Practice Paradigms Before and After Introduction of the Diagnosis-Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): an Institutional Experience

Katsakhyan, Levon; Song, Sharon; Lepe, Marcos; Shojaei, Hadi; Montone, Kathleen T.; LiVolsi, Virginia A.; Baloch, Zubair W.

doi:10.1007/s12022-020-09614-5

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…Systematic review demonstrated significant heterogeneity of cytopathologic findings among the largest observational studies containing ≥14 cases having NIFTP histodiagnosis with cytopathologic correlations. Fifty largest studies included into the systematic analysis (totally 2603 cases with cyto‐histopathological correlations) were reported by Faquin, 5 Mainthia, 6 Zhou, 7 Rosario, 8 Lastra, 9 Çelik, 10 Maletta, 11 Canberk, 12 Lau, 13 Strickland, 14 Howitt, 15 Yang, 16 Song, 17 Kim, 18 Bychkov, 19 Katsakhyan, 20 Brandler, 21 Zhang, 22 Chandler, 23 Zhao, 24 You, 25 Larouche, 26 Hirokawa, 27 Yan, 28 Bizzarro, 29 Glass, 30 Sung, 31 Koshikawa, 32 Legesse, 33 Hahn, 34 Mao, 35 Maleki, 36 Mito, 37 Linhares, 38 Yan, 28 Range and Jiang, 39 Lindeman, 40 Kim, 18 Ibrahim and Wu, 41 Mahajan, 42 Ng, 43 Singh, 44 Selvaggi, 45 Lee, 46 Rana, 47 Li, 48 Kiernan, 49 Ventura, 50 Paulson, 51 and Jaconi et al 52 (Table 4).…”

Section: Resultsmentioning

confidence: 99%

Detailed fine needle aspiration cytopathology findings of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features with nuclear grading correlated to that of biopsy and Bethesda category and systematic review

Kaçar Özkara,

Turan

2023

Diagnostic Cytopathology

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BackgroundNoninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) poses diagnostic challenge in fine needle aspiration cytopathology (FNAC). We aimed first to document our FNAC Bethesda categories (BCs) for all of our NIFTPs and compare our findings with those in the literature with series containing at least 14 cases each.MethodsCases with final histopathological diagnoses of NIFTP and their preoperative FNAC were retrieved from 2006 to 2022 and our cytopathological BCs were documented. Then the slides were re‐reviewed in a blinded manner for detailed classification and the results of both the BCs and blinded reclassification were compared with series in the literature for both BCs and detailed cytopathological review of the cases.ResultsThyroid FNACs of 43 out of 86 patients with final NIFTP diagnoses were obtained. Females composed 72.1% (F/M: 31/12); mean age and mean tumor diameter was 47.6 (19–72 years) and 23.4 mm (7–60 mm), respectively. Totally 81.4% (35/43) were classified in the “indeterminate” diagnostic categories; namely 44.2% (19/43) were reported as atypia of undetermined significance (AUS; BC III), 20.9% (9/43) were follicular neoplasm (FN; BC IV), and 16.3% (7/43) were suspicious for malignancy (SM; BC V). No patient was diagnosed as positive for malignancy (BC VI), preoperatively.Detailed cytomorphologic reevaluation revealed heterogeneous cytopathologic findings and nuclear grade (especially nuclear enlargement, membrane irregularity and elongation) significantly increased with respect to BCs. Systematic review confirmed extremely heterogeneous cytomorphologic nature of NIFTP.ConclusionsNIFTPs were categorized most frequently as AUS, followed by FN and SM on FNAC. Our re‐review were not able to specify features solely unique to NIFTP alone but may distinguish these cases from classic papillary thyroid carcinoma.

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Section: Resultsmentioning

confidence: 99%

Detailed fine needle aspiration cytopathology findings of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features with nuclear grading correlated to that of biopsy and Bethesda category and systematic review

Kaçar Özkara,

Turan

2023

Diagnostic Cytopathology

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“…Hemithyroidectomy is the preferred surgical approach, providing there are no lesions in the contralateral lobe, as recommended by the American Thyroid Association guidelines [23]. However, Katsakhyan et al [25] did not nd signi cant changes in the number of total or partial thyroidectomies performed as initial surgeries comparing a pre-to a post-NIFTP cohort. Perhaps more time is needed to show changes, as a signi cant increase in the rate of hemithyroidectomies was found when comparing surgical treatment of thyroid cancer before or after the release of the 2015 American Thyroid Association Guidelines [26].…”

Section: Resultsmentioning

confidence: 99%

Non-invasive follicular neoplasm with papillary-like nuclear features: a challenging and infrequent entity in Argentina

Saban

Tolaba²,

Orlandi³

et al. 2022

Endocrine

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Purpose: Non-invasive encapsulated follicular variant of papillary thyroid cancer was reclassi ed as noninvasive 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 pro le. 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%) ful lled 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 ndings 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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“…of cytologic diagnoses in pre-and post-NIFTP periods. 45 One explanation is that nuclear features of NIFTP are usually subtle and typically not well developed enough to warrant a definitive cytologic diagnosis of PTC, 38,46 yet the majority of CSC demonstrate diffuse PTC nuclear features. 29 In our study, there were no false-positive diagnoses of NIFTP using our original criteria (pre-RC) or after using RC (post-RC) (Table 3).…”

Section: Discussionmentioning

confidence: 99%

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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Practice Paradigms Before and After Introduction of the Diagnosis-Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): an Institutional Experience

Cited by 11 publications

References 28 publications

Detailed fine needle aspiration cytopathology findings of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features with nuclear grading correlated to that of biopsy and Bethesda category and systematic review

Detailed fine needle aspiration cytopathology findings of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features with nuclear grading correlated to that of biopsy and Bethesda category and systematic review

Non-invasive follicular neoplasm with papillary-like nuclear features: a challenging and infrequent entity in Argentina

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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