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

Ferris, Robert L.; Nikiforov, Yuri E.; Terris, David J.; Seethala, Raja R.; Ridge, John A.; Angelos, Peter; Duh, Quan Yang; Wong, Richard J.; Sabra, Mona M.; Fagin, James A.; McIver, Bryan; Bernet, Victor; Harrell, R. Mack; Busaidy, Naifa L.; Cibas, Edmund S.; Faquin, William C.; Sadow, Peter M.; Baloch, Zubair W.; Shindo, Maisie L.; Orloff, Lisa A.; Davies, Louise; Randolph, Gregory W.

doi:10.1002/hed.25141

Cited by 45 publications

(45 citation statements)

References 28 publications

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“…According to the current ATA clinical guidelines, NIFTP is a surgical disease. It requires surgical removal and histological evaluation, because it is a precancer in definition and should be removed under the Western logic . However, in Asian perspectives, accurate distinction between FA and borderline tumors (UMP and NIFTP) is not important clinically, and under‐diagnosis of borderline tumors as FA does not harm to the patients because both can be treated by simple excision and cured.…”

Section: Follicular Adenoma and Borderline Tumorsmentioning

confidence: 99%

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Kakudo

Bychkov

Bai

et al. 2018

Pathology International

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Section: Follicular Adenoma and Borderline Tumorsmentioning

confidence: 99%

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Kakudo

Bychkov

Bai

et al. 2018

Pathology International

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“…All follicular‐patterned tumors, including NIFTP, remain surgical disease. A nodule's entire capsule needs to be examined thoroughly to make the diagnosis . Whereas most studies focus on malignancy, the risk of neoplasm is important.…”

Section: Discussionmentioning

confidence: 99%

“…While the BRAF V600E mutation and RET‐PTC1/3 fusions correlate with a very high risk of malignancy, this is not true for all targets in the molecular assays. RAS mutations and PAX8‐PPARγ fusions have been recognized in a broad spectrum of follicular‐based tumors, ranging from benign to malignant neoplasms …”

Section: Discussionmentioning

confidence: 99%

“…If the diagnostic criteria are strictly applied, these tumors are not anticipated to have the molecular aberrations such as BRAF V600E that are strongly associated with classic PTC. Rather, they exhibit a high number of mutations related to follicular‐based tumors, with the most common being RAS mutations …”

Section: Discussionmentioning

confidence: 99%

“…For these patients, extensive surgery can be deemed overtreatment. There has been a noticeable shift toward more conservative management and personalized medicine . Ancillary molecular testing is often endorsed as a supplement to enhance the diagnostic yield of FNAs with indeterminate cytology .…”

Section: Introductionmentioning

confidence: 99%

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Risk of malignancy and neoplasia predicted by three molecular testing platforms in indeterminate thyroid nodules on fine‐needle aspiration

Partyka

Trevino

Randolph

et al. 2019

Diagnostic Cytopathology

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BACKGROUND The management of thyroid nodules with indeterminate cytology is challenging. Recently, molecular testing on fine‐needle aspirates (FNAs) has been advocated to determine whether clinical follow‐up or surgery is warranted for patients. Three different testing platforms were performed on aspirates from our institution (Afirma Thyroid FNA Analysis, RosettaGX Reveal, and Interpace ThyGenX/ThyraMIR). This study compares their diagnostic efficacy. METHODS We conducted a retrospective analysis of indeterminate thyroid FNAs with correlating molecular testing over 4 years (2015‐2018). The aspirates included diagnoses of follicular lesion of undetermined significance, follicular neoplasm, or suspicious for malignancy (SM). Based on cases that underwent surgical resection (Afirma, n = 37; Rosetta, n = 19; Interpace, n = 14), we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for risk of malignancy and neoplasia. RESULTS The three tests performed similarly when predicting risk of malignancy. They showed high sensitivity (80‐100%) and NPV (90‐100%) but lower specificity (10‐64%) and PPV (21‐44%). When assessing their value to predict neoplasia, each test had a high PPV (76‐89%) but low NPV (20‐33%). The sensitivity for neoplasm was intermediate to high (50‐93%), and the specificity remained extremely variable (11‐67%). CONCLUSION Overall, these molecular platforms performed similarly, displaying high NPV but low to intermediate PPV for malignancy and low NPV but high PPV for neoplasm. The risk of neoplasm is a good index for surgery, and we argue that many of the neoplasms are low‐risk tumors. We endorse conservative treatment with lobectomy for cases that are indeterminate at FNA but suspicious by molecular testing.

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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

Elsheikh,

Thomas,

Brainard

et al. 2024

Cancer Cytopathology

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BackgroundNoninvasive 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 MethodsA 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.ResultsRC 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.ConclusionsRC 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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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

Cited by 45 publications

References 28 publications

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

Risk of malignancy and neoplasia predicted by three molecular testing platforms in indeterminate thyroid nodules on fine‐needle aspiration

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

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