hospital, China Yuan Zhang, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Objective: To explore the clinical application of 3-D color energy(3CDE)mapping in the diagnosis of the thyroid nodules. Methods: A total of 62 thyroid nodules in 56 patients were detected on 3 CDE mapping.The ultrasonic data were compared with results of surgery and pathology. Results: The mapping of thyroid nodules had high reproducibility.Benign and malignant thyroid nodules has their own characteristics.About 73.3%(11/15)of malignant thyroid nodules displayed dilatated,distorted and irregular distributed vessels.In benign nodules the cyst or cystic solid noudles showed that the vessels distributed surrounding the mass,and the substantial nodules showed thin,regular vessels arranged from outside toward the inner.All the two types counted to 87.2%(41/ 47).Therefor,significant difference was present as benign nodules VS malignant(P⬍0.05). Conclusions: 3CDE provided directviewing and thyroid nodular morphology,and 3CDE nodular mapping can display the vessel structure. The relationship with adjacent tissue and distribution of vessels may also help confirm new vessels of thyroid nodules.3CDE mapping is a new method for analysing tumor characterisitcs. 1483 Application of 2D and 3D Ultrasonography in the Diagnosis of Thyroid Nodules Quan Jiang, Pudong New District Hospital, China Yuan Zhang, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Ying Wan Zhang, Department of Ultrasound, Pudong New District Hospital, Shanghai, China Objective: To apply two-dimensional and 3D ultrasonography were performed in 56 patients with 62 thyroid nodules. The results were compared with those of operation and pathology.
Abstracts Results: Images of 3D ultrasonography provided relationship between nodules and adjacent tissue rapidly. Benign solid nodules of thyroid showed a complete hyperechogenic interface, and 88.9% nodules showed regular halo. There were nodules extending to carotid presented to be malignancy. Solid cystic nodules in thyroid were benign mostly (92.6%), and malignant mixed echogenic nodules presented irregular surface. Conclusion: Three-dimensional ultrasonography extends the view of two-dimensional ultrasonography and provides direct stereo morphologic features and is a new imaging modality for thyroid diseases. 1484 Application of 2D Color Doppler Ultrasonography in Diagnosis of Thyroid Diseases Quan Jiang, Pudong New District Hospital, China Cheng Yu Xu, Department of Ultrasound, Pudong New District Hospital, Shanghai 201200, China, China Objective: To explore the diagnosis and differential diagnosis value of ultrasongraphy in patients with thyroid diseases. Methods: Twenty cases with normal thyroid and ninety-eight cases with thyroid diseases were examined with two dimensional color Doppler ultrasonography. Results: Different thyroid diseases have their own some unique characteristics. Conclusion: Comprehensive evaluation of different available sonarographical methods can increase greatly accuracy in diagnosing thyroid diseases. 1485 Which Study is More Accurate, FDG PET/CT or Ultrasonography? Detection of Metastasis or Recurrence After Surgical Treatment in Patients with Differentiated Thyroid Carcinoma Jae-Hwan Kim, Korea Cancer Center Hospital, Korea Tae-Hyun Lee, Korea Cancer Center Hospital, Korea Young-Joo Chung, Korea Cancer Center Hospital, Korea Kie-Hwan Kim, Korea Cancer Center Hospital, Korea Purpose: To compare the accuracy of FDG PET/CT and ultrasonography (US) for detection of recurrence or metastasis after surgical treatment in patients with differentiated thyroid carcinoma. Materials and Methods: One hundred and twenty-eight patients with differentiated thyroid carcinoma, who had previously undergone neck operation, were evaluated with FDG PET/CT and US. The two studies were performed within 3 months of each other. Diagnosis of recurrence or metastasis was based on histological results. The results of FDG PET/CT and US were analyzed and sensitivity and specificity values were calculated statistically. Results: Recurrence or metastasis occurred in 40 out of 128 patients. Thirty-one patients were detected in both FDG PET/CT and US. Eight patients were detected only in US. One patient who had high SUV on FDG PET/CT was not detected by US due to its location which was just posterior to thyroid cartilage. The sensitivity, specificity, accuracy, positive, and negative predictive values of FDG PET/CT were 80%, 82%, 82%, 68%, and 90%, respectively. Whereas, those of US were 97%, 85%, 89%, 75%, and 99%. US-guided percutaneous needle aspiration was performed in 57 recurrent or metastatic lesions of 37 patients. Twenty-eight lesions of 57 recurrences or metastasis occurred in level VI. Conclusion: In our study, US of neck proved to be more accurate than FDG PET/CT. To detect recurrent or metastatic disease after surgical treatment in patients with differentiated thyroid carcinoma, US of neck is a better screening modality.
S231
1486 Evaluation of the Role of Thyroid Ultrasonography and Fine Needle Aspiration Cytology for the Diagnosis of Thyroid Cancers in 38,848 Patients at a Single Medical Center Jen-Der Lin, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Bie Yu Bie Yu, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Chuen Hsuen, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Jeng-Yeou Chen, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Miaw-Jene Liou, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Tzu-Chieh Chao, Chang Gung Memorial Hospital, Chang Gung University, Taiwan The combined use of thyroid ultrasonography with fine-needle aspiration cytology (FNAC) is an effective and economical tool for the diagnosis of thyroid nodules. Objective: To realize the contribution of thyroid ultrasound with FNAC including decreased thyroid cancer tumor size underwent surgical treatment, increasing ratio of papillary thyroid microcarcinoma. Methods: Retrospectively review the data during the period between 1986 and 2007, a total of 38,848 patients underwent thyroid ultrasonography with FNAC in the Chang Gung Medical Center, Linkou, Taiwan. At the end of 2007, approximately 6,754 patients including 5,552 women (mean age 43.39 ⫾ 14.03 years) and 1,202 men (mean age 46.59 ⫾ 15.23 years) developed thyroid nodules (17.39%) underwent surgery. Results: The percentage of patients who underwent surgical treatment decreased from 23.8% to 11.5%. Of the 6,754 operative cases, lesions in the case of 1,549 patients (22.93%) were histologically proved to be thyroid cancer. The percentage of thyroid cancers in surgically treated cases increased from 18.52% to 27.51%. Among the thyroid cancer patients, follicular thyroid cancers were detected in 157 patients (10.14%). The incidence of follicular thyroid cancer among all the thyroid cancer patients decreased from 15.79% to 7.30%. The mean tumor size of thyroid cancer decreased from 3.60⫾2.38 cm to 2.37⫾1.69 cm, and the percentage of papillary thyroid microcarcinomas in thyroid cancer increased from 8.06% to 22.94%. Conclusions: This study illustrated that the application of thyroid ultrasound with FNAC could decrease number of patients who underwent unnecessary surgery by facilitating the early detection of thyroid cancers. 1487 Ultrasound Appearances of Malignant Lymphoma of the Thyroid Tsukasa Murakami, Noguchi Thyroid Clinic and Hospital Foundation, Japan Hitoshi Noguchi, Noguchi Thyroid Clinic and Hospital Foundation, Japan Nobuhiro Nakatake, Noguchi Thyroid Clinic and Hospital Foundation, Japan Seigo Tachibana, Noguchi Thyroid Clinic and Hospital Foundation, Japan Shiro Noguchi, Noguchi Thyroid Clinic and Hospital Foundation, Japan Objectives: Ultrasound findings of primary malignant lymphoma of the thyroid were investigated among consecutive patients in a single thyroid disease center.