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Annals of Surgical Oncology

, Volume 26, Issue 1, pp 93–97 | Cite as

Effect of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Malignancy Rates in Thyroid Nodules: How to Counsel Patients on Extent of Surgery

  • Brenessa M. Lindeman
  • Matthew A. Nehs
  • Trevor E. Angell
  • Erik K. Alexander
  • Atul A. Gawande
  • Francis D. MooreJr.
  • Gerard M. Doherty
  • Nancy L. ChoEmail author
Endocrine Tumors
  • 144 Downloads

Abstract

Purpose

To investigate the impact of the nomenclature change to “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP) on reported malignancy rates following thyroidectomy.

Methods

Retrospective cohort study of patients with thyroid nodules sampled preoperatively with fine-needle aspiration (FNA) and subsequently removed at one tertiary-care hospital from 4/2016 to 2/2017. Surgical procedure, anatomic pathology, thyroid cytopathology classification, and demographic characteristics were recorded.

Results

Thyroidectomy was performed in 353 patients. Twenty-six patients (7.3%) had NIFTP on anatomic pathology. Preoperative FNA demonstrated atypia of undetermined significance (AUS/Bethesda III) in 13 (50%), suspicious for malignancy (SUS/Bethesda V) in 6 (23%), suspicious for follicular neoplasm (SFN/Bethesda IV) in 4 (15%), benign/Bethesda I in 2 (8%), and malignant/Bethesda VI in 1 (4%). Invasive malignancy rates across cytologic categories changed as follows: benign (n = 74) from 4 to 1%, AUS (n = 85) from 33 to 18% (p < 0.05), SFN (n = 58) from 29 to 22%, SUS (n = 33) from 91 to 73% (p < 0.05), and malignant (n = 99) from 99 to 98%. Overall decrease in invasive malignancy was 7.3% for the entire population and 13.1% for indeterminate preoperative FNA cytology (Bethesda III–V). Among 26 NIFTP patients, 17 had thyroid lobectomy (TL) and 9 underwent total thyroidectomy (TT). Eight of the nine patients with TT could have been definitively treated with TL, an 89% decrease.

Conclusions

The NIFTP nomenclature change led to an overall decrease in the malignancy rate at our institution, especially for Bethesda III–V categories. Patients may be counseled toward more conservative surgical options if NIFTP is in the differential.

Notes

Disclosures

None.

References

  1. 1.
    SEER Cancer Stat Facts: Thyroid cancer. National Cancer Institute. Bethesda, MD. http://seer.cancer.gov/statfacts/html/thyro.html
  2. 2.
    Vivero M, Kraft S, Barletta JA. Risk stratification of follicular variant of papillary thyroid carcinoma. Thyroid. 2013;23:273–9.CrossRefGoogle Scholar
  3. 3.
    Gupta S, Ajise O, Dultz L, Wang B, Nonaka D, Ogilvie J, Heller KS, Patel KN. Follicular variant of papillary thyroid cancer: encapsulated, nonencapsulated, and diffuse: distinct biologic and clinical entities. Arch Otolaryngol Head Neck Surg. 2012;138:227–33.CrossRefGoogle Scholar
  4. 4.
    Ganly I, Wang L, Tuttle RM, et al. Invasion rather than nuclear features correlates with outcome in encapsulated follicular tumors: further evidence for the reclassification of the encapsulated papillary thyroid carcinoma follicular variant. Hum Pathol. 2015;46:657–64.CrossRefGoogle Scholar
  5. 5.
    Nikiforov Y, Seethala RR, Tallini G, Baloch ZW, Basolo F, Thompson LDR, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2016;2:1023–9.CrossRefGoogle Scholar
  6. 6.
    Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009;19(11):1159–65.  https://doi.org/10.1089/thy.2009/0274.CrossRefGoogle Scholar
  7. 7.
    Thompson LD. Ninety-four cases of encapsulated follicular variant of papillary thyroid carcinoma: a name change to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features would help prevent overtreatment. Mod Pathol. 2016;29:698–07.CrossRefGoogle Scholar
  8. 8.
    Kiernan CM, Weiss VL, Mehrad M, Ely K, Baregamian N, Solorzano CC. New terminology-noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) and its effect on the rate of malignancy at a single institution. Surgery. 2018;163(1):55–9.CrossRefGoogle Scholar
  9. 9.
    Zhou H, Baloch ZW, Nayar R, Bizzarro T, Fadda G, Adhikari-Guragain D, Hatem J, Larocca LM, Samolczyk J, Slade J, Rossi ED. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): Implications for the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Cancer. 2017.  https://doi.org/10.1002/cncy.21926. [Epub ahead of print].
  10. 10.
    Lau RP, Paulsen JD, Brandler TC, Liu CZ, Simsir A, Zhou F. Impact of the reclassification of “noninvasive encapsulated follicular variant of papillary thyroid carcinoma” to “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” on the Bethesda System for Reporting Thyroid Cytopathology: a large academic institution’s experience. Am J Clin Pathol. 2017.  https://doi.org/10.1093/ajcp/aqx136. [Epub ahead of print].
  11. 11.
    Li W, Sciallis A, Lew M, Pang J, Jing X. Implementing noninvasive follicular thyroid neoplasm with papillary-like nuclear features may potentially impact the risk of malignancy for thyroid nodules categorized as AUS/FLUS and FN/SFN. Diagn Cytopathol. 2018;46(2):148–53.  https://doi.org/10.1002/dc.23866.CrossRefGoogle Scholar
  12. 12.
    Yassa L, Cibas ES, Benson CB, Frates MC, Doubilet PM, Gawande AA, Moore FD Jr., Kim BW, Nose V, Marqusee E, Larsen PR, Alexander EK. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer Cytopathol. 2007; 111(6):508–16.CrossRefGoogle Scholar
  13. 13.
    Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid. 2017;27(11):1341–46.  https://doi.org/10.1089/thy.2017.0500.CrossRefGoogle Scholar
  14. 14.
    Brandler TC, Yee J, Zhou F, Cho M, Cangiarella J, Wei XJ, Yee-Chang M, Sun W. Does noninvasive follicular thyroid neoplasm with papillary-like nuclear features have distinctive features on sonography? Diagn Cytopathol. 2018;46(2):139–47.  https://doi.org/10.1002/dc.23863.CrossRefGoogle Scholar
  15. 15.
    You SH, Lee KE, Yoo RE, Choi HJ, Jung KC, Won JK, Kang KM, Yoon TJ, Choi SH, Sohn CH, Kim JH. Prevention of total thyroidectomy in noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) based on combined interpretation of ultrasonographic and cytopathologic results. Clin Endocrinol (Oxf). 2018;88(2):114–22.  https://doi.org/10.1111/cen.13473.CrossRefGoogle Scholar
  16. 16.
    Strickland KC, Vivero M, Jo VY, Lower AC, Hollowell M, Qian X, Wieczorek TJ, French CA, Teot LA, Sadow PM, Alexander EK, Cibas ES, Barletta JA, Krane JF. Preoperative cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a prospective analysis. Thyroid. 2016;26(10):1466–71.CrossRefGoogle Scholar
  17. 17.
    Brandler TC, Zhou F, Liu CZ, Cho M, Lau RP, Simsir A, Patel KN, Sun W. Can noninvasive follicular thyroid neoplasm with papillary-like nuclear features be distinguished from classic papillary thyroid carcinoma and follicular adenomas by fine-needle aspiration? Cancer Cytopathol. 2017;125(6):378–88.CrossRefGoogle Scholar
  18. 18.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.CrossRefGoogle Scholar
  19. 19.
    Strickland KC, Howitt BE, Marqusee E, Alexander EK, Cibas ES, Krane JF, Barletta JA. The impact of noninvasive follicular variant of papillary thyroid carcinoma on rates of malignancy for fine-needle aspiration diagnostic categories. Thyroid. 2015;25(9):987–92.CrossRefGoogle Scholar
  20. 20.
    Vanderlaan PA, Krane JF, Cibas ES. The frequency of “atypia of undetermined significance” interpretations for thyroid fine-needle aspirations is negatively correlated with histologically proven malignant outcomes. Acta Cytol. 2011;55(6):512–7.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Brenessa M. Lindeman
    • 1
  • Matthew A. Nehs
    • 2
  • Trevor E. Angell
    • 2
  • Erik K. Alexander
    • 2
  • Atul A. Gawande
    • 2
  • Francis D. MooreJr.
    • 2
  • Gerard M. Doherty
    • 2
  • Nancy L. Cho
    • 2
    Email author
  1. 1.University of Alabama at BirminghamBirminghamUSA
  2. 2.Brigham and Women’s HospitalBostonUSA

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