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Morphologische Diagnosekriterien der nichtinvasiven follikulären Neoplasie mit PTC-äquivalenten Kernmerkmalen (NIFTP)

Eine diagnostische Herausforderung zum Nutzen des Patienten

Morphologic diagnostic criteria of noninvasive follicular neoplasia with papillary-like nuclear features (NIFTP)

A diagnostic challenge for the patient’s benefit

  • Schwerpunkt: Endokrine/Neuroendokrine Pathologie
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Zusammenfassung

Durch die Einführung der nichtinvasiven follikulären Neoplasie mit PTC-äquivalenten Kernmerkmalen (NIFTP) wird Patienten mit einer biologisch indolenten Subgruppe der follikulären Variante des papillären Karzinoms (FV-PTC) sowohl eine Übertherapie als auch der psychologisch belastende Befund Krebs/Karzinom erspart. Zur Diagnose einer NIFTP bestehen allerdings stringente histologische und molekularpathologische Kriterien. Eine NIFTP kann wenige Millimeter groß, aber auch deutlich größer als 4 cm sein. Histologisch muss eine gekapselte/eindeutig demarkierte Läsion mit (>70 %) follikulärem Aufbau und den Kerncharakteristika des PTC als Grundvoraussetzung vorliegen. Invasion von Kapsel/Gefäßen muss ebenso ausgeschlossen sein wie größere Anteile (>30 %) mit solidem/trabekulärem/insulärem Aufbau, Psammomkörperchen, Tumornekrosen, eine erhöhte Mitoserate (≥3/10 HPF) und/oder eine BRAF-V600E-Mutation. Die Etablierung der NIFTP machte eine Neudefinition der Diagnosekriterien des PTC notwendig und hat Auswirkungen auf die Bewertung der Feinnadelpunktion (FNB) der Schilddrüse. Obwohl eine Vorhersage schwierig ist, könnte die korrekte Diagnose der NIFTP zu einer Reduktion der Schilddrüsenkarzinominzidenz von 10–20 % führen.

Abstract

The major goals of the introduction of the noninvasive follicular neoplasia with papillary-like nuclear features (NIFTP) are to spare patients with a biologically indolent subgroup of the follicular variant of papillary carcinoma (FV-PTC) both overtreatment and the psychologically burden of a cancer/carcinoma diagnosis. However, strict histological and molecular pathological criteria have been introduced for the diagnosis of NIFTP. NIFTP tumors may be a few millimeters in diameter, but may also measure more than 4 cm. Histologically, an encapsulated/clearly demarcated lesion with (>70%) follicular structure and the nuclear characteristics of PTC must be present as a prerequisite; invasion of capsule/vessels must be excluded as well as significant proportions (>30%) showing a solid/trabecular/insular growth pattern, psammoma bodies, tumor necrosis, an increased mitotic rate (>3/10 HPF), and/or a BRAF V600E mutation. The establishment of the NIFTP necessitated a redefinition of the diagnostic criteria of PTC and has implications on the evaluation of fine needle biopsy (FNB) of the thyroid gland. Although a prediction is difficult, the correct diagnosis of NIFTP could lead to a 10–20% reduction in thyroid carcinoma incidence.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    S. Theurer &  K. W. Schmid

  2. Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    H. Dralle

  3. Klinik für Endokrinologie, Diabetologie und Stoffwechselerkrankungen, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    D. Führer-Sakel

  4. Klinik für Nuklearmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    K. Herrmann

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Interessenkonflikt

S. Theurer, H. Dralle, D. Führer-Sakel, K. Herrmann und K. W. Schmid geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen oder an menschlichem Gewebe wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Die Untersuchungen erfolgten unter Einhaltung der Vorgaben der Zentralen Ethikkommission der Bundesärztekammer.

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K. W. Schmid, Essen

H. A. Baba, Essen

H.-U. Schildhaus, Essen

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Theurer, S., Dralle, H., Führer-Sakel, D. et al. Morphologische Diagnosekriterien der nichtinvasiven follikulären Neoplasie mit PTC-äquivalenten Kernmerkmalen (NIFTP). Pathologe 40, 220–226 (2019). https://doi.org/10.1007/s00292-019-0597-0

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