“The other side of the coin”: understanding noninvasive follicular tumor with papillary-like nuclear features in unifocal and multifocal settings

Canberk, Şule; Montezuma, Diana; Taştekin, Ebru; Grangeia, Diana; Demirhas, Mehmet Polat; Akbas, Meryem; Tokat, Fatma; İnce, Ümit; Soares, Paula; Schmitt, Fernando

doi:10.1016/j.humpath.2018.10.040

Cited by 27 publications

(20 citation statements)

References 21 publications

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“…The predictions, which were based on retrospective data from four institutions (three Italian and one American), resulted in a calculated rate of NIFTP of 18.6% among all PTC cases (4). After more than 3 years from the introduction of the new nomenclature, it appears that the initial calculations were overestimated (8,9,10,11,12,13,14,15,16,17,18,19,20,21).…”

Section: Epidemiologymentioning

confidence: 99%

Section: Clinical and Ultrasonographic Featuresmentioning

confidence: 99%

“…In clinical practice, NIFTP presents as a single nodule (10) or a lesion in the context of a multinodular background (27, 40, 41). The multifocal form of NIFTP is present in 2.7-14.7% of patients (10,40,42). The coexistence of a malignant lesion in the same or in the second lobe of the thyroid may affect 14.9-46.3% of NIFTP patients (it most often coexists with papillary thyroid microcarcinoma) (10,21,41).…”

Section: Clinical and Ultrasonographic Featuresmentioning

confidence: 99%

Section: Treatment and Monitoringmentioning

confidence: 99%

“…Decisions on the extent of surgery should consider that bilateral disease and multifocal disease are part of the spectrum of NIFTP neoplasms (10,40,42). The coexistence of malignant lesions in the same or the other thyroid lobe may affect up to 15-46% of NIFTP patients (10,21,41). In the study by Canberk et al, 15% of NIFTP cases (11/74) were accompanied by malignant lesions in the contralateral thyroid lobe, including five PTCs, five microcarcinoma FVPTCs and one IFVPTC; two of the contralateral malignancies showed microscopic extrathyroidal extension (10).…”

Section: Treatment and Monitoringmentioning

confidence: 99%

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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Zajkowska

Kopczyński

Góźdż

et al. 2020

Endocrine Connections

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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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Section: Epidemiologymentioning

confidence: 99%

Section: Clinical and Ultrasonographic Featuresmentioning

confidence: 99%

Section: Clinical and Ultrasonographic Featuresmentioning

confidence: 99%

Section: Treatment and Monitoringmentioning

confidence: 99%

Section: Treatment and Monitoringmentioning

confidence: 99%

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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Zajkowska

Kopczyński

Góźdż

et al. 2020

Endocrine Connections

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Case report & review: Bilateral NIFTP harboring concomitant HRAS and KRAS mutation: Report of an unusual case and literature review

Brogna,

Collina,

Chiofalo

et al. 2024

Molecular Carcinogenesis

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Diagnosis and treatment of thyroid disease are affected by the wide range of thyroid cancer subtypes and their varying degrees of aggressiveness. To better describe the indolent nature of thyroid neoplasms previously classified as noninvasive follicular variant of papillary thyroid carcinoma (NI‐FVPTC), the Endocrine Pathology Society working group has recently coined the term “noninvasive follicular thyroid neoplasm with papillary‐like nuclear features” (NIFTP). The purpose of this nomenclature change is to avoid patients the distress of cancer diagnosis and to decrease the overtreatment of thyroid nodules with a RAS‐LIKE molecular profile similar to follicular adenoma. Consequently, the reclassification has a significant impact on thyroid nodule clinical care as well as histopathologic and cytopathologic diagnosis. This paper will focus on a unique case of Bilateral NIFTP harboring concomitant HRAS and KRAS mutation; we will also review the background, molecular features, and clinical implications of NIFTP as well as the factors behind the nomenclature update. It also seemed helpful to emphasize the impact of NIFTP on clinical practice to avoid overtreating nodules that could be safely managed with lobectomy alone. Actually, despite the diagnosis is postsurgery, a comprehensive preoperative evaluation may raise a suspicion of NIFTP and suggest a more careful plan for treatment. Here, we present a unique case of bilateral NIFTP after total thyroidectomy; subsequent molecular analysis revealed that the patient's right nodule harbored an isolated p.(Q61K) HRAS mutation, while the left a p.(Q61K) KRAS mutation. To the best of our knowledge, this is the first case report of this nature. The existence of simultaneous mutations highlights the occurrence of intratumoral heterogeneity (ITH) also in the context of FVPTC, which requires comprehensive investigation. The available information shows that NIFTP, identified in accordance with stringent inclusion and exclusion criteria, exhibits a very latent clinical behavior even in the face of conservative lobectomy, lacking of radioactive iodine therapy. However, it cannot be regarded as a benign lesion because there is a small but significant incidence of adverse events, such as lymph nodes and distant metastases. Currently, NIFTP can only be suspected before surgery: several efforts could be explored to identify key molecular, cytological, and ultrasonographic traits that may be helpful in raising the possibility of NIFTP in the preoperative context. Additionally, our discovery of simultaneous mutations within the same lesion strengthens the evidence of ITH even in FVPTC. Although the extent and biological impact of this phenomenon in NIFTP are still debated, a deeper understanding is essential to ensure appropriate clinical management.

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NIFTP in Asian Practice

Bychkov,

Rana,

Liu

et al. 2023

Thyroid FNA Cytology

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“The other side of the coin”: understanding noninvasive follicular tumor with papillary-like nuclear features in unifocal and multifocal settings

Cited by 27 publications

References 21 publications

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Case report & review: Bilateral NIFTP harboring concomitant HRAS and KRAS mutation: Report of an unusual case and literature review

NIFTP in Asian Practice

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