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Thyroid Cancer pp 59–67Cite as

A Patient with a Pathological Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP)

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Abstract

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was proposed in 2016 as a new pathological diagnosis to replace the low-risk histologic diagnosis of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (NIEFVPTC). Development of this new nomenclature specifically omitted the word “cancer” from the name, since these tumors have been shown to have very low malignant potential and affected patients do not benefit from completion thyroidectomy and radioactive iodine (RAI) therapy. NIFTP was subsequently codified as a diagnostic entity by the World Health Organization in 2017.

Fewer than 1% of NIFTP tumors have been found on long-term follow-up to have local or distant metastases, despite conservative management without completion thyroidectomy or radioactive iodine treatment. Rigorous criteria for the diagnosis of NIFTP include (1) encapsulation or clear demarcation; (2) follicular growth pattern with <1% papillae (and no true papillae), no psammoma bodies, and <30% solid/trabecular/insular growth pattern; (3) nuclear score of 2–3 (papillary-like features present); (4) no vascular or capsular invasion; (5) no tumor necrosis; and (6) no high mitotic activity (defined as three mitoses per ten high-power fields). These tumors often have indeterminate cytology, a low-risk ultrasonographic appearance, and a RAS or RAS-like molecular profile. Lobectomy without completion thyroidectomy or RAI is both definitively diagnostic and therapeutic since the diagnosis of NIFPT requires excision of the entire tumor for pathologic evaluation, and treatment beyond simple lobectomy does not add further outcome benefit.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes, and Metabolism, New York University, New York, NY, USA

    David Carruthers & Steven P. Hodak

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  1. David Carruthers
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  2. Steven P. Hodak
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Correspondence to Steven P. Hodak .

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Editors and Affiliations

  1. Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    Giorgio Grani

  2. Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David S. Cooper

  3. Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy

    Cosimo Durante

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Carruthers, D., Hodak, S.P. (2021). A Patient with a Pathological Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP). In: Grani, G., Cooper, D.S., Durante, C. (eds) Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-61919-0_8

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  • DOI: https://doi.org/10.1007/978-3-030-61919-0_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-61918-3

  • Online ISBN: 978-3-030-61919-0

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