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Endocrine

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Non-invasive follicular thyroid neoplasm with papillary-like nuclearfeatures (NIFTP): a review and update

  • Bita Geramizadeh
  • Zahra MalekiEmail author
Review

Abstract

Background

The nomenclature “Non-invasive Follicular Neoplasm with Papillary-like Nuclear Features (NIFTP)” was introduced in 2016. While NIFTP differs from classic papillary thyroid carcinoma (PTC) in imaging, cytomorphology, histology, molecular profile, treatment, follow up, outcome, and behavior, it largely overlaps with follicular variant of PTC at imaging and cytomorphology. Herein, we review the literature for better understanding NIFTP, and its impact on patient care.

Methods

The English literature was thoroughly evaluated with the key word of “Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP)”.

Observations

NIFTP presents as a thyroid nodule. On imaging, it is a round-to-oval, well circumscribed mass with solid internal content. Aspirated material shows a microfollicular pattern with focal nuclear features of PTC mostly reported in categories 3–5 of the Bethesda System for Reporting Thyroid Cytology (TBRSTC). NIFTP has decreased risk of malignancy in TBRSTC categories 3–6. Histologic examination of NIFTP reveals an encapsulated neoplasm with follicular pattern and nuclear features of PTC with no capsular or vascular invasion. No papillary structure, atypia, or mitosis is present. In contrast to PTC, only 4% of NIFTP cases harbor a BRAF mutation. Because NIFTP carries an excellent prognosis and indolent behavior, the tumor behavior was changed from malignant to a neoplasm with tumor with extremely indolent behavior. The recommended treatment is lobectomy with no further ablation therapy. Until better understanding of NIFTP, patient’s follow up should be occasionally performed by neck ultrasonography and serum thyroglobulin measurement.

Conclusion

NIFTP carries an excellent prognosis. It is critical for both clinicians and patients to be aware of extremely indolent behavior of NIFTP in order to prevent unnecessary, aggressive treatment.

Highlights

  • Non-invasive follicular thyroid neoplasm with papillary like nuclear features (NIFTP) refers to a subset of encapsulated thyroid neoplasms that was recently reclassified from malignant to tumor with extremely indolent behavior.

  • The tumor behavior and molecular profile differ from papillary thyroid carcinoma and it is treated with lobectomy with a favorable outcome.

Keywords

NIFTP Thyroid Fine needle aspiration (FNA) TBRSTC Cytology Review 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. 1.Department of PathologyMedical School of Shiraz University, Shiraz University of Medical SciencesShirazIran
  2. 2.Division of Cytopathology, Department of PathologyThe Johns-Hopkins HospitalBaltimoreUSA

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