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Elsheikh TM, Thomas M, Brainard J, Di Marco J, Manosky E, Springer B, Underwood D, Chute DJ. Papillae, psammoma bodies, and/or many nuclear pseudoinclusions are helpful criteria but should not be required for a definitive cytologic diagnosis of papillary thyroid carcinoma: An institutional experience of 207 cases with surgical follow up. Cancer Cytopathol 2024. [PMID: 38563725 DOI: 10.1002/cncy.22817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Noninvasive follicular thyroid neoplasm with papillary-like features (NIFTP) was introduced in 2016 replacing noninvasive follicular variant of papillary thyroid carcinoma, with recommendations to label them "noncancer." To avoid reducing risk of malignancy (ROM) and overdiagnosing NIFTP as malignant, some authors required restricted cytologic criteria (RC) for a definitive diagnosis of papillary thyroid carcinoma (PTC), including papillae, psammoma bodies. or ≥3 nuclear pseudoinclusions. Since then, NIFTP criteria have been revised, biologic behavior better understood, and incidence reported to be much lower than initially anticipated. This study examines the impact of RC on PTC cytologic diagnoses, ROM, and detection of clinically significant carcinomas (CSC). MATERIALS AND METHODS A total of 207 thyroid FNAs originally diagnosed as PTC and suspicious for PTC (SPTC) with surgical follow-up were evaluated. RC were retrospectively applied to cases as a requirement for diagnosing PTC, and cases that did not meet RC were reclassified as SPTC. ROMs and diagnostic accuracies of pre- and post-RC diagnoses were correlated with followup CSC. RESULTS RC were met in 118/142 (83%) and 20/65 (31%) of cases originally diagnosed as PTC and SPTC, respectively. Post-RC, 29% (19/65) of CSC originally diagnosed as SPTC were upgraded to PTC, and 17% (24/142) of CSC originally diagnosed as PTC were downgraded to SPTC. No NIFTPs were diagnosed as malignant. CONCLUSIONS RC should not be required for a definitive diagnosis of PTC when other nuclear features of PTC are diffuse and overt. Applying RC, however, helps the pathologist arrive at a more definitive diagnosis of PTC in suspicious cases.
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Affiliation(s)
- Tarik M Elsheikh
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Thomas
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer Brainard
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica Di Marco
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erica Manosky
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bridgette Springer
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dawn Underwood
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah J Chute
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Mahjabin F, Gonsalves C, Drew PA, Mukhtar F, Leon ME. Understanding and Overcoming the Pitfalls in Cytopathological Diagnosis of Hyalinizing Trabecular Tumor of Thyroid. Int J Surg Pathol 2024; 32:91-96. [PMID: 37050854 DOI: 10.1177/10668969231166295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Hyalinizing trabecular tumor (HTT), a rare low-malignant-potential thyroid neoplasm, is usually treated with conservative surgery. However, cytomorphological diagnosis of HTT is challenging due to the significant overlap of nuclear features with more common malignancies such as papillary thyroid carcinoma (PTC), which usually requires more radical surgical intervention. To avoid unnecessary overtreatment, a precise diagnosis of HTT is therefore essential. Advances in molecular diagnostics provide the opportunity to overcome the limitations of cytological analysis. We present a case of HTT in a 71-year-old male who was initially suspected to be PTC based on cytopathology. However, further molecular analysis revealed PAX8::GLIS3 gene fusion, classifying the lesion as HTT and preventing surgical overtreatment. We discuss the diagnostic pitfall of cytopathology in HTT and suggest using emerging molecular genetic tools to avoid it.
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Affiliation(s)
- Fnu Mahjabin
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine Gonsalves
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Peter A Drew
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Faisal Mukhtar
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Marino E Leon
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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Xiong XJ, Xiao MM, Zhang YX, Liu DG, Jin ML, Wang J, Xu HT, Li QC, Wu GP. The Accurate Interpretation and Clinical Significance of Morphological Features of Fine Needle Aspiration Cells in Papillary Thyroid Carcinoma. Anal Cell Pathol (Amst) 2023; 2023:9397755. [PMID: 37181946 PMCID: PMC10171979 DOI: 10.1155/2023/9397755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/01/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid gland; fine needle aspiration cytology is the most basic and reliable diagnostic method before PTC operation. However, it is not clear which cell morphological changes can be used as a reliable standard for the diagnosis of PTC. A retrospective analysis was performed on 337 patients with PTC confirmed by postoperative histology. An additional 197 randomly selected patients with benign thyroid lesions were included in the study and used as a control group. True papillary arrangements, swirl arrangements, and escape arrangements had high specificity, all of which were 100%, but only swirl arrangements had ideal sensitivity (77.61%). The nuclear volume characteristics had a high sensitivity of more than 90%, but the specificities of both nuclear crowding and nuclear overlap were too low, only 16.34% and 23.35%. The sensitivities of five nuclear structural characteristics were more than 90%, but only the specificity of intranuclear cytoplasmic pseudoinclusions (INCIs) reached 100%, nuclear contour irregularity and pale nuclei with powdery chromatin also had ideal interpretation value except for grooves and marginally placed micronucleoli. Although the sensitivity of psammoma bodies (PBs) was low, the specificity was 100%. In terms of preparation methods, the method of liquid-based preparation (LBP) is obviously better than that of conventional smears. The diagnostic efficiency by the combined detection method of parallel tests showed that without reducing the specificity, the sensitivity increased with the increase of the number of morphological characteristics and finally reached 98.81%. The INCIs and swirl arrangements are the most common and important indicators for the diagnosis of PTC, whereas papillary-like arrangements, the crowding and overlap of nuclear, grooves, marginally placed micronucleoli, and multinucleated giant cells are of little significance for the diagnosis of PTC.
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Affiliation(s)
- Xue-Jiao Xiong
- Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Ming-Ming Xiao
- Department of Pathology, The People's Hospital of Liaoning Province, Shenyang 110016, China
| | - Yi-Xia Zhang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang 110001, China
| | - Dong-Ge Liu
- Department of Pathology, Beijing Hospital, National Geriatric Center, Beijing 100730, China
| | - Mu-Lan Jin
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Jian Wang
- Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Hong-Tao Xu
- Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Qing-Chang Li
- Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Guang-Ping Wu
- Department of Pathology, The First Hospital of China Medical University, Shenyang 110001, China
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Amita K, Rakshitha HB, Sanjay M, Kalappa P. Cytological Features of "Non-Invasive Follicular Tumour with Papillary like Nuclear Features" - A Single Institutional Experience in India. J Cytol 2023; 40:28-34. [PMID: 37179965 PMCID: PMC10167831 DOI: 10.4103/joc.joc_192_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 10/17/2022] [Accepted: 02/01/2023] [Indexed: 05/15/2023] Open
Abstract
Background The term noninvasive follicular tumor with papillary-like nuclear features (NIFTP) was introduced as a surrogate for noninvasive encapsulated follicular variant of papillary thyroid carcinoma with a defined set of histopathologic criteria. There are very few studies depicting the cytological cues for the diagnosis of NIFTP. The objective of the study was to determine the spectrum of cytological features in fine needle aspiration cytology (FNAC) smears of cases histopathologically diagnosed as NIFTP. Methods This was a retrospective cross-sectional study conducted over a duration of four years between January 2017 and December 2020. All surgically resected cases (n-21), who met the diagnostic criteria of NIFTP on histopathology and who underwent preoperative FNAC were included and reviewed in the study. Results Out of a total of 21 cases, at FNAC, diagnosis of benign, suspicious for malignancy, follicular variant of papillary thyroid carcinoma, and classic papillary thyroid carcinoma (PTC) was rendered in 14 (66.6%), 2 (9.5%), 2 (9.5%), and 3 (14.28%), respectively. Scanty cellularity was noted in 12 (57.1%) cases. Papillae, sheets, and microfollicles were seen in 1 (4.7%), 10 (47.6%), and 13 (61.9%) cases, respectively. Nucleomegaly, nuclear membrane irregularities, nuclear crowding, and overlapping were seen in 7 (33.3%), 9 (42.8%), and 9 (42.8%), respectively. Nucleoli, nuclear grooving, and inclusions were seen in 3 (14.2%) 10 (47.6%), and 5 (23.8%) cases, respectively. Conclusion At FNAC, NIFTP can be found in every category of The Bethesda System for Reporting Thyroid cytopathology (TBSRTC). Nuclear membrane irregularities, nuclear grooving, mild nuclear crowding, and overlapping were noted in a modest number of cases. However, the absence or rare occurrence of features such as papillae, inclusions, nucleoli, and metaplastic cytoplasm may help prevent an overdiagnosis of malignancy.
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Affiliation(s)
- K Amita
- Professor, Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
| | - HB Rakshitha
- Associate Professor, Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
| | - M Sanjay
- Associate Professor, Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
| | - Prashantha Kalappa
- Professor, Centre for Research and Innovation, Department of Chemistry, Adichunchanagiri School of Natural Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
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Sabán M, Tolaba N, Orlandi AM, Deutsch S, Pitoia F, Lowenstein A, Calabrese MC, Cavallo A, Iotti A, Monteros Alvi M, Nallar M, Jaén A, Figurelli S, Carrizo F, Colobraro A, García Tascón G, Saccoliti M, Paes de Lima A, Lencioni M, Califano I, Cabezón C. Non-invasive follicular neoplasm with papillary-like nuclear features: a challenging and infrequent entity in Argentina. Endocrine 2022; 77:493-499. [PMID: 35799079 DOI: 10.1007/s12020-022-03115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/12/2022] [Indexed: 04/17/2023]
Abstract
PURPOSE Non-invasive encapsulated follicular variant of papillary thyroid cancer was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). These neoplasms have an extremely low malignant potential. The aim of this study was (1) to assess the prevalence of NIFTP in patients with papillary thyroid carcinoma, (2) to evaluate their outcomes, and (3) to determine their molecular profile. METHODS Multicenter, descriptive, retrospective study. Patients with papillary thyroid cancer diagnosed from January 2006 to December 2016 from 11 referral centers were included. Diagnosis of NIFTP was based on criteria described by Nikiforov et al. in 2018. At least two pathologists agreed on the diagnosis. Two thousand six hundred and seventy-seven papillary thyroid cancer patients were included; 456 (17%) of them were follicular variant papillary thyroid cancer, and 30 (1.12%) fulfilled diagnostic criteria for NIFTP. RESULTS Each of the 30 included patients underwent a total thyroidectomy, and 50% were treated with radioiodine (median dose 100 mCi). After a median follow-up of 37 months, 84% of patients had an excellent response, 3% had an indeterminate response and data was missing in the remaining 13%. No metastatic lymph nodes, distant metastases or recurrences were found. RAS mutations were detected in 4 patients (13%). CONCLUSION The prevalence of NIFTP in our series is amongst the lowest reported. Excellent outcomes of patients underscore their low malignant potential. Molecular findings differ from other series, probably related to environmental or ethnic features of our population and the meticulous criteria for diagnosing NIFTP.
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Affiliation(s)
| | | | | | | | - Fabián Pitoia
- Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | | | | | | | | | | | | | - Ana Jaén
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Inés Califano
- Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Carmen Cabezón
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Wong KS, Barletta JA. The new endocrine WHO classification: What does this mean for thyroid cytology? Cancer Cytopathol 2022; 130:658-662. [PMID: 35969231 DOI: 10.1002/cncy.22634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
The new World Health Organization classification of endocrine tumors will include many updates on thyroid pathology. This summary highlights the changes that are most relevant for cytopathologists.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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7
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Roberts JW, Lubin DJ, Shi Q, Viswanathan K. Cytomorphologic features of thyroid nodules harboring thyroid adenoma‐associated fusion: A single institutional review of 11 cases. Diagn Cytopathol 2022; 50:327-334. [DOI: 10.1002/dc.24958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022]
Affiliation(s)
- James W. Roberts
- Department of Pathology and Laboratory Medicine Emory University Hospital Midtown Atlanta Georgia USA
| | - Daniel J. Lubin
- Department of Pathology and Laboratory Medicine Emory University Hospital Midtown Atlanta Georgia USA
| | - Qiuying Shi
- Department of Pathology and Laboratory Medicine Emory University Hospital Midtown Atlanta Georgia USA
| | - Kartik Viswanathan
- Department of Pathology and Laboratory Medicine Emory University Hospital Midtown Atlanta Georgia USA
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8
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Seok JY, Fan X. TROP-2 and 5hmC expression in follicular-patterned thyroid neoplasm emphasizing tiny well-formed papillae. Ann Diagn Pathol 2022; 57:151903. [PMID: 35121239 DOI: 10.1016/j.anndiagpath.2022.151903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Follicular-patterned thyroid neoplasms (FPTNs), characterized by predominantly follicular growth pattern, represent diverse pathological entities. We aimed to study the nuclear features and the immunoexpression of trophoblast cell-surface antigen 2 (TROP-2) and 5-hydroxymethylcytosine (5hmC) in FPTNs. DESIGN FPTNs were divided into 4 groups: I) noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), II) encapsulated follicular variant of papillary thyroid carcinoma (FVPTC) with capsular invasion, III) infiltrative FVPTC, and IV) PTC with a predominantly follicular pattern and well-formed papillae (<1%). Nuclear characteristics were evaluated by image analysis. TROP-2 and 5hmC immunostains were analyzed correlating with histological features using QuPath. RESULTS From the group I to II, III, and IV, there is a gradual increase in nuclear atypia in terms of the nuclear area, max caliper, perimeter, circularity, and hematoxylin OD means (corresponding to nuclear enlargement, membrane irregularity, and clearing). A similar trend is observed in the TROP-2 expression. 5hmC expression is highly preserved in groups I, II, and III in contrast to a significant loss in group IV. Group IV tumors show more frequent regional lymph node involvement and the highest BRAF V600E mutation rate. CONCLUSION Among FPTNs, group IV tumors exhibit the most advanced nuclear atypia, highest TROP-2 expression, significant 5HMC expression loss, frequent regional lymph node involvement, and the highest BRAF V600E mutation rate. Our data further support that the presence of any true papillae should be an exclusion criterion for NIFTP. Therefore, well-formed papillae even if very minute (<1% of the tumor) should not be overlooked.
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Affiliation(s)
- Jae Yeon Seok
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea; Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xuemo Fan
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Kholová I, Haaga E, Ludvik J, Kalfert D, Ludvikova M. Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP): Tumour Entity with a Short History. A Review on Challenges in Our Microscopes, Molecular and Ultrasonographic Profile. Diagnostics (Basel) 2022; 12:diagnostics12020250. [PMID: 35204341 PMCID: PMC8871310 DOI: 10.3390/diagnostics12020250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
Since Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) was introduced as a new thyroid tumour entity, many studies, and meta-analyses on diagnosing NIFTP have been published. NIFTP-revised histopathological criteria emerged in 2018. NIFTP is defined as a histological entity and its diagnosis requires a careful histological examination. Its molecular profile is similar to follicular-like tumours. Ultrasound features are unable to differentiate NIFTP. NIFTP is not a cytological diagnosis, but it influences the risk of malignancy in several categories of The Bethesda System for Reporting Thyroid Cytopathology terminology.
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Affiliation(s)
- Ivana Kholová
- Pathology, Fimlab Laboratories, Arvo Ylpön Katu 4, 33520 Tampere, Finland;
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Correspondence: ; Tel.: +358-3-311-74851
| | - Elina Haaga
- Pathology, Fimlab Laboratories, Arvo Ylpön Katu 4, 33520 Tampere, Finland;
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
| | - Jaroslav Ludvik
- Department of Imaging Methods, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 30460 Pilsen, Czech Republic;
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic;
| | - Marie Ludvikova
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic;
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Al-Maghrabi H, Tashkandi M, Khayyat W, Alghamdi A, Alsalmi M, Alzahrani A, Al-Hakami H, Alqarni M. Non-invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) lowers the risk of malignancy in the bethesda system for reporting thyroid cytopathology diagnostic categories. Saudi J Med Med Sci 2022; 10:105-110. [PMID: 35602399 PMCID: PMC9121695 DOI: 10.4103/sjmms.sjmms_202_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/25/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The introduction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been shown to decrease the risk of malignancy (ROM) in The Bethesda System for Reporting Thyroid Cytopathology. This knowledge may alter the management of patients with thyroid nodules. Objectives: To correlate cytological diagnosis with histological diagnosis for establishing the ROM of all Bethesda system categories after the introduction of NIFTP. Methods: This was a retrospective cohort study. All consecutive fine-needle aspiration cytology (FNAC) specimens collected from January 1, 2013, to December 31, 2017, at King Abdullah Medical City, Jeddah, Saudi Arabia, were assessed, and patients who underwent surgical excision of thyroid nodules were further analyzed. The ROM and overall ROM for each Bethesda category were calculated with and without considering NIFTP as a malignant tumor. Results: Overall, 1066 FNAC specimens were collected, of which 281 had a surgical correlation. Our cases included 18 (6.4%) non-diagnostic (ND), 109 (38.8%) benign, 28 (9.9%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 39 (13.8%) follicular neoplasm or suspicion for follicular neoplasm (FN/SFN), 20 (7.1%) suspicion for malignancy (SM), and 67 (23.8%) malignant (POM) cases. After considering NIFTP diagnosis on resection specimens, the ROM decreased as follows: ND, 38.8% to 27.7% (P = 0.2388); benign, 21.1% to 11.9% (P = 0.0343); AUS/FLUS, 50% to 39.2% (P = 0.2089); FN/SFN, 53.8% to 33.3% (P = 0.0336); SM, 85% to 75% (P = 0.2147); POM, 95.5% to 88% (P = 0.0582). Conclusion: The introduction of NIFTP would significantly decrease the ROM of thyroid FNAC in both benign and FN/SFN categories of the Bethesda system.
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Haaga E, Kalfert D, Ludvíková M, Kholová I. Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis. Acta Cytol 2021; 66:85-105. [PMID: 34781293 DOI: 10.1159/000519757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A low-risk thyroid tumour, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced in 2016. NIFTP criteria require a thorough histological examination to rule out capsular and lymphovascular invasion, which denies the possibility of preoperative cytological diagnosis. Nevertheless, since the adoption of the new entity, the cytology of NIFTP has been a subject of interest. OBJECTIVES The present systematic review and meta-analysis investigate the cytological diagnosis of NIFTP. METHOD An online PubMed literature search was conducted between March 1, 2020, and June 30, 2020, for all original articles considering the cytology of histologically proven NIFTP. The studies including data on fine needle aspiration specimens classified by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) categories, risk of malignancy (ROMs) in the TBSRTC categories, and cytomorphological features of NIFTP were included in the meta-analysis. Non-English studies and case reports were excluded. The data were tabulated and statistical analysis was performed with Open Meta-Analyst program. RESULTS Fifty-eight studies with a total of 2,553 NIFTP cases were included in the study. The pooled prevalence of NIFTP cases was calculated among 25,892 surgically resected cases from 20 studies and the results show that NIFTP consisted 4.4% (95% confidence interval [CI]: 3.5-5.4%) of all cases. Most of the NIFTP cases (79.0%) belonged to the intermediate categories of TBSRTC. The pooled distribution of NIFTP cases in each TBSRTC category was 1.3% (95% CI: 0.8-1.7%) in non-diagnostic (ND), 8.9% (95% CI: 6.9-10.8%) in benign, 29.2% (95% CI: 25.0-33.4%) in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 24.2% (95% CI: 19.6-28.9%) in follicular neoplasm (FN), 19.5% (95% CI: 16.1-22.9%) in suspicious for malignancy (SM), and 6.9% (95% CI: 5.2-8.7%) in malignant. Compared to pre-NIFTP era, the pooled risk differences of ROM were reduced by 2.4% in ND, 2.7% in benign, 8.2% in AUS/FLUS, 8.2% in FN, 7.3% in SM, and 1.1% in the malignant category. The cytomorphological features of NIFTP were similar to follicular variant of papillary thyroid carcinoma (FVPTC) but lesser to papillary thyroid carcinoma (PTC). CONCLUSIONS Based on our results, NIFTP remains a histological diagnosis. Although cytomorphological features cannot be used in differentiating NIFTP from FVPTC, they may guide in separating NIFTP from PTC. Features such as papillae, microfollicles, giant cells, psammoma bodies, and the amount of papillary-like nuclear features should be taken into account when suspicious of NIFTP. NIFTP should not have papillae or psammoma bodies, and giant cells were rarely observed.
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Affiliation(s)
- Elina Haaga
- Pathology, Fimlab Laboratories, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czechia
| | - Marie Ludvíková
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
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Higgins S, James BC, Sacks B, Mowschenson P, Nishino M, Hasselgren PO. Can Cytologic and Sonographic Features Help Prevent Overtreatment of Bethesda V Thyroid Nodules? J Surg Res 2021; 268:112-118. [PMID: 34298210 DOI: 10.1016/j.jss.2021.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 05/10/2021] [Accepted: 05/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although nearly half of thyroid nodules with Bethesda V cytology (suspicious for malignancy) may be benign or harbor low-grade neoplasms that can be sufficiently treated with lobectomy, many patients with Bethesda V cytology continue to be treated with total thyroidectomy. The objectives of this study were to establish whether cytomorphologic and ultrasonographic features can determine appropriate surgery for thyroid nodules with Bethesda V cytology and how often patients are overtreated with total instead of partial thyroidectomy. METHODS Utilizing a 10-y prospective database starting January 1, 2004, cytomorphologic and ultrasonographic features of thyroid nodules with Bethesda V cytology were reviewed. Overtreatment was defined as total thyroidectomy when histopathology revealed benign nodule, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) or a unilateral < 4 cm low risk cancer. RESULTS Sixty-three patients were included in the study. Seventeen (27%) had benign, 14 (22%) NIFTP, and 32 (51%) malignant nodules. On cytology, nuclear pseudoinclusions, and on ultrasound, taller-than-wide configuration, were more common in malignant than benign or NIFTP nodules. Among 56 patients who underwent total thyroidectomy, 14 and 11 had a benign or NIFTP nodule, respectively, and 13 had a unilateral < 4 cm low risk cancer, suggesting that 68% (38/56) were overtreated. CONCLUSIONS Total thyroidectomy for Bethesda V thyroid nodules may result in overtreatment in more than half of the patients. Although certain cytomorphologic and ultarsonographic features may be helpful in determining appropriate surgery for Bethesda V thyroid nodules, additional characteristics are needed to reduce overtreatment of these nodules.
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Affiliation(s)
- Sara Higgins
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Benjamin C James
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Barry Sacks
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Peter Mowschenson
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Per-Olof Hasselgren
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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13
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Bai Y, Kakudo K, Jung CK. Updates in the Pathologic Classification of Thyroid Neoplasms: A Review of the World Health Organization Classification. Endocrinol Metab (Seoul) 2020; 35:696-715. [PMID: 33261309 PMCID: PMC7803616 DOI: 10.3803/enm.2020.807] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
Advances in medical sciences and evidence-based medicine have led to momentous changes in classification and management of thyroid neoplasms. Much progress has been made toward avoiding overdiagnosis and overtreatment of thyroid cancers. The new 2017 World Health Organization (WHO) classification of thyroid neoplasms updated the diagnostic criteria and molecular and genetic characteristics reflecting the biology and behavior of the tumors, and newly introduced the category of borderline malignancy or uncertain malignant potential. Some neoplasms were subclassified, renamed, or redefined as a specific entity. This review introduces changes in the fourth edition WHO classification of thyroid tumors and updates the contemporary diagnosis and classification of thyroid tumors. We also discuss several challenges with the proposal of new diagnostic entities, since they have unique histopathologic and molecular features and clinical relevance.
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Affiliation(s)
- Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing,
China
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi,
Japan
- Department of Human Pathology, Wakayama Medical University, Graduate School of Medicine, Wakayama,
Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, The Catholic University of Korea, Seoul,
Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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14
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan.,Cytopathology Laboratory, Okamoto Thyroid Clinic, Osaka, Japan.,Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Japan.,Department of Human Pathology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
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15
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Piga I, Capitoli G, Clerici F, Brambilla V, Leni D, Scardilli M, Canini V, Cipriani N, Bono F, Valsecchi MG, Galimberti S, Magni F, Pagni F. Molecular trait of follicular-patterned thyroid neoplasms defined by MALDI-imaging. Biochim Biophys Acta Proteins Proteom 2020; 1868:140511. [PMID: 32750549 DOI: 10.1016/j.bbapap.2020.140511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
In the field of thyroid neoplasms, the most interesting recent change regards the introduction of a new terminology for follicular-patterned thyroid tumors, named Noninvasive Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP). This pre-malignant tumor is considered to be the putative precursor of invasive carcinoma. However, given that several issues are still unresolved, the application of ancillary tools, based on omics-techniques, may improve the clinical management of these challenging cases. The present paper highlights the proteomic profiles of a series of NIFTPs submitted to Fine Needle Aspirations (FNAs) and analysed by MALDI-imaging in order to confirm the heterogeneous phenotype of nodules included in the present NIFTP terminology and to underline the necessity of more accurate biomarkers that can be used for their characterization. Ethical and economic implications in terms of healthcare costs, operative risks, morbidity, as well as the potential need for lifelong hormone replacement therapy, seem to be significant reasons to approach the characterization of NIFTPs using alternative tools such as MALDI-MSI.
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Affiliation(s)
- Isabella Piga
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesca Clerici
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | | | - Davide Leni
- Radiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | | | - Valentina Canini
- Department of Medicine and surgery, UNIMIB, Pathology, Monza, Italy
| | - Nicole Cipriani
- Gross Pathology and Anatomic Pathology Informatics, University of Chicago, Chicago, USA
| | - Francesca Bono
- Department of Medicine and surgery, UNIMIB, Pathology, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fulvio Magni
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Fabio Pagni
- Department of Medicine and surgery, UNIMIB, Pathology, Monza, Italy.
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16
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Chu YH, Sadow PM. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): Diagnostic updates and molecular advances. Semin Diagn Pathol 2020; 37:213-218. [PMID: 32646613 DOI: 10.1053/j.semdp.2020.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022]
Abstract
The noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a strictly defined thyroid lesion, reclassified in 2016, in order to more accurately reflect the biological behavior of the tumor and thus, modify the way the lesion is clinically approached and perceived both by practitioners and patients. Additionally, this newly specified designation also allows for more uniformity in reporting for general pathologists less comfortable to exclude overt malignancy with certain nuclear features. In recent years, increasing molecular analyses correlated with longitudinal clinical outcomes have fostered improved diagnostic and treatment paradigms. Important revisions made to the definition of NIFTP in 2018 include the prohibition of any true papillae formation and the exclusion of lesions harboring the BRAF V600E mutation and other high-risk genetic abnormalities. These changes reflect the imperfection of the current criteria in outcome prediction and the global efforts for improvement. NIFTP are lesions with a wide range of size and cytomorphology. Although not addressed in the original series, large (≥4 cm) and oncocytic NIFTP have recently been shown to incur no recurrence or metastatic risk. Molecularly, NIFTP have a similar mutational profile as other follicular thyroid neoplasms, with frequent RAS family mutations and PAX8-PPARɤ fusions. However, the transcriptomic landscape is highly heterogenous, adding difficulty to gene expression-based cytopathologic classification. This review summarizes the evolution of the NIFTP concept and important advances in recent literature.
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Affiliation(s)
- Ying-Hsia Chu
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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17
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Katsakhyan L, Song S, Lepe M, Shojaei H, Montone KT, LiVolsi VA, Baloch ZW. Practice Paradigms Before and After Introduction of the Diagnosis-Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): an Institutional Experience. Endocr Pathol 2020; 31:174-181. [PMID: 32146581 DOI: 10.1007/s12022-020-09614-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The recently adopted terminology of "Noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) reflects the indolent behavior of these tumors. In contrast to conventional papillary thyroid carcinomas, NIFTP can be managed conservatively. The purpose of this study was to investigate changes in surgical and pathologic practice patterns at our institution since the introduction of the NIFTP diagnosis in 2016. A retrospective analysis of all thyroid specimens received in our laboratory between January 2015 and April 2017 was performed. The final cohort consisted of 1508 thyroidectomy specimens from 1508 patients (1153 (76.5%) women and 355 (23.5%) men), of which 1011 (67%) were total thyroidectomies and 497 (33%) were partial thyroidectomies. There were 558 (69.2%) total thyroidectomies and 248 (30.8%) partial thyroidectomies performed prior to introduction of the NIFTP diagnosis and 453 (64.5%) and 249 (35.5%) total and partial thyroidectomies, respectively, after the change in nomenclature. Within a year following the initial use of this diagnosis, 67 NIFTP cases were identified (9.5% of all thyroidectomies), whereas compared with the year preceding it, malignant diagnoses decreased from 54.5 (439) to 44.6% (313), and the benign category remained unchanged from 44.5 (367) to 45.9% (322). For the entirely submitted 67 NIFTP cases, the mean number of blocks submitted was 14.7 (0.98 blocks/g); for malignant lesions 17.7 (0.92 blocks/g); and for benign lesions 16.6 (0.75 blocks/g). The results of our study suggest that NIFTP are encountered in almost 10% of thyroidectomies at our institution with expected shifts in cytology and surgical pathology diagnoses as a result of the change in nomenclature. During this time period, significant shifts towards less aggressive surgical management were not observed. All 67 NIFTP nodules were submitted entirely with no significant difference in the number of cassettes submitted for NIFTP nodules as compared with follicular variant papillary thyroid carcinoma (PTC), classic variant PTC, or follicular adenoma.
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MESH Headings
- Adenocarcinoma, Follicular/classification
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Male
- Middle Aged
- Pathology, Surgical/standards
- Pathology, Surgical/statistics & numerical data
- Pathology, Surgical/trends
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Practice Patterns, Physicians'/trends
- Retrospective Studies
- Thyroid Cancer, Papillary/classification
- Thyroid Cancer, Papillary/surgery
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/surgery
- Thyroidectomy/statistics & numerical data
- Young Adult
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Affiliation(s)
- Levon Katsakhyan
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA.
| | - Sharon Song
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Marcos Lepe
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Hadi Shojaei
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Kathleen T Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
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18
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Zajkowska K, Kopczyński J, Góźdź S, Kowalska A. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity. Endocr Connect 2020; 9:EC-19-0566.R1. [PMID: 32061158 PMCID: PMC7077601 DOI: 10.1530/ec-19-0566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/12/2020] [Indexed: 01/14/2023]
Abstract
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a borderline thyroid tumour formerly known as noninvasive encapsulated follicular variant of papillary thyroid carcinoma. The prevalence of NIFTP is estimated at 4.4-9.1% of all papillary thyroid carcinomas worldwide; however, the rate of occurrence of NIFTP is eight times lower in Asian countries than in Western Europe and America. At the molecular level, NIFTP is characterised by the lack of BRAF V600E and BRAF V600E-like mutations or other high-risk mutations (TERT, TP53), and a high rate of RAS mutations, which is similar to other follicular-pattern thyroid tumours. The diagnosis of NIFTP can only be made after histological examination of the entire tumour removed during surgery, and is based on strictly defined inclusion and exclusion criteria. Although the diagnosis is postoperative, the combination of certain findings of preoperative tests including ultrasonography, cytology, and molecular testing may raise suspicion of NIFTP. These tumours can be effectively treated by lobectomy, although total thyroidectomy remains an option for some patients. Radioactive iodine and thyroid stimulating hormone suppression therapy are not required. NIFTP has an extremely good prognosis, even when treated conservatively with lobectomy alone. Nevertheless, it cannot be considered as a benign lesion. The risk of adverse outcomes, including lymph node and distant metastases, is low but not negligible.
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Affiliation(s)
| | | | - Stanisław Góźdź
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology, Holycross Cancer Centre, Kielce, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
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19
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Larouche V, Pusztaszeri MP, Filimon S, Payne R, Hier M, Tamilia M. Preoperative prediction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: a Canadian single-Centre experience. J Otolaryngol Head Neck Surg 2020; 49:1. [PMID: 31898554 PMCID: PMC6941342 DOI: 10.1186/s40463-019-0397-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background An international group of experts recommended reclassifying non-invasive follicular variant of papillary thyroid cancers (FVPTC) as ‘non-invasive follicular thyroid neoplasm with papillary-like nuclear features’ (NIFTP) in April 2016. The purpose of this study was to establish preoperative clinical, laboratory, ultrasonographic, and cytological variables, which can differentiate NIFTP from FVPTC. Methods We conducted a retrospective chart review of consecutive patients from a single institution evaluated between January 2012 and December 2017. 203 adult patients underwent lobectomy or total thyroidectomy for a FVPTC during that period. Each patient’s medical chart was reviewed and information on pre-operative variables was recorded. An expert pathologist reviewed all surgical specimens and reclassified a subset of FVPTC as NIFTP according to the specific criteria. Results Overall, 44 patients were included in the NIFTP group and 159 in the non-NIFTP group. Mean age was 50.1 years in the NIFTP group and 50.7 in the non-NIFTP group. Most patients were female (86.4% (38/44) in the NIFTP group vs 79.8% (127/159) in the non-NIFTP group). More patients underwent lobectomy in the NIFTP group (50% (22/44) vs 16.4% (26/159) in the non-NIFTP group, p = < 0.0001). Less patients received radioactive iodine in the NIFTP group (31.8% (14/44) vs 52.2% (83/159) in the non-NIFTP group, p = 0.0177). Preoperative thyroglobulin levels were lower in NIFTP patients (Median 25.55 mcg/L +/− 67.8 vs 76.06 mcg/L +/− 119.8 in Non-NIFTP, p = 0.0104). NIFTP nodules were smaller (Mean size 22.97 mm +/− 12.3 vs 25.88 mm +/− 11.2 for non-NIFTP, p = 0.0448) and more often solid than non-NIFTP (93.2% (41/44) vs 74.8% (119/159) for non-NIFTP, p = 0.0067). 2017 ACR TIRADS nodule category of 1–4 on ultrasound had a negative predictive value and a sensitivity of 100% for NIFTP. ROC Curve Analysis demonstrated that a preoperative thyroglobulin level of 31.3 mcg/L had a sensitivity of 75% and a specificity of 62.5% to differentiate NIFTP from non-NIFTP cancers. Conclusion Lower preoperative thyroglobulin levels, smaller nodule size, solid texture and 2017 ACR TIRADS Category of 1–4 are more strongly associated with NIFTP than FVPTC and can favour less invasive surgical options such as lobectomy.
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Affiliation(s)
- Vincent Larouche
- Division of Endocrinology and Metabolism, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada.
| | - Marc Philippe Pusztaszeri
- Division of Pathology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Sabin Filimon
- Internal Medicine Residency Training Program, McGill University, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Richard Payne
- Division of Oto-Rhino-Laryngology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Michael Hier
- Division of Oto-Rhino-Laryngology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Michael Tamilia
- Division of Endocrinology and Metabolism, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
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20
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Rana C, Manjunath S, Ramakant P, Singh K, Babu S, Mishra A. Noninvasive follicular neoplasm with papillary like nuclear features: A comprehensive analysis with a diagnostic algorithm. Diagn Cytopathol 2019; 48:330-341. [PMID: 31880867 DOI: 10.1002/dc.24375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) lacks the carcinoma label, avoiding aggressive therapy, physiological, social and financial impact of cancer diagnosis. Unfortunately, the preoperative diagnosis is still a challenge. Varied incidence of NIFTP has been document with limited data on preoperative cytological, radiological characteristics and the impact on risk of malignancy in each category of the Bethesda system of reporting thyroid cytopathology. METHOD Retrospective analysis of 20 NIFTPs with an attempt to provide a preoperative diagnostic algorithm based on the cytological and ultrasound features along with incidence and implication on risk of malignancy in various Bethesda categories with its impact on patient management. RESULT Incidence of NIFTP in our study was higher in comparison to that documented from other Asian countries. TIRADS 3 was the most common sonographic diagnosis. NIFTP was commonly preceded by indeterminate or benign Bethesda category. Major impact of excluding NIFTP form malignant category was seen on Bethesda categories II and IV with 20% and 27% reduction in risk of malignancy, respectively. CONCLUSION Retrospective analysis should not be confined only to follicular variant of papillary thyroid carcinoma but cases of follicular adenoma and adenomatous colloid nodule should always be included in review to ascertain the true incidence of NIFTP. NIFTPs are less likely to have malignant preoperative cytology. NIFTP shares major cytological and ultrasound features with follicular adenoma, adenomatous colloid nodule and minimally invasive follicular papillary carcinoma. When analyzed together, taking minor findings in consideration, can favor a diagnosis.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, India
| | - Shreyamsa Manjunath
- Department of Endocrine surgery, King George's Medical University, Lucknow, India
| | - Pooja Ramakant
- Department of Endocrine surgery, King George's Medical University, Lucknow, India
| | - Kulranjan Singh
- Department of Endocrine surgery, King George's Medical University, Lucknow, India
| | - Suresh Babu
- Department of Pathology, King George's Medical University, Lucknow, India
| | - Anand Mishra
- Department of Endocrine surgery, King George's Medical University, Lucknow, India
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21
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Patel KN, Angell TE, Babiarz J, Barth NM, Blevins T, Duh QY, Ghossein RA, Harrell RM, Huang J, Kennedy GC, Kim SY, Kloos RT, LiVolsi VA, Randolph GW, Sadow PM, Shanik MH, Sosa JA, Traweek ST, Walsh PS, Whitney D, Yeh MW, Ladenson PW. Performance of a Genomic Sequencing Classifier for the Preoperative Diagnosis of Cytologically Indeterminate Thyroid Nodules. JAMA Surg 2019; 153:817-824. [PMID: 29799911 DOI: 10.1001/jamasurg.2018.1153] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Use of next-generation sequencing of RNA and machine learning algorithms can classify the risk of malignancy in cytologically indeterminate thyroid nodules to limit unnecessary diagnostic surgery. Objective To measure the performance of a genomic sequencing classifier for cytologically indeterminate thyroid nodules. Design, Setting, and Participants A blinded validation study was conducted on a set of cytologically indeterminate thyroid nodules collected by fine-needle aspiration biopsy between June 2009 and December 2010 from 49 academic and community centers in the United States. All patients underwent surgery without genomic information and were assigned a histopathology diagnosis by an expert panel blinded to all genomic information. There were 210 potentially eligible thyroid biopsy samples with Bethesda III or IV indeterminate cytopathology that constituted a cohort previously used to validate the gene expression classifier. Of these, 191 samples (91.0%) had adequate residual RNA for validation of the genomic sequencing classifier. Algorithm development and independent validation occurred between August 2016 and May 2017. Exposures Thyroid nodule surgical histopathology diagnosis by an expert panel blinded to all genomic data. Main Outcomes and Measures The primary end point was measurement of genomic sequencing classifier sensitivity, specificity, and negative and positive predictive values in biopsies from Bethesda III and IV nodules. The secondary end point was measurement of classifier performance in biopsies from Bethesda II, V, and VI nodules. Results Of the 183 included patients, 142 (77.6%) were women, and the mean (range) age was 51.7 (22.0-85.0) years. The genomic sequencing classifier had a sensitivity of 91% (95% CI, 79-98) and a specificity of 68% (95% CI, 60-76). At 24% cancer prevalence, the negative predictive value was 96% (95% CI, 90-99) and the positive predictive value was 47% (95% CI, 36-58). Conclusions and Relevance The genomic sequencing classifier demonstrates high sensitivity and accuracy for identifying benign nodules. Its 36% increase in specificity compared with the gene expression classifier potentially increases the number of patients with benign nodules who can safely avoid unnecessary diagnostic surgery.
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Affiliation(s)
- Kepal N Patel
- Division of Endocrine Surgery, Department of Surgery, New York University Langone Medical Center, New York
| | - Trevor E Angell
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua Babiarz
- Department of Research and Development, Veracyte Inc, San Francisco, California
| | - Neil M Barth
- Department of Medical Affairs, Veracyte Inc, San Francisco, California.,Department of Clinical Affairs, Veracyte Inc, San Francisco, California
| | | | - Quan-Yang Duh
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco
| | - Ronald A Ghossein
- Division of Head and Neck Pathology, Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - R Mack Harrell
- The Memorial Center for Integrative Endocrine Surgery, Hollywood, Florida.,The Memorial Center for Integrative Endocrine Surgery, Weston, Florida.,The Memorial Center for Integrative Endocrine Surgery, Boca Raton, Florida
| | - Jing Huang
- Department of Research and Development, Veracyte Inc, San Francisco, California
| | - Giulia C Kennedy
- Department of Research and Development, Veracyte Inc, San Francisco, California
| | - Su Yeon Kim
- Department of Research and Development, Veracyte Inc, San Francisco, California
| | - Richard T Kloos
- Department of Medical Affairs, Veracyte Inc, San Francisco, California
| | - Virginia A LiVolsi
- Anatomic Pathology Division, Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Peter M Sadow
- Head and Neck Pathology Subspecialty, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Julie A Sosa
- Section of Endocrine Surgery, Department of Surgery, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | - P Sean Walsh
- Department of Research and Development, Veracyte Inc, San Francisco, California
| | - Duncan Whitney
- Department of Research and Development, Veracyte Inc, San Francisco, California
| | - Michael W Yeh
- Department of Surgery, Endocrine Surgery Program, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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Maleki S, Zandvakili A, Gera S, Khutti SD, Gersten A, Khader SN. Differentiating Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features from Classic Papillary Thyroid Carcinoma: Analysis of Cytomorphologic Descriptions Using a Novel Machine-Learning Approach. J Pathol Inform 2019; 10:29. [PMID: 31579155 PMCID: PMC6767786 DOI: 10.4103/jpi.jpi_25_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Recent studies show various cytomorphologic features that can assist in the differentiation of classic papillary thyroid carcinoma (cPTC) from noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Differentiating these two entities changes the clinical management significantly. We evaluated the performance of support vector machine (SVM), a machine learning algorithm, in differentiating cases of NIFTP and encapsulated follicular variant of papillary thyroid carcinoma with no capsular or lymphovascular invasion (EFVPTC) from cases of cPTC with the use of microscopic descriptions. SVM is a supervised learning algorithm used in classification problems. It assigns the input data to one of two categories by building a model based on a set of training examples (learning) and then using that learned model to classify new examples. Methods: Surgical pathology cases with the diagnosis of cPTC, NIFTP, and EFVPTC, were obtained from the laboratory information system. Only cases with existing fine-needle aspiration matching the tumor and available microscopic description were included. NIFTP cases with ipsilateral micro-PTC were excluded. The final cohort consisted of 59 cases (29 cPTCs and 30 NIFTP/EFVPTCs). Results: SVM successfully differentiated cPTC from NIFTP/EFVPTC 76.05 ± 0.96% of times (above chance, P < 0.05) with the sensitivity of 72.6% and specificity of 81.6% in detecting cPTC. Conclusions: This machine learning algorithm was successful in distinguishing NIFTP/EFVPTC from cPTC. Our results are compatible with the prior studies, which show cytologic features are helpful in differentiating these two entities. Furthermore, this study shows the power and potential of this approach for clinical use and in developing data-driven scoring systems, which can guide cytopathology and surgical pathology diagnosis.
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Affiliation(s)
- Sara Maleki
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pathology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Amin Zandvakili
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Shweta Gera
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Seema D Khutti
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, New York, USA
| | - Adam Gersten
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Samer N Khader
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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23
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Ruanpeng D, Cheungpasitporn W, Thongprayoon C, Hennessey JV, Shrestha RT. Systematic Review and Meta-analysis of the Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Cytological Diagnosis and Thyroid Cancer Prevalence. Endocr Pathol 2019; 30:189-200. [PMID: 31338752 DOI: 10.1007/s12022-019-09583-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A re-named diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) likely impacts the prevalence of thyroid cancer and risk of malignancy in populations based on the established Bethesda System of Reporting Thyroid Cytopathology (TBSRTC). This study was done to investigate the prevalence and cytological distribution of NIFTP. PRISMA guided systematic review was done from a database search of Pubmed, EMBASE, and Medline using the search terms "non-invasive follicular thyroid neoplasm with papillary-like nuclear features", "non-invasive follicular variant of papillary carcinoma", "niftp", and "Bethesda" until November 2018. Original articles with surgically proven diagnoses of NIFTP using strict NIFTP criteria were included. Twenty-nine studies with 1563 cases of NIFTP were included. The pooled prevalence of NIFTP in cases which would be classified previously as the follicular variant of papillary thyroid cancer (FVPTC) and papillary thyroid cancer (PTC) were 43.5% (95% CI 33.5-54.0%) and 4.4% (95% CI 2.0-9.0%) respectively. The pooled TBSRTC distribution of cases diagnosed as NIFTP was: from the non-diagnostic category 3.6% (95% CI 2.4-5.3%), benign 10.0% (95% CI 7.2-13.6%), AUS/FLUS 34.2% (95% CI 28.2-40.8%), FN/SFN 22.7% (95% CI 17.2-29.4%), suspicious for malignancy 22.4% (95% CI 17.7-27.9%), and malignant 7.5% (95% CI 4.2-12.9%). While a significant reduction in FVPTC prevalence is anticipated, a modest reduction of PTC prevalence is also expected with adoption of the NIFTP terminology that would be distributed mainly among lesions classified as indeterminate thyroid nodules. Further studies are needed to identify unique clinical characteristics of these lesions preoperatively.
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MESH Headings
- Biopsy, Fine-Needle/standards
- Biopsy, Fine-Needle/statistics & numerical data
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/epidemiology
- Carcinoma, Papillary, Follicular/pathology
- Cell Nucleus/pathology
- Cytodiagnosis/methods
- Cytodiagnosis/standards
- Cytodiagnosis/statistics & numerical data
- Diagnosis, Differential
- Guideline Adherence/standards
- Guideline Adherence/statistics & numerical data
- Humans
- Predictive Value of Tests
- Prevalence
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/epidemiology
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Nodule/diagnosis
- Thyroid Nodule/epidemiology
- Thyroid Nodule/pathology
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Affiliation(s)
- Darin Ruanpeng
- Department of Medicine, University Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Wisit Cheungpasitporn
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - James V Hennessey
- Department of Endocrinology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, GZ-6, 02215, MA, USA
| | - Rupendra T Shrestha
- Department of Medicine, University Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA.
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24
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Endo M, Nabhan F, Porter K, Roll K, Shirley LA, Azaryan I, Tonkovich D, Perlick J, Ryan LE, Khawaja R, Meng S, Phay JE, Ringel MD, Sipos JA. Afirma Gene Sequencing Classifier Compared with Gene Expression Classifier in Indeterminate Thyroid Nodules. Thyroid 2019; 29:1115-1124. [PMID: 31154940 PMCID: PMC7141558 DOI: 10.1089/thy.2018.0733] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: The Afirma Gene Expression Classifier (GEC) has been used to further characterize cytologically indeterminate (cyto-I) thyroid nodules into either benign or suspicious categories. However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. The Afirma Gene Sequencing Classifier (GSC) was developed to improve PPV while maintaining a high negative predictive value (NPV), yet real-world assessment of its performance is lacking. Methods: We analyzed all patients who had cyto-I nodules and molecular testing with either GEC or GSC between 2011 and 2018 at a single academic medical center. Clinical information was obtained for 343 GEC-tested nodules and 164 GSC-tested nodules. Results: The GSC had a statistically significant higher benign call rate (76.2% vs. 48.1%, p < 0.001), PPV (60.0% vs. 33.3%, p = 0.01), and specificity (94.3% vs. 61.4%, p < 0.001) than the GEC. Improvement was statistically significant in both Bethesda III and Bethesda IV nodules. In particular, the benign call rate of GSC was significantly higher in nodules with Hürthle cell changes (88.8% vs. 25.7%, p < 0.01). The rate of surgical intervention in the indeterminate nodule cohort has decreased by 66.4% since switching to the GSC; 52.5% of indeterminate nodules went to surgery while using the GEC compared with 17.6% with the GSC (p < 0.001). This reduction was statistically significant in nodules with Bethesda III diagnoses, demonstrating a 70.9% decrease (GEC 51.3% vs. GSC 14.9%, p < 0.001), and in nodules with Bethesda IV cytology, a 39.2% decrease was noted (GEC 54.8% vs. GSC 33.3%, p = 0.003). Conclusions: Data from a single academic tertiary center show an improved specificity and PPV while maintaining high sensitivity and NPV for GSC compared with GEC. A statistically significant increase in benign call rates was observed in GSC compared with GEC, likely indicating fewer false positive results. After implementation of GSC, surgical interventions have been reduced by 68%.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adult
- Aged
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Female
- Gene Expression
- Gene Expression Profiling
- Humans
- Male
- Middle Aged
- Predictive Value of Tests
- Retrospective Studies
- Sequence Analysis, DNA
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/genetics
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Nodule/genetics
- Thyroid Nodule/pathology
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Affiliation(s)
- Mayumi Endo
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
- Address correspondence to: Mayumi Endo, MD, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, 1581 Dodd Drive, Columbus, OH 43210
| | - Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Kyle Porter
- Department of Biomedical Informatics, Center for Biostatistics and Bioinformatics, The Ohio State University, Columbus, Ohio
| | - Katie Roll
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Lawrence A. Shirley
- Division of Surgical Oncology; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Irina Azaryan
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Dena Tonkovich
- Division of Pathology, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Jeanette Perlick
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Laura E. Ryan
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Raheela Khawaja
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Shumei Meng
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - John E. Phay
- Division of Surgical Oncology; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Matthew D. Ringel
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Jennifer A. Sipos
- Division of Endocrinology, Diabetes, and Metabolism; The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
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25
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Pusztaszeri M, Bongiovanni M. The impact of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on the diagnosis of thyroid nodules. Gland Surg 2019; 8:S86-S97. [PMID: 31475095 DOI: 10.21037/gs.2018.12.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
More than 70 years ago, Prof. Pierre Masson, a renowned French-Canadian pathologist (1880-1959), advised us that "No classification is more difficult to establish than that of thyroid carcinomas…Of all cancers, they teach, perhaps, the greatest lessons of humility to histopathologists." Almost 70 years later, the recent evidence-based reclassification of the non-invasive encapsulated follicular variant of papillary thyroid carcinoma (FVPTC) as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), has demonstrated that this problematic is still ongoing. For about 30 years, it was wrongly assumed that the encapsulated FVPTC behaved and spread like its classical counterpart and, therefore, that it should be treated likewise. As such, the renaming of a malignant entity as a nonmalignant (albeit not benign) neoplasm has contributed to optimizing patient care by deescalating treatment and follow-up for an indolent neoplasm, decreasing medical expense and complications possibly caused by further treatment including radioactive iodine, and reassuring patients with this diagnosis. At the same time, NIFTP has significant implications not only for the practice of thyroid cytopathology but also for surgical pathology and for molecular tests, creating significant new challenges. NIFTP has rigorous histopathologic diagnostic criteria, including papillary-like nuclear features, and submission of the entire tumor capsule and content is required to exclude both invasion and presence of papillary structures. Cytologically, because of the morphological overlap with other follicular neoplasms and with papillary thyroid carcinoma (PTC), most NIFTP are diagnosed into one of the indeterminate Bethesda categories (III-V) and can be adequately triaged for surgery. From a molecular view, NIFTP are most often characterized by RAS-type mutations, similar to other follicular-patterned lesions, and molecular testing can be helpful to suggest NIFTP preoperatively. In this review, we focus on the impact of NIFTP on the diagnosis of thyroid nodules.
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Affiliation(s)
- Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
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26
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Lee HS, Lee JW, Park JH, Kim WS, Han HS, Lee SE. Comprehensive analysis for diagnosis of preoperative non-invasive follicular thyroid neoplasm with papillary-like nuclear features. PLoS One 2019; 14:e0218046. [PMID: 31276506 PMCID: PMC6611592 DOI: 10.1371/journal.pone.0218046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/24/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The current paradigm in the treatment of patients with non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a diagnostic lobectomy rather than complete thyroidectomy and postoperative radioiodine treatment. Consequently, preoperative diagnosis of NIFTP is considered to be important. METHODS We performed the comprehensive analysis for diagnosis of preoperative 20 NIFTPs in comparison with 41 invasive encapsulated follicular papillary thyroid carcinomas (I-EFVPTCs) using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and molecular analysis for BRAF and RAS mutations. RESULTS K-TIRADS 3 was identified as the most common sonographic diagnosis in both NIFTP and I-EFVPTC. Unlike I-EFVPTC, K-TIRADS 5 was not identified in NIFTP. AUS/FLUS was the most common cytopathological diagnosis and none of the cases were classified as malignant category in both groups, although the difference in distribution was not significant between the groups. BRAF mutation was not found in NIFTP but was present in 9.8% of cases in I-EFVPTC. The frequency of RAS mutation in I-EFVPTCs was twice as high as that of NIFTP. Wild-type BRAF and RAS in NIFTP was significantly higher than I-EFVPTC. CONCLUSION The existence of overlapping features between the groups was evident, hence conclusive distinction between radiology, cytology and molecular analysis could not be achieved. Apparently, the diagnosis of NIFTP based on comprehensive analysis was not confirmable but could perceive or at least favor the diagnosis of NIFTP.
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Affiliation(s)
- Hye Seung Lee
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae-Wook Lee
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Park
- Department of Hemato-Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Wan-Seop Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung Eun Lee
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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27
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Koshikawa T, Fujita N, Ueda N, Ota Y, Sasaki E, Murakami Y, Hosoda W, Yatabe Y, Hanai N, Higuchi M, Hirokawa M, Miyauchi A. Important cytological findings for distinction between follicular variant and conventional papillary thyroid carcinoma, including noninvasive follicular thyroid tumors with papillary-like nuclear features. Endocr J 2019; 66:475-483. [PMID: 30867345 DOI: 10.1507/endocrj.ej18-0525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We studied cytological specimens of conventional papillary thyroid carcinoma (PTC), follicular variant papillary thyroid carcinoma (FVPTC), and noninvasive follicular thyroid tumor with papillary-like nuclear features (NIFTP) (formerly noninvasive FVPTC) to identify useful cytological parameters for their differentiation. Cytological findings of invasive FVPTC and NIFTP were very similar to each other but differed from those of conventional PTC. Intranuclear cytoplasmic inclusions, true papillary cell clusters, monolayered cell sheets, ropy colloids, multinucleate giant cells, psammoma bodies, and cystic background were the observed characteristic features of conventional PTC. Microfollicular cell clusters and dense globules of colloids were characteristic features of invasive FVPTC and NIFTP. Scoring the eight parameters (intranuclear cytoplasmic inclusions, nuclear grooves, powdery chromatin, true papillary cell clusters, ropy colloids, multinucleate giant cells, psammoma bodies, and cystic background) readily distinguished NIFTP from conventional PTC, but could not distinguish NIFTP from invasive FVPTC. The average total score of NIFTP, invasive FVPTC, and conventional PTC were 2.60 ± 0.55, 2.63 ± 0.62, and 4.57 ± 0.99, respectively. The difference between conventional PTC and NIFTP or invasive FVPTC was statistically significant (p < 0.001, Student's t-test). Individuals with more than three of the identified parameters likely harbor conventional PTC, rather than NIFTP. In this way, 87.5% (112/128) of conventional PTCs could be differentiated from NIFTP, and definitively diagnosed as malignant by cytology.
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Affiliation(s)
- Takashi Koshikawa
- Department of Pathology, Shubun University Faculty of Nursing, Ichinomiya 491-0938, Japan
- Department of Clinical Laboratories, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Nao Fujita
- Department of Clinical Laboratories, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Nanae Ueda
- Department of Clinical Laboratories, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Yuko Ota
- Department of Clinical Laboratories, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Yoshiko Murakami
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Waki Hosoda
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan
| | - Miyoko Higuchi
- Department of Laboratory Medicine, Kuma Hospital, Kobe 856-8562, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe 856-8562, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 856-8562, Japan
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28
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Sung S, Margolskee E, Chen D, Tiscornia-Wasserman P. Incidence of noninvasive follicular thyroid neoplasm with papillary-like nuclear features and change in risk of malignancy for "The Bethesda System for Reporting Thyroid Cytology". J Am Soc Cytopathol 2019; 8:133-140. [PMID: 31097289 DOI: 10.1016/j.jasc.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The second edition of The Bethesda System for Reporting Thyroid Cytopathology has incorporated the recent change in nomenclature, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), with an anticipated change in the risk of malignancy (ROM). We examined our institutional experience in the incidence of NIFTP and the change in the ROM in The Bethesda System for Reporting Thyroid Cytopathology. MATERIALS AND METHODS A computerized search was performed from January 2013 to August 2017 for all thyroid fine needle aspirations (FNAs), the corresponding surgical resection specimens, and clinical follow-up data. All thyroid specimens reported as follicular variant of papillary thyroid carcinoma were reviewed and reclassified, and all NIFTP diagnoses from April 2016 to August 2017 were identified. The ROM for each category was calculated before and after the change and analyzed for significance. RESULTS A total of 4500 thyroid FNA cases were collected. Of these, 479 cases had surgical resection specimens available and 36 cases had been diagnosed as NIFTP. Of these, 22 had been previously diagnosed as FVPT. Of 27 cases of NIFTP, 14 and 13 were atypia of undetermined significance/follicular lesion of undetermined significance and follicular neoplasm/suspicious for follicular neoplasm, respectively. A reduction in the ROM was observed in these 2 categories (P = 0.03 and P = 0.04, respectively). CONCLUSIONS In our institution, NIFTP has accounted for 13% of all malignant thyroid neoplasms since the change in nomenclature. Although the ROM was decreased in the affected categories, with absolute statistically significant decreases in ROM of 15% and 16.2% for category III and IV, respectively, the overall ROM change was marginal.
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Affiliation(s)
- Simon Sung
- Department of Pathology and Cell Biology, Columbia University Medical Center/New York Presbyterian, New York, New York.
| | - Elizabeth Margolskee
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Diane Chen
- Department of Pathology and Cell Biology, Columbia University Medical Center/New York Presbyterian, New York, New York
| | - Patricia Tiscornia-Wasserman
- Department of Pathology and Cell Biology, Columbia University Medical Center/New York Presbyterian, New York, New York
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29
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Ali SZ, Siperstein A, Sadow PM, Golding AC, Kennedy GC, Kloos RT, Ladenson PW. Extending expressed RNA genomics from surgical decision making for cytologically indeterminate thyroid nodules to targeting therapies for metastatic thyroid cancer. Cancer Cytopathol 2019; 127:362-369. [PMID: 31017745 PMCID: PMC6618055 DOI: 10.1002/cncy.22132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 12/13/2022]
Abstract
The Afirma Genomic Sequencing Classifier (GSC) is a rule‐out test for malignancy/noninvasive follicular thyroid neoplasms with papillary‐like nuclear features among patients with Bethesda category III/IV nodules, whereas the complimentary Xpression Atlas provides genomic insights from a curated panel of 511 genes among GSC suspicious and Bethesda category V/VI nodules. Together, they facilitate personalized treatment decisions based on genomic insights derived from the transcriptome of the biopsied target and extend the diagnostic and therapeutic reach of cytopathologists and fine‐needle aspiration biopsy sample collection.
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Affiliation(s)
- Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Allan C Golding
- Department of Medicine, Florida International University, Memorial Healthcare System, Hollywood, Florida
| | - Giulia C Kennedy
- Department of Clinical Affairs, Veracyte Inc, South San Francisco, California.,Department of Medical Affairs, Veracyte Inc, South San Francisco, California.,Department of Research and Development, Veracyte Inc, South San Francisco, California
| | - Richard T Kloos
- Department of Medical Affairs, Veracyte Inc, South San Francisco, California
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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30
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Abstract
Ancillary molecular testing has emerged as a promising way to refine the preoperative risk stratification of thyroid nodules with indeterminate fine needle aspiration (FNA) biopsy results. Commercially available molecular tests for thyroid FNAs include those that analyze samples for mutations and gene fusions, gene expression alterations, microRNA expression alterations, chromosomal copy number alterations, or a combination thereof. This review summarizes the performance characteristics of the most current iterations of three tests currently marketed for cytologically indeterminate thyroid nodules: ThyroSeq v3, ThyGeNEXT/ThyraMIR, and Afirma Gene Sequencing Classifier.
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Affiliation(s)
- Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA,
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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31
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Bongiovanni M, Giovanella L, Romanelli F, Trimboli P. Cytological Diagnoses Associated with Noninvasive Follicular Thyroid Neoplasms with Papillary-Like Nuclear Features According to the Bethesda System for Reporting Thyroid Cytopathology: A Systematic Review and Meta-Analysis. Thyroid 2019; 29:222-228. [PMID: 30426887 DOI: 10.1089/thy.2018.0394] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The recent introduction of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) in the World Health Organization classification of thyroid tumors has significantly modified the risk of malignancy of cytological diagnoses. In fact, while this tumor was previously classified as a carcinoma (the encapsulated, noninvasive form follicular variant of papillary thyroid carcinoma), it is now considered a neoplasm with low malignant potential. Given that the cytological features of NIFTP are not specific and overlap with other pathologic entities, there is no specific cytological diagnostic category for NIFTP. To obtain more robust information about the cytological findings associated with NIFTP, published articles were systematically reviewed, and a meta-analysis of the data was conducted. METHODS The review was conducted according to PRISMA guidelines. A comprehensive literature search of the PubMed/MEDLINE and Scopus databases was conducted using a combination of terms "noninvasive," "encapsulated," "follicular variant," "NIFTP," and "thyroid cancer." The search was updated to June 2018, and references of the retrieved articles were also screened. Only original articles reporting the classification of histologically proven NIFTPs with cytological findings according to The Bethesda System for Reporting Thyroid Cytopathology were eligible for inclusion. RESULTS The literature search revealed 117 articles, of which 15 were included in the study. All studies were retrospective. A total of 915 NIFTP cases were retrieved. The incidence of cases cytologically classified according to the Bethesda system was as follows: non-diagnostic 3%, benign 10%, atypia of undetermined significance or follicular lesion of undetermined significance 30%, follicular neoplasm or suspicious for a follicular neoplasm 21%, suspicious for malignancy 24%, and malignant 8%. Mild heterogeneity between the studies was found. Publication bias was absent. CONCLUSIONS This meta-analysis shows that the cytological diagnoses associated with NIFTP by fine-needle aspiration cytology includes a wide spectrum of findings. The majority of cases are cytologically indeterminate, and the remainder may be read as non-diagnostic, benign, or malignant. In order to develop an accurate presurgical diagnosis of these cases, further cytological and/or molecular characteristics need to be identified.
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Affiliation(s)
- Massimo Bongiovanni
- 1 Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | - Luca Giovanella
- 2 Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Pierpaolo Trimboli
- 2 Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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32
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Shrestha RT, Ruanpeng D, Hennessey JV. Cytomorphology of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features and the Impact of New Nomenclature on Molecular Testing. Med Sci (Basel) 2019; 7:E15. [PMID: 30678281 PMCID: PMC6410294 DOI: 10.3390/medsci7020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022] Open
Abstract
The re-naming of noninvasive follicular variant papillary thyroid cancer to the apparently non-malignant, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) impacts the prevalence of malignancy rates, thereby affecting mutation frequency in papillary thyroid cancer. Preoperative assessment of such nodules could affect management in the future. The original publications following the designation of the new nomenclature have been extensively reviewed. With the adoption of NIFTP terminology, a reduction in the follicular variant of papillary thyroid cancer (FVPTC) prevalence is anticipated, as is a modest reduction of papillary thyroid cancer (PTC) prevalence that would be distributed mainly across indeterminate thyroid nodules. Identifying NIFTP preoperatively remains challenging. RAS mutations are predominant but the presence of BRAF V600E mutation has been observed and could indicate inclusion of the classical PTC. The histological diagnosis of NIFTP to designate low-risk encapsulated follicular variant papillary thyroid cancers (EFVPTCs) would impact malignancy rates, thereby altering the mutation prevalence. The histopathologic criteria have recently been refined with an exclusion of well-formed papillae. The preoperative identification of NIFTP using cytomorphology and gene testing remains challenging.
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Affiliation(s)
- Rupendra T Shrestha
- University of Minnesota Twin Cities, Department of Medicine, Minneapolis, MN 55455, USA.
| | - Darin Ruanpeng
- University of Minnesota Twin Cities, Department of Medicine, Minneapolis, MN 55455, USA.
| | - James V Hennessey
- Division of Endocrinology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, GZ-6, Boston, MA 02215, USA.
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Nishino M. How is noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) shaping the way we interpret thyroid cytology? J Am Soc Cytopathol 2019; 8:1-4. [PMID: 30929753 DOI: 10.1016/j.jasc.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Abstract
Genomic, clinical, and pathologic studies have prompted a more risk-stratified approach to the management of patients with thyroid nodules. The recent nomenclature change concerning noninvasive follicular thyroid neoplasm with papillary-like nuclear features reflects the clinical trend toward conservative treatment choices for carefully selected low-risk thyroid neoplasms. These developments have occurred in parallel with a growing array of molecular tests intended to improve clinical triage for patients with indeterminate fine needle aspiration diagnoses. This review discusses the implications of the nomenclature revision on the interpretation of thyroid fine needle aspiration and updates available ancillary molecular tests for thyroid fine needle aspirations.
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Affiliation(s)
- Michiya Nishino
- Department of Pathology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Jeffrey F Krane
- Department of Pathology, Harvard Medical School and Brigham and Women's Hospital, 75 Francis Street, Amory 3, Boston, MA 02115, USA
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Trabzonlu L, Paksoy N. Cytomorphological Analysis of Thyroid Nodules Diagnosed as Follicular Variant of Papillary Thyroid Carcinoma: a Fine Needle Aspiration Study of Diagnostic Clues in 42 Cases and the Impact of Using Bethesda System in Reporting-an Institutional Experience. Endocr Pathol 2018; 29:351-356. [PMID: 30315491 DOI: 10.1007/s12022-018-9550-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary thyroid carcinoma (PTC) after classical PTC (cPTC). Follicular thyroid lesions such as follicular adenomas/carcinomas, FVPTC, and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) pose some diagnostic challenges for FNAC. In this study, we aimed to explore whether FNAC can demonstrate diagnostic clues by re-evaluating cytology slides from histopathologically diagnosed FVPTC cases. A total of 42 patients were enrolled in this study: patients were diagnosed with FVPTC via surgical resection between 2006 and 2016, and all patients were subjected to preoperative FNAC, which was conducted at either a private center or at the teaching hospital of Kocaeli University and reported by the same cytopathologist (NP). Clinical and cytomorphological characteristics were reviewed by both authors .Most cases (76.2%) are diagnosed either Bethesda IV or V. The majority of cases had a high cellularity (38/42; 90.5%), and the most frequent observations were monolayer and large syncytial groups of cells (95.2%). While microfollicular structures were observed in 30 (71.4%) cases, nuclear crowding and large naked nuclei were observed in all cases. Nuclear grooves were sparsely detected in 23 (54.8%) cases, and nuclear pseudoinclusions were detected in only six (14.3%) cases. Because thyrocytes often have a mixed architecture in FVPTC, despite a distinct follicular morphology, we believe that nuclear overcrowding, enlargement, and hyperchromasia in cases presenting with increased cellularity are notable clues for the cytodiagnosis of FVPTC. We believe that the primary aim of FNAC in such cases is to give preoperative diagnosis as either category IV or V. Nuclear crowding, monolayered clusters with large syncytial formations, nuclear enlargement, and hyperchromasia are notable cytomorphologic clues for the diagnosis of FVPTC on FNAC.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
- Pathology Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nadir Paksoy
- Department of Pathology, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey.
- Dr Paksoy's Private Cytopathology/FNA Practice, Hurriyet Cad. Safak Apt. 125/17, 41300, Izmit, Kocaeli, Turkey.
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Abstract
Population-based studies have demonstrated that an increasing number of incidental thyroid nodules are being identified. The corresponding increase in thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of thyroid cancers and to more thyroid surgeries being performed. Small papillary thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated thyroid cancer, as the complications related to thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparathyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus thyroid surgery for papillary thyroid microcarcinoma, the extent of thyroid surgery and lymphadenectomy for low-risk differentiated thyroid cancer, and the use of molecular testing to guide decision-making about whether surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated thyroid cancer. Additionally, innovative thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following thyroidectomy.
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Affiliation(s)
- Tracy S Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Julie Ann Sosa
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
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Cho H, Kim JY, Oh YL. Diagnostic value of HBME-1, CK19, Galectin 3, and CD56 in the subtypes of follicular variant of papillary thyroid carcinoma. Pathol Int 2018; 68:605-613. [DOI: 10.1111/pin.12729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/30/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Haeyon Cho
- Department of Pathology and Translational Genomics; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Ji-Ye Kim
- Department of Pathology; National Cancer Center; Goyang Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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38
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Lindeman BM, Nehs MA, Angell TE, Alexander EK, Gawande AA, Moore FD, Doherty GM, Cho NL. Effect of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Malignancy Rates in Thyroid Nodules: How to Counsel Patients on Extent of Surgery. Ann Surg Oncol 2018; 26:93-97. [DOI: 10.1245/s10434-018-6932-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 02/06/2023]
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Brandler TC, Liu CZ, Cho M, Zhou F, Cangiarella J, Yee-Chang M, Shi Y, Simsir A, Sun W. Does Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP) Have a Unique Molecular Profile? Am J Clin Pathol 2018; 150:451-460. [PMID: 30052723 DOI: 10.1093/ajcp/aqy075] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Recognizing preoperative characteristics of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is important for clinical management. Therefore, we assessed presurgical NIFTP molecular profiles using fine-needle aspiration (FNA) material. METHODS Presurgical FNA reports of 39 surgically confirmed NIFTP cases from January 2013 through May 2017 were assessed for Afirma and ThyroSeq results. RESULTS Twenty-one of 39 NIFTP nodules were preoperatively tested with Afirma with two benign and 19 suspicious results. Twenty-seven of 39 nodules were tested with ThyroSeq (nine of 39 had both Afirma and Thyroseq): 18 (67%) had RAS mutations (13 NRAS, four HRAS, one KRAS), and three of 18 had multiple alterations (NRAS + TP53, n = 1; NRAS + PTEN, n = 2). BRAF T599_R603 + EIF1AX mutation (n = 1), PTEN mutation (n = 1), MET overexpression (n = 1), PAX8/PPARG fusion (n = 3), and THADA/IGF2BP3 fusion (n = 3) comprised the remainder. CONCLUSIONS NIFTP cases most commonly displayed suspicious Afirma results and RAS mutations on ThyroSeq, lacking aggressive/BRAF-V600E-like mutations. While NIFTP remains a surgical entity, the lack of aggressive/BRAF-V600E-like mutations can aid in determining the extent of surgery.
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Affiliation(s)
- Tamar C Brandler
- Department of Pathology, New York University Langone Medical Center, New York
| | - Cheng Z Liu
- Department of Pathology, New York University Langone Medical Center, New York
| | - Margaret Cho
- Department of Pathology, New York University Langone Medical Center, New York
| | - Fang Zhou
- Department of Pathology, New York University Langone Medical Center, New York
| | - Joan Cangiarella
- Department of Pathology, New York University Langone Medical Center, New York
| | - Melissa Yee-Chang
- Department of Pathology, New York University Langone Medical Center, New York
| | - Yan Shi
- Department of Pathology, New York University Langone Medical Center, New York
| | - Aylin Simsir
- Department of Pathology, New York University Langone Medical Center, New York
| | - Wei Sun
- Department of Pathology, New York University Langone Medical Center, New York
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40
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Brandler TC, Cho M, Wei XJ, Simms A, Levine P, Hernandez O, Oweity T, Zhou F, Simsir A, Rosen L, Sun W. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: An interobserver study of key cytomorphological features from a large academic medical centre. Cytopathology 2018; 30:39-45. [PMID: 30230094 DOI: 10.1111/cyt.12632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Because of the indolent nature of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and potential requisite for a more conservative treatment, it is crucial to identify features of this entity preoperatively. Our group recently published findings that there are several cytomorphological features that may be used as clues to distinguish NIFTP, papillary thyroid carcinoma (PTC) and follicular adenoma (FA) on fine needle aspiration. Therefore, we aimed to determine the interobserver reproducibility of these findings. METHODS Presurgical fine-needle aspiration slides from NIFTP (n = 30), classic PTC (n = 30) and FA (n = 30) collected from 1/2013-8/2016 were reviewed by seven cytopathologists blindly. Presence of selected cytomorphological features was recorded and compared to determine percent agreement and inter-rater reliability among study cytopathologists using Gwet's AC1 statistics. RESULTS For all the cytomorphological features, the overall percent agreement amongst the pathologists ranged between 65.1% and 86.8% (Gwet's AC1 0.30-0.80). There was substantial or almost perfect agreement (Gwet's AC1 > 0.60) in seven cytomorphological features in the classic PTC group, in six features in the NIFTP group and in five features in the FA group. There were no features with poor agreement (Gwet's AC1 < 0.0). CONCLUSIONS The current study supports the reproducibility of our previous findings. The high level of agreement amongst pathologists for these groups, and particularly the NIFTP group, supports the notion that when viewed in combination as a cytological profile, these cytomorphological features may assist the cytopathologist in raising the possibility of NIFTP preoperatively. This can potentially aid clinicians in deciding whether more conservative treatment may be appropriate.
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Affiliation(s)
- Tamar C Brandler
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Margaret Cho
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Xiao-Jun Wei
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Anthony Simms
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Pascale Levine
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Osvaldo Hernandez
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Thaira Oweity
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Aylin Simsir
- Department of Pathology, New York University Langone Health, New York City, New York
| | - Lisa Rosen
- Independent Statistician, New York City, New York
| | - Wei Sun
- Department of Pathology, New York University Langone Health, New York City, New York
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Ferris RL, Nikiforov Y, Terris D, Seethala RR, Ridge JA, Angelos P, Duh Q, Wong R, Sabra MM, Fagin JA, McIver B, Bernet VJ, Harrell RM, Busaidy N, Cibas ES, Faquin WC, Sadow P, Baloch Z, Shindo M, Orloff L, Davies L, Randolph GW. AHNS Series: Do you know your guidelines? AHNS Endocrine Section Consensus Statement: State-of-the-art thyroid surgical recommendations in the era of noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Head Neck 2018; 40:1881-1888. [PMID: 29947030 PMCID: PMC6175359 DOI: 10.1002/hed.25141] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 01/31/2023] Open
Abstract
The newly introduced pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) will result in less bilateral thyroid surgery as well as deescalation in T4 suppressive and radioactive iodine treatment. Although, NIFTP is a nonmalignant lesion that has nuclear features of some papillary malignancies, the challenge for the surgeon is to identify a lesion as possibly NIFTP before the pathologic diagnosis. NIFTP, due to its reduction of overall rates of malignancy, will result in the initial surgical pendulum swinging toward lobectomy instead of initial total thyroidectomy. This American Head and Neck Society endocrine section consensus statement is intended to inform preoperative evaluation to attempt to identify those patients whose final pathology report may ultimately harbor NIFTP and can be offered a conservative surgical plan to assist in cost-effective, optimal management of patients with NIFTP.
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Affiliation(s)
- Robert L. Ferris
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Yuri Nikiforov
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Davis Terris
- Department of Otolaryngology ‐ Head and Neck SurgeryAugusta UniversityAugustaGeorgia
| | - Raja R. Seethala
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - J. Andrew Ridge
- Department of Surgical OncologyFox Chase Cancer CenterPhiladelphiaPennsylvania
| | - Peter Angelos
- Department of SurgeryUniversity of Chicago Medical CenterChicagoIllinois
| | - Quan‐Yang Duh
- Department of SurgeryUniversity of California San FranciscoSan FranciscoCalifornia
| | - Richard Wong
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Mona M. Sabra
- Department of EndocrinologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - James A. Fagin
- Department of EndocrinologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Bryan McIver
- Department of Head and Neck ‐ Endocrine OncologyMoffitt Cancer CenterTampaFlorida
| | - Victor J. Bernet
- Department of EndocrinologyMayo Clinic JacksonvilleJacksonvilleFlorida
| | - R. Mack Harrell
- Department of EndocrinologyMemorial Regional HospitalHollywoodFlorida
| | - Naifa Busaidy
- Department of Endocrine NeoplasiaMD Anderson Cancer Center; HoustonTexas
| | - Edmund S. Cibas
- Department of PathologyBrigham and Women's HospitalBostonMassachusetts
| | - William C. Faquin
- Department of PathologyMassachusetts General HospitalBostonMassachusetts
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
| | - Peter Sadow
- Department of PathologyMassachusetts General HospitalBostonMassachusetts
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
| | - Zubair Baloch
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Maisie Shindo
- Department of OtolaryngologyOregon Health Science UniversityPortlandOregon
| | - Lisa Orloff
- Department of OtolaryngologyStanford UniversityStanfordCalifornia
| | - Louise Davies
- Department of Otolaryngology and AudiologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Gregory W. Randolph
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
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42
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Hung YP, Barletta JA. A user's guide to non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Histopathology 2018; 72:53-69. [PMID: 29239036 DOI: 10.1111/his.13363] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022]
Abstract
The term non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was recently introduced to replace a subset of follicular variant of papillary thyroid carcinoma (FVPTC). The goal of this change was to promote more conservative management of these tumours and spare patients the psychological burden of a cancer diagnosis. The histological diagnosis of NIFTP is stringent: the tumour needs to demonstrate encapsulation or circumscription, a purely follicular architecture and the presence of nuclear features of papillary thyroid carcinoma, while lacking capsular and vascular invasion, a significant component of solid growth and high-grade features (increased mitotic activity and necrosis). In order to ensure that these inclusion and exclusion criteria are met, the tumour must be sampled extensively, with the entire capsule/periphery submitted in all cases. When sampled by fine-needle aspiration, NIFTP is usually classified within the indeterminate categories of the Bethesda System for Reporting Thyroid Cytopathology. NIFTP is characterized genetically by frequent RAS mutations, although rarely other alterations, such as the BRAF K601E mutation and gene rearrangements in PPARG or THADA, may occur. In this review, we will examine the history of FVPTC and the findings and factors that culminated in the introduction of the NIFTP terminology. A discussion will follow with the histological, cytological and molecular characteristics of NIFTP. We will conclude by considering the potential impact of the introduction of the NIFTP terminology.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
Thyroid carcinomas originating from follicular cells have the prognosis of heterogeneous diseases, but pathologists classify them all as malignant disease. Epidemiologists have issued a stern warning regarding over-diagnosis and overtreatment of patients with indolent thyroid tumors that cause no harm to the patients. Review of the literature revealed that there were several proposals of borderline/precursor tumors to some indolent thyroid carcinomas. Thyroid tumor of uncertain malignant potential (UMP) was first proposed by Williams for encapsulated follicular pattern thyroid tumors to solve problems due to observer variation. Rosai et al. proposed to rename papillary microcarcinoma (PMC) to papillary micro-tumor as the overwhelming majority of them are of no clinical significance. Liu et al. proposed well-differentiated tumor with uncertain behavior (WDT-UB) which covered WDT of UMP (WDT-UMP) and non-invasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). The EFVPTC without invasion was renamed as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) by an international panel of pathologists. A new prognostic classification of thyroid tumors was proposed by Kakudo et al., in which extremely low risk tumors were grouped in a borderline tumors category. The borderline/precursor thyroid tumors included encapsulated tumors [capsular invasion only follicular carcinoma, encapsulated papillary carcinoma without invasion, WDT-UMP and follicular tumor of UMP (FT-UMP)] and non-encapsulated tumors (PMC). The UMP and NIFTP were incorporated in the 4th edition WHO classification of thyroid tumors as a new tumor entity in chapter 2-2A: other encapsulated follicular patterned thyroid tumors. Their behavior codes were decided to be 1 (borderline or uncertain behavior), and not 0 (benign), 2 (in situ carcinoma) or 3 (malignant). These borderline/precursor thyroid tumors are indolent tumors biologically and should be treated more conservatively than as previously recommended for thyroid follicular cell carcinomas [total thyroidectomy (TTX) followed by radio-active iodine (RAI) treatment] by western clinical guidelines.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Kindai University Faculty of Medicine, Nara Hospital, Nara, Japan
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44
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Abstract
In this paper, we aim to focus on false positive results in the evaluation of thyroid aspirations, covering cystic, inflammatory, follicular and oncocytic lesions, papillary carcinoma, and medullary carcinoma of thyroid. The recently described entity noninvasive follicular thyroid neoplasm with papillary-like nuclear features is also discussed detailing the impact of its introduction on the sensitivity and specificity of thyroid FNA, as well as the use of molecular tests for diagnostics. Medicolegal issues in relation to current practice in English law are also described.
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Affiliation(s)
- D C Malheiros
- Faculdade de Ciências, Médicas da Santa Casa de São Paulo, São Paulo, Brasil.,IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal
| | - S Canberk
- IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Pathology subdivision of Cytopathology, Acibadem University, Atasehir-Istanbul, Turkey
| | - D N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
| | - F Schmitt
- IPATIMUP, Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,I3S, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Medical Faculty of Porto University, Porto, Portugal
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45
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Vuttariello E, Borra M, Mauriello E, Calise C, D'Andrea B, Capiluongo A, Fulciniti F, Cipolletta A, Monaco M, Pezzullo L, Chiappetta G. Multiplex PCR approach to simultaneously identify several mutations in fine needle cytology thyroid samples. Oncotarget 2018; 8:49351-49358. [PMID: 28537891 PMCID: PMC5564773 DOI: 10.18632/oncotarget.17656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/19/2017] [Indexed: 12/31/2022] Open
Abstract
The most frequent initial manifestation of thyroid cancer is the appearance of a nodule. More than 20% of the general population has a palpable thyroid nodule and the percentage rises to 70% based on ultrasound identification. In 95% of cases the nodule is simply a hyperplastic or benign lesion. The most reliable diagnostic test for thyroid nodules is fine needle aspiration (FNA), but cytological discrimination between malignant and benign follicular neoplasms remains difficult. Cytological analysis is now, almost routinely, being combined with molecular genetics to enable the pathologist to make a more objective diagnosis. In this study, we performed the molecular analysis using a new simplified procedure that involves a panel of BRAF, RAS, RET and RET/PTC gene mutations in easily obtainable FNA samples, in the attempt to improve the efficacy of the FNA diagnosis of thyroid nodules and thus patient management. In this new procedure, PCR and sequencing analysis are used to detect point mutations, and, in parallel, RT-PCR is used to detect the chimeric RET/PTC1 and RET/PTC3 transcripts in RNA extracted from FNA.
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Affiliation(s)
- Emilia Vuttariello
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Marco Borra
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A.Dorhn", Naples, Italy
| | - Elvira Mauriello
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A.Dorhn", Naples, Italy
| | | | - Barbara D'Andrea
- Molecular Biology and Bioinformatics Unit, Stazione Zoologica "A.Dorhn", Naples, Italy.,CMO, Naples, Italy
| | - Anna Capiluongo
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Franco Fulciniti
- Clinical Cytopathology Service, Institute of Pathology, Locarno, Switzerland
| | - Anna Cipolletta
- SC Anatomia Patologica e Citopatologia, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Mario Monaco
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Luciano Pezzullo
- Thyroid Surgery Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - Gennaro Chiappetta
- Functional Genomics Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
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46
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Mahajan S, Agarwal S, Kocheri N, Jain D, Mathur SR, Iyer VK. Cytopathology of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: A comparative study with similar patterned papillary thyroid carcinoma variants. Cytopathology 2018; 29:233-240. [DOI: 10.1111/cyt.12537] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/31/2023]
Affiliation(s)
- S. Mahajan
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. Agarwal
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - N. Kocheri
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - D. Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. R. Mathur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - V. K. Iyer
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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47
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Kim M, Kim JE, Kim HJ, Chung YR, Kwak Y, Park SY. Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features and Its Impact on the Risk of Malignancy in the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience. J Pathol Transl Med 2018; 52:171-178. [PMID: 29614546 PMCID: PMC5964291 DOI: 10.4132/jptm.2018.04.03] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 01/05/2023] Open
Abstract
Background This study was performed to analyze cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) and its impact on the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Methods Five thousand five hundred and forty-nine cases of thyroid fine-needle aspiration cytology (FNAC) diagnosed between 2012 and 2014 were included in this study. Diagnostic categories based on TBSRTC were compared with final surgical diagnoses, and the ROM in each category was calculated both when NIFTP was included in malignant lesions and when excluded from malignant lesions. Results Of the 5,549 thyroid FNAC cases, 1,891 cases underwent surgical resection. In final diagnosis, 1,700 cases were revealed as papillary thyroid carcinoma (PTC), and 25 cases were reclassified as NIFTP. The cytologic diagnoses of NIFTP were non-diagnostic in one, benign in five, atypia of undetermined significance (AUS) in 14, follicular neoplasm in two, and suspicious for malignancy in three cases. Collectively, NIFTP/encapsulated follicular variant of PTC (EFVPTC) were more frequently classified as benign, AUS, or follicular neoplasm and less frequently categorized as malignant compared to conventional PTCs. Exclusion of NIFTP from malignant diagnoses resulted in a slight decrease in malignancy rates in non-diagnostic, benign, AUS, follicular neoplasm, and suspicious for malignancy categories without any statistical significance. Conclusions The decrease in the ROM was not significant when NIFTP was excluded from malignant lesions. In thyroid FNACs, NIFTP/EFVPTCs were mostly classified into indeterminate categories. Therefore, it might be feasible to separate NIFTP/EFVPTC from conventional PTC on FNAC to guide clinicians to conservative management for patients with NIFTP/EFVPTC.
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Affiliation(s)
- Milim Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Joung Eun Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yul Ri Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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48
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Amendoeira I, Maia T, Sobrinho-Simões M. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): impact on the reclassification of thyroid nodules. Endocr Relat Cancer 2018; 25:R247-R258. [PMID: 29439059 DOI: 10.1530/erc-17-0513] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 12/19/2022]
Abstract
The 2017 edition of the WHO book on Classification of Tumours of Endocrine Organs includes a new section entitled 'Other encapsulated follicular-patterned thyroid tumours', in which the newly created NIFTP (non-invasive follicular thyroid neoplasm with papillary-like nuclear features) is identified and described in detail. Despite deleting the word 'carcinoma' from its name, NIFTP is not a benign tumor either and is best regarded as a neoplasm with 'very low malignant potential'. The main goal of the introduction of NIFTP category is to prevent overdiagnosis and overtreatment. Sampling constraints, especially when dealing with heterogeneous and/or large nodules, and difficulties in the invasiveness evaluation, are the major weaknesses of the histological characterization of NIFTP. At the cytological level, NIFTP can be separated from classic papillary carcinoma (cPTC) but not from encapsulated, invasive follicular variant PTC. The impact of NIFTP individualization for cytopathology is the drop of rates of malignancy for each Bethesda category in general and for indeterminate categories in particular. The biggest impact will be seen in institutions with a high frequency of FVPTC. The introduction of NIFTP has changed the utility of predictive values of molecular tests because RAS mutations and PAX8-PPARg rearrangements are frequently detected in NIFTP. This turns less promising the application of mutation detection panels as indicators of malignancy and will probably contribute to switch to a rule-out approach of molecular testing. Selection for surgery will go on being determined by a combined detection of clinical, cytological and ultrasound suspicious features.
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Affiliation(s)
- Isabel Amendoeira
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
- Department of Pathology, Medical Faculty of the University of Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Tiago Maia
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
- Department of Pathology, Medical Faculty of the University of Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
- Department of Pathology, Medical Faculty of the University of Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- I3S - Institute of Investigation and Innovation in Health, Porto, Portugal
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49
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Strickland KC, Eszlinger M, Paschke R, Angell TE, Alexander EK, Marqusee E, Nehs MA, Jo VY, Lowe A, Vivero M, Hollowell M, Qian X, Wieczorek T, French CA, Teot LA, Cibas ES, Lindeman NI, Krane JF, Barletta JA. Molecular Testing of Nodules with a Suspicious or Malignant Cytologic Diagnosis in the Setting of Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP). Endocr Pathol 2018; 29:68-74. [PMID: 29396809 DOI: 10.1007/s12022-018-9515-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an indolent thyroid tumor characterized by frequent RAS mutations and an absence of the BRAF V600E mutation commonly seen in classical papillary thyroid carcinoma (cPTC). The ability to differentiate potential NIFTP/follicular variant of papillary thyroid carcinoma (FVPTC) from cPTC at the time of fine-needle aspiration (FNA) can facilitate conservative management of NIFTP. The aim of the current study was to investigate how molecular testing may add to cytologic assessment in the pre-operative differentiation of potential NIFTP/FVPTC and cPTC. We had previously evaluated cytologists' ability to prospectively distinguish potential NIFTP/FVPTC from cPTC in a cohort of 56 consecutive FNAs diagnosed as malignant or suspicious for malignancy. We utilized this cohort to perform molecular analysis. Detected molecular abnormalities were stratified into two groups: (1) those supporting malignancy and (2) those supporting a diagnosis of potential NIFTP/FVPTC. The cytologists' characterization of cases and the detected molecular alterations were correlated with the final histologic diagnoses. Molecular testing was performed in 52 (93%) of the 56 cases. For the 37 cases cytologists favored to be cPTC, 31 (84%) had a molecular result that supported malignancy (28 BRAF V600E mutations, 2 NTRK1 fusions, 1 AGK-BRAF fusion). For the 8 cases that were favored to be NIFTP/FVPTC by cytologists, 7 (88%) had a molecular result that supported conservative management (1 NRAS mutation, 6 wild-type result). Seven cases were designated as cytomorphologically indeterminate for NIFTP/FVPTC or cPTC, of which 6 (86%) had a molecular result that would have aided in the pre-operative assessment of potential NIFTP/FVPTC or cPTC/malignancy. These included 3 BRAF V600E mutations in nodules that were cPTC on resection, an HRAS mutation, and a wild-type result in the 2 nodules that were NIFTP, and a TERT promoter mutation along with an NRAS mutation in a poorly differentiated thyroid carcinoma. For nodules with an FNA diagnosis of suspicious for malignancy or malignant, cytologists can differentiate most cases of potential NIFTP/FVPTC from cPTC. However, molecular testing may be valuable for a subset of cases, especially those that are indeterminate for potential NIFTP/FVPTC versus cPTC based on cytologic features alone.
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Affiliation(s)
- Kyle C Strickland
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Markus Eszlinger
- Departments of Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ralf Paschke
- Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Trevor E Angell
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Erik K Alexander
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ellen Marqusee
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Alarice Lowe
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Marina Vivero
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Monica Hollowell
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Xiaohua Qian
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Tad Wieczorek
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Christopher A French
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Lisa A Teot
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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50
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Abstract
Incidental thyroid nodules that are found on an imaging study performed for reasons other than thyroid pathology represent a common scenario encountered by health care providers. The initial workup for these nodules comprises a thorough history and physical examination, thyroid function tests, a dedicated thyroid ultrasound, and fine-needle aspiration of any suspicious lesions. Management ranges from observation and reassurance to surgical resection and depends on the cytologic diagnosis. In cases of cytologically indeterminate or discordant nodules, surgical excision (lobectomy) offers a definitive diagnosis, although molecular testing or a reasonable period of observation may be useful as less invasive adjuncts. CA Cancer J Clin 2018;68:97-105. © 2018 American Cancer Society.
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Affiliation(s)
- Sarah B Fisher
- Fellow, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy D Perrier
- Professor, Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Chief, Section of Surgical Endocrinology, Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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