1
|
Zand A, Kim TH, Rodriguez EF, Moatamed NA. THADA-IGF2BP3 gene fusions in thyroid fine needle aspiration is involved in the pathway to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features". Diagn Cytopathol 2024. [PMID: 38877784 DOI: 10.1002/dc.25373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The increased usage and adaptation of molecular testing of thyroid fine needle aspirations (FNA) has expanded the variety and number of gene fusions identified. While the identified number of molecular alterations is increasing, the definitive association between preoperative molecular analysis and phenotype has yet to be established. The aim of this study was to examine Thyroid adenoma-associated (THADA)-IGF2BP3 molecular fusions with FNA categorization, surgical pathology diagnosis, and other molecular alterations detected by ThyroSeq Genomic Classifier testing. METHODS FNA cytology samples of thyroid nodules from 04/2017 to 01/2023 with the diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) or follicular neoplasm suspicious for follicular neoplasm (FN/SFN; Bethesda IV) with associated ThyroSeqV3 testing were reviewed. Parameters including patient demographics, FNA diagnosis, ThyroSeq V3 results, and surgical pathology follow up were examined. RESULTS 87 out of 249 (35%) FNA specimens of thyroid nodules displayed molecular alterations. 64 cases (74%) had a cytology diagnosis of AUS and 23 (26%) had FN. RAS mutation was observed in 48 cases. On surgical follow-up, 17 (35%) cases showed non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), while 14 (29%) patients had a malignant diagnosis. THADA-IGF2BP3 fusions were seen in 8 cases, all with NIFTP on surgical pathology follow-up (100%). CONCLUSIONS Analysis of THADA-IGF2BP3 fusion, in our institutional series, shows close association with NIFTP cases. THADA-IGF2BP3 fusion, which seems to be a favorable prognostic indicator in general, may serve as a molecular marker for non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).
Collapse
Affiliation(s)
- Amanda Zand
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, California, Los Angeles, USA
| | - Teresa H Kim
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, California, Los Angeles, USA
| | - Erika F Rodriguez
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, California, Los Angeles, USA
| | - Neda A Moatamed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, California, Los Angeles, USA
| |
Collapse
|
2
|
Elsheikh TM, Thomas M, Brainard J, Di Marco J, Manosky E, Springer B, Underwood D, Chute DJ. Papillae, psammoma bodies, and/or many nuclear pseudoinclusions are helpful criteria but should not be required for a definitive cytologic diagnosis of papillary thyroid carcinoma: An institutional experience of 207 cases with surgical follow up. Cancer Cytopathol 2024; 132:348-358. [PMID: 38563725 DOI: 10.1002/cncy.22817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Noninvasive follicular thyroid neoplasm with papillary-like features (NIFTP) was introduced in 2016 replacing noninvasive follicular variant of papillary thyroid carcinoma, with recommendations to label them "noncancer." To avoid reducing risk of malignancy (ROM) and overdiagnosing NIFTP as malignant, some authors required restricted cytologic criteria (RC) for a definitive diagnosis of papillary thyroid carcinoma (PTC), including papillae, psammoma bodies. or ≥3 nuclear pseudoinclusions. Since then, NIFTP criteria have been revised, biologic behavior better understood, and incidence reported to be much lower than initially anticipated. This study examines the impact of RC on PTC cytologic diagnoses, ROM, and detection of clinically significant carcinomas (CSC). MATERIALS AND METHODS A total of 207 thyroid FNAs originally diagnosed as PTC and suspicious for PTC (SPTC) with surgical follow-up were evaluated. RC were retrospectively applied to cases as a requirement for diagnosing PTC, and cases that did not meet RC were reclassified as SPTC. ROMs and diagnostic accuracies of pre- and post-RC diagnoses were correlated with followup CSC. RESULTS RC were met in 118/142 (83%) and 20/65 (31%) of cases originally diagnosed as PTC and SPTC, respectively. Post-RC, 29% (19/65) of CSC originally diagnosed as SPTC were upgraded to PTC, and 17% (24/142) of CSC originally diagnosed as PTC were downgraded to SPTC. No NIFTPs were diagnosed as malignant. CONCLUSIONS RC should not be required for a definitive diagnosis of PTC when other nuclear features of PTC are diffuse and overt. Applying RC, however, helps the pathologist arrive at a more definitive diagnosis of PTC in suspicious cases.
Collapse
Affiliation(s)
- Tarik M Elsheikh
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew Thomas
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer Brainard
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica Di Marco
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erica Manosky
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bridgette Springer
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dawn Underwood
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Deborah J Chute
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2023; 33:1039-1044. [PMID: 37427847 DOI: 10.1089/thy.2023.0141] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Since the publication of the first edition in 2010, The Bethesda System for Reporting Thyroid Cytopathology has allowed cytopathologists to use a standardized, category-based reporting system for thyroid fine needle aspirations. The third edition builds on the success of the 2 earlier editions and offers several key updates. The most important is the assignment of a single name for each of the 6 diagnostic categories: (i) nondiagnostic; (ii) benign; (iii) atypia of undetermined significance; (iv) follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. Each of the categories has an implied risk of malignancy (ROM), which has been updated and refined based on data reported after the second edition. The third edition offers an average ROM for each category, in addition to the expected range of cancer risk. The atypia of undetermined significance subcategorization is simplified into 2 subgroups based on the implied ROM and molecular profiling. A discussion of pediatric thyroid disease has been added, and pediatric ROMs and management algorithms are discussed in the relevant sections. Nomenclature has been updated to align with the 2022 World Health Organization Classification of Thyroid Neoplasms. Two new chapters have been added: one that addresses the significant and expanded use of molecular and ancillary testing in thyroid cytopathology, and another that summarizes clinical perspectives and imaging findings in thyroid disease.
Collapse
Affiliation(s)
- Syed Z Ali
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | | | - Fernando C Schmitt
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Philippe Vielh
- Department of Pathology, Medipath and the American Hospital of Paris, Paris, France
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for reporting thyroid cytopathology. J Am Soc Cytopathol 2023; 12:319-325. [PMID: 37438235 DOI: 10.1016/j.jasc.2023.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Since the publication of the first edition in 2010, The Bethesda System for Reporting Thyroid Cytopathology has allowed cytopathologists to use a standardized, category-based reporting system for thyroid fine needle aspirations. The third edition builds on the success of the 2 earlier editions and offers several key updates. The most important is the assignment of a single name for each of the 6 diagnostic categories: (i) nondiagnostic; (ii) benign; (iii) atypia of undetermined significance; (iv) follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. Each of the categories has an implied risk of malignancy (ROM), which has been updated and refined based on data reported after the second edition. The third edition offers an average ROM for each category, in addition to the expected range of cancer risk. The atypia of undetermined significance subcategorization is simplified into 2 subgroups based on the implied ROM and molecular profiling. A discussion of pediatric thyroid disease has been added, and pediatric ROMs and management algorithms are discussed in the relevant sections. Nomenclature has been updated to align with the 2022 World Health Organization Classification of Thyroid Neoplasms. Two new chapters have been added: one that addresses the significant and expanded use of molecular and ancillary testing in thyroid cytopathology, and another that summarizes clinical perspectives and imaging findings in thyroid disease.
Collapse
Affiliation(s)
- Syed Z Ali
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | | | - Fernando C Schmitt
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Philippe Vielh
- Department of Pathology, Medipath and the American Hospital of Paris, Paris, France
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
Follicular Neoplasm of Thyroid Revisited: Current Differential Diagnosis and the Impact of Molecular Testing. Adv Anat Pathol 2023; 30:11-23. [PMID: 36102526 DOI: 10.1097/pap.0000000000000368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diagnosis of "follicular neoplasm" (FN) in thyroid cytopathology has a long history that originated not long after the practice of fine-needle aspiration (FNA) of thyroid nodules. From the outset, this interpretive category was intended to convey a set of differential diagnoses rather than a precise diagnosis, as key diagnostic features, such as capsular and vascular invasion, were not detectable on cytology preparations. Cytologic-histologic correlation studies over the past several decades have shown that FN interpretation can be applied to the spectrum of nonneoplastic tumors to carcinomas. Most tumors classified as FN include follicular adenoma, follicular carcinoma, noninvasive follicular thyroid tumor with papillary-like nuclear features, and follicular variant of papillary thyroid carcinoma. Less common entities that may be classified as FN on FNA include hyalinizing trabecular tumor (HTT), poorly differentiated thyroid carcinoma, medullary carcinoma, and nonthyroidal lesions such as parathyroid tissue, paraganglioma, and metastatic tumors. Advances in our ability to detect characteristic molecular alterations (eg, GLIS gene rearrangements for hyalinizing trabecular tumor) in FNA samples may assist in the identification of some of these entities. In this review, we summarize the pathophysiology, history, and evolution of the terminology and the current differential diagnosis according to the recently published 2022 World Health Organization classification, molecular testing, and management of nodules classified as FN.
Collapse
|
6
|
Wong KS, Barletta JA. The new endocrine WHO classification: What does this mean for thyroid cytology? Cancer Cytopathol 2022; 130:658-662. [PMID: 35969231 DOI: 10.1002/cncy.22634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
The new World Health Organization classification of endocrine tumors will include many updates on thyroid pathology. This summary highlights the changes that are most relevant for cytopathologists.
Collapse
Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
LiVolsi VA, Baloch Z. Noninvasive Follicular Tumor With Papillary-like Nuclear Features: A Practice Changer in Thyroid Pathology. Arch Pathol Lab Med 2021; 145:659-663. [PMID: 32223558 DOI: 10.5858/arpa.2019-0689-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— This article presents a review of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), including its separation from follicular variant of papillary carcinoma of the thyroid, its evolution, and current definition and pathologic characteristics. OBJECTIVES.— To emphasize the understanding of the concept of NIFTP as a neoplasm based on molecular analyses, its critical histopathologic features, the microscopic findings that exclude the diagnosis, and the importance of complete sectioning of the tumor to exclude neoplasms that should be diagnosed as carcinomas. Important distinctions are discussed including difficulties with literature that shows NIFTP with metastases, inadequacy of sectioning of the tumor, and lack of descriptive histology of the surrounding thyroid and possible other lesions. DATA SOURCES.— Review of articles in the English literature on NIFTP, as well as comparative papers showing differences and distinctions between this entity and papillary carcinomas. CONCLUSIONS.— This article concludes that with the current state of knowledge on NIFTP with studies from all over the world, this entity is a low-risk neoplasm that, when diagnosed using appropriate criteria, should not be associated with metastatic or recurrent disease, at least on intermediate length of follow-up. This review includes discussion of multifocal NIFTP, as well as the recently defined micro-NIFTP (1 cm or less), and describes features of the tumor that remain to be studied and correlated with outcome: oncocytic variants of NIFTP, percentage of allowable solid areas of growth in the lesions, and definitions of true neoplastic papillae and hyperplastic ones and how these should influence the diagnosis of NIFTP.
Collapse
Affiliation(s)
- Virginia A LiVolsi
- From the Department of Pathology & Laboratory Medicine, the Hospital of the University of Pennsylvania, Philadelphia
| | - Zubair Baloch
- From the Department of Pathology & Laboratory Medicine, the Hospital of the University of Pennsylvania, Philadelphia
| |
Collapse
|
8
|
Zurikat RO, Khader M, Azzam MI, Zahid ZM, Daoud SF, Nusirat SF, Albsoul N, Al-Natsheh MA, Al-Abbadi MA. Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP): a 13-year retrospective review at Jordan University Hospital. Endocrine 2020; 69:339-346. [PMID: 32319013 DOI: 10.1007/s12020-020-02299-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) is the term to describe what was previously known as encapsulated follicular variant of papillary thyroid carcinoma. This new paradigm shift was agreed upon by experts in the field. The objective of this study is to evaluate cases previously diagnosed as follicular adenomas, follicular variant of papillary thyroid carcinoma and hyperplastic nodules to be reclassified as NIFTP according to the new criteria. Furthermore, the clinical follow-up of these NIFTP cases is evaluated. METHODS This retrospective study reviewed potential NIFTP cases over the last 13 years, at Jordan University Hospital. RESULTS A total of 811 thyroid surgery reports were identified and revised to identify the potential NIFTP cases. The review yielded 173 cases identified as potential NIFTP cases. Further pathological slide review resulted in a revised diagnosis of 32 cases of NIFTP according to the new criteria. The NIFTP cases comprised 4% of the total number of thyroidectomy cases and 16.1% of the total pool of previously diagnosed papillary thyroid carcinoma cases at our institution. While 111 cases retained their original diagnosis. Follow-up showed that all patients are alive and well with no evidence of disease. CONCLUSION Patients with NIFTP are not uncommon and the diagnosis is made only after a thorough evaluation of excision. Therefore, initial conservative management of solitary thyroid nodules suspicious for NIFTP in the form of lobectomy is recommended to avoid unnecessary total thyroidectomies. Our follow-up of NIFTP cases is similar to all previous reports.
Collapse
Affiliation(s)
- Rajai O Zurikat
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Majd Khader
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Muayad I Azzam
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Zaid M Zahid
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Samer F Daoud
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Salam F Nusirat
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Nader Albsoul
- Department of General Surgery, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Motaz A Al-Natsheh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan.
| |
Collapse
|
9
|
Katsakhyan L, Song S, Lepe M, Shojaei H, Montone KT, LiVolsi VA, Baloch ZW. Practice Paradigms Before and After Introduction of the Diagnosis-Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): an Institutional Experience. Endocr Pathol 2020; 31:174-181. [PMID: 32146581 DOI: 10.1007/s12022-020-09614-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The recently adopted terminology of "Noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) reflects the indolent behavior of these tumors. In contrast to conventional papillary thyroid carcinomas, NIFTP can be managed conservatively. The purpose of this study was to investigate changes in surgical and pathologic practice patterns at our institution since the introduction of the NIFTP diagnosis in 2016. A retrospective analysis of all thyroid specimens received in our laboratory between January 2015 and April 2017 was performed. The final cohort consisted of 1508 thyroidectomy specimens from 1508 patients (1153 (76.5%) women and 355 (23.5%) men), of which 1011 (67%) were total thyroidectomies and 497 (33%) were partial thyroidectomies. There were 558 (69.2%) total thyroidectomies and 248 (30.8%) partial thyroidectomies performed prior to introduction of the NIFTP diagnosis and 453 (64.5%) and 249 (35.5%) total and partial thyroidectomies, respectively, after the change in nomenclature. Within a year following the initial use of this diagnosis, 67 NIFTP cases were identified (9.5% of all thyroidectomies), whereas compared with the year preceding it, malignant diagnoses decreased from 54.5 (439) to 44.6% (313), and the benign category remained unchanged from 44.5 (367) to 45.9% (322). For the entirely submitted 67 NIFTP cases, the mean number of blocks submitted was 14.7 (0.98 blocks/g); for malignant lesions 17.7 (0.92 blocks/g); and for benign lesions 16.6 (0.75 blocks/g). The results of our study suggest that NIFTP are encountered in almost 10% of thyroidectomies at our institution with expected shifts in cytology and surgical pathology diagnoses as a result of the change in nomenclature. During this time period, significant shifts towards less aggressive surgical management were not observed. All 67 NIFTP nodules were submitted entirely with no significant difference in the number of cassettes submitted for NIFTP nodules as compared with follicular variant papillary thyroid carcinoma (PTC), classic variant PTC, or follicular adenoma.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/classification
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Male
- Middle Aged
- Pathology, Surgical/standards
- Pathology, Surgical/statistics & numerical data
- Pathology, Surgical/trends
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Practice Patterns, Physicians'/trends
- Retrospective Studies
- Thyroid Cancer, Papillary/classification
- Thyroid Cancer, Papillary/surgery
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/surgery
- Thyroidectomy/statistics & numerical data
- Young Adult
Collapse
Affiliation(s)
- Levon Katsakhyan
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA.
| | - Sharon Song
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Marcos Lepe
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Hadi Shojaei
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Kathleen T Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders. 3400 Spruce street, Philadelphia, PA, 19104, USA
| |
Collapse
|
10
|
Deftereos G, Schmechel SC, Waner EE, Itani M, Dighe MK, Tylee TS. Differential outcomes of patients with thyroid FNA diagnoses of AUS/FLUS with and without nuclear atypia: The potential need for separation in the Bethesda System. Diagn Cytopathol 2020; 48:610-617. [PMID: 32259404 DOI: 10.1002/dc.24424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND In the current version of The Bethesda System (TBS) for thyroid cytopathology, the atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) category has an estimated risk of malignancy of 10% to 30%. Diagnostic criteria include presence of nuclear atypia, suggestive of papillary thyroid carcinoma (PTC), as well as other types of atypia, which can be seen with non-malignant entities. Aim of this study was to investigate differential outcomes of AUS/FLUS, based on specific morphologic criteria, and assess their respective malignancy risks. METHODS From a total of 1233 patients undergoing thyroid FNAs between 2010 and 2014 at the University of Washington, 119 had AUS/FLUS without nuclear atypia, and 64 with nuclear atypia. Outcomes for patients with and without nuclear atypia (with the exception of 24 patients lost to follow-up) were evaluated and results were compared. RESULTS 16/57 (28.1%) patients with AUS/FLUS and nuclear atypia subsequently had carcinomas on thyroidectomy, statistically higher than the 8/102 patients (7.8%, P = .001) without nuclear atypia. When comparing only patients who underwent surgery (n = 63), again those with AUS/FLUS and nuclear atypia had statistically higher rates of carcinoma (16/31, 51.6%), compared to those without (8/32, 25%; P = .0394). Overall, 24/159 (15.1%) of patients with AUS/FLUS had carcinoma on subsequent histology. CONCLUSION Malignancy rates for AUS/FLUS were in line with TBS estimated risks. However, our data demonstrate that the presence or absence of nuclear atypia is associated with different malignancy rates, suggesting the possibility that the AUS/FLUS category may best be split into two subcategories with different implied risks of malignancy.
Collapse
Affiliation(s)
- Georgios Deftereos
- Department of Pathology, University of Washington, Seattle, WA, USA.,Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Stephen C Schmechel
- Department of Pathology, University of Washington, Seattle, WA, USA.,Sarapath Diagnostics, FL
| | - Emily E Waner
- Department of Medicine, University of Washington, Seattle, WA.,Division of Hospital Medicine, University of Colorado, Denver, CO
| | - Malak Itani
- Department of Radiology, University of Washington, Seattle, WA.,Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Manjiri K Dighe
- Department of Radiology, University of Washington, Seattle, WA
| | - Tracy S Tylee
- Department of Medicine, Division of Metabolism, University of Washington, Seattle, WA
| |
Collapse
|
11
|
Yu L, Hong H, Han J, Leng SX, Zhang H, Yan X. Comparison of Survival and Risk Factors of Differentiated Thyroid Cancer in the Geriatric Population. Front Oncol 2020; 10:42. [PMID: 32117715 PMCID: PMC7008846 DOI: 10.3389/fonc.2020.00042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose: The incidence rate of differentiated thyroid cancer (DTC), the most common type of thyroid cancer, has increased in the past two decades. The present study analyzed the clinical and pathological characteristics of DTC, and discussed the risk factors for survival in elderly age-risk DTC patients. Methods: Elderly patients who were diagnosed with DTC, and subsequently underwent surgery for DTC, were identified from the SEER database (1988–2008). Based on histology, these patients were divided into C-PTC, FV-PTC, and FTC. The clinical characteristics, pathological features, and treatments undertaken were compared among these patients. Cox proportional hazards analysis was performed to evaluate the risk factors to disease-specific survival (DSS). Results: In elderly DTC patients, FV-PTC shows intermediate tumor features compared to C-PTC and FTC, but presented a better outcome. Being male, African-American, tumors sized bigger than 4 cm, extrathyroidal extension, lymph node metastasis, and distant metastasis, were all strong risk factors for DSS in elderly DTC patients (all p < 0.05). No difference was found between lobectomy and total thyroidectomy with respect to DSS, and radiation therapy conferred no apparent advantage with respect to DSS (both p > 0.05). Discussion: Patients with FV-PTC needed more specific histology cataloging and risk assessment, suggesting conservative therapy. Risk stratification should be paid attention to, and treatment should be individualized for elderly patients.
Collapse
Affiliation(s)
- Lujiao Yu
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Hong Hong
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Jinyu Han
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Haiyan Zhang
- Department of Geriatrics, The First Hospital of China Medical University, Shenyang, China
| | - Xu Yan
- The VIP Department, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, China
| |
Collapse
|
12
|
Zajkowska K, Kopczyński J, Góźdź S, Kowalska A. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity. Endocr Connect 2020; 9:EC-19-0566.R1. [PMID: 32061158 PMCID: PMC7077601 DOI: 10.1530/ec-19-0566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/12/2020] [Indexed: 01/14/2023]
Abstract
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.
Collapse
Affiliation(s)
| | | | - Stanisław Góźdź
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology, Holycross Cancer Centre, Kielce, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| |
Collapse
|
13
|
Abstract
Thyroid carcinoma is the most common cancer in the endocrine system. Recent advances, using next-generation sequencing, have shed light on the molecular pathogenesis of thyroid cancer. Constitutional activation of the mitogen-activated protein kinase pathway through RAS mutation, BRAF mutation, and/or fusions involving receptor tyrosine kinase (eg, (REarranged during Transfection) RET-PTC) plays a central role in tumorigenesis and opens doors to promising tyrosine kinase inhibitor therapy. Several molecular signatures, such as TERT promoter mutation and TP53 mutation, are associated with tumor progression. This article provides a concise and updated summary of the main genetic alterations in thyroid carcinoma.
Collapse
Affiliation(s)
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| |
Collapse
|
14
|
Maleki S, Zandvakili A, Gera S, Khutti SD, Gersten A, Khader SN. Differentiating Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features from Classic Papillary Thyroid Carcinoma: Analysis of Cytomorphologic Descriptions Using a Novel Machine-Learning Approach. J Pathol Inform 2019; 10:29. [PMID: 31579155 PMCID: PMC6767786 DOI: 10.4103/jpi.jpi_25_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Recent studies show various cytomorphologic features that can assist in the differentiation of classic papillary thyroid carcinoma (cPTC) from noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Differentiating these two entities changes the clinical management significantly. We evaluated the performance of support vector machine (SVM), a machine learning algorithm, in differentiating cases of NIFTP and encapsulated follicular variant of papillary thyroid carcinoma with no capsular or lymphovascular invasion (EFVPTC) from cases of cPTC with the use of microscopic descriptions. SVM is a supervised learning algorithm used in classification problems. It assigns the input data to one of two categories by building a model based on a set of training examples (learning) and then using that learned model to classify new examples. Methods: Surgical pathology cases with the diagnosis of cPTC, NIFTP, and EFVPTC, were obtained from the laboratory information system. Only cases with existing fine-needle aspiration matching the tumor and available microscopic description were included. NIFTP cases with ipsilateral micro-PTC were excluded. The final cohort consisted of 59 cases (29 cPTCs and 30 NIFTP/EFVPTCs). Results: SVM successfully differentiated cPTC from NIFTP/EFVPTC 76.05 ± 0.96% of times (above chance, P < 0.05) with the sensitivity of 72.6% and specificity of 81.6% in detecting cPTC. Conclusions: This machine learning algorithm was successful in distinguishing NIFTP/EFVPTC from cPTC. Our results are compatible with the prior studies, which show cytologic features are helpful in differentiating these two entities. Furthermore, this study shows the power and potential of this approach for clinical use and in developing data-driven scoring systems, which can guide cytopathology and surgical pathology diagnosis.
Collapse
Affiliation(s)
- Sara Maleki
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pathology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Amin Zandvakili
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Shweta Gera
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Seema D Khutti
- Department of Pathology and Laboratory Medicine, Hofstra Northwell Health School of Medicine, New York, USA
| | - Adam Gersten
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Samer N Khader
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
15
|
Yan L, Sethi S, Park J. Cytologic and clinical features of NIFTP: Can we diagnose based on preoperative fine‐needle aspiration. Diagn Cytopathol 2019; 47:1259-1266. [DOI: 10.1002/dc.24309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/03/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Lei Yan
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Shenon Sethi
- Department of PathologyRush University Medical Center Chicago Illinois
| | - Ji‐Weon Park
- Department of PathologyRush University Medical Center Chicago Illinois
| |
Collapse
|
16
|
Vance J, Gilani SM. Thyroid cytopathology: updates and molecular testing. Pathologica 2019; 111:51-57. [PMID: 31388195 PMCID: PMC8186012 DOI: 10.32074/1591-951x-10-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/25/2019] [Indexed: 11/30/2022] Open
Abstract
The utility of fine needle aspiration (FNA) is well described in the context of evaluating thyroid lesions. Among the various international systems of classification of thyroid cytology, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has also provided a sound framework to standardize the reporting of FNA cytology results. New molecular evidence and clinical studies demonstrated the need for revision of the nomenclature resulting in introduction of new categories, such as the noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP). Indeterminate thyroid cytology results pose a challenge for further management and the continued development of molecular markers may aid in the management of indeterminate thyroid lesions.
Collapse
Affiliation(s)
- J Vance
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - S M Gilani
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| |
Collapse
|
17
|
Pusztaszeri M, Bongiovanni M. The impact of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on the diagnosis of thyroid nodules. Gland Surg 2019; 8:S86-S97. [PMID: 31475095 DOI: 10.21037/gs.2018.12.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
More than 70 years ago, Prof. Pierre Masson, a renowned French-Canadian pathologist (1880-1959), advised us that "No classification is more difficult to establish than that of thyroid carcinomas…Of all cancers, they teach, perhaps, the greatest lessons of humility to histopathologists." Almost 70 years later, the recent evidence-based reclassification of the non-invasive encapsulated follicular variant of papillary thyroid carcinoma (FVPTC) as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), has demonstrated that this problematic is still ongoing. For about 30 years, it was wrongly assumed that the encapsulated FVPTC behaved and spread like its classical counterpart and, therefore, that it should be treated likewise. As such, the renaming of a malignant entity as a nonmalignant (albeit not benign) neoplasm has contributed to optimizing patient care by deescalating treatment and follow-up for an indolent neoplasm, decreasing medical expense and complications possibly caused by further treatment including radioactive iodine, and reassuring patients with this diagnosis. At the same time, NIFTP has significant implications not only for the practice of thyroid cytopathology but also for surgical pathology and for molecular tests, creating significant new challenges. NIFTP has rigorous histopathologic diagnostic criteria, including papillary-like nuclear features, and submission of the entire tumor capsule and content is required to exclude both invasion and presence of papillary structures. Cytologically, because of the morphological overlap with other follicular neoplasms and with papillary thyroid carcinoma (PTC), most NIFTP are diagnosed into one of the indeterminate Bethesda categories (III-V) and can be adequately triaged for surgery. From a molecular view, NIFTP are most often characterized by RAS-type mutations, similar to other follicular-patterned lesions, and molecular testing can be helpful to suggest NIFTP preoperatively. In this review, we focus on the impact of NIFTP on the diagnosis of thyroid nodules.
Collapse
Affiliation(s)
- Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| |
Collapse
|
18
|
Angell TE. Getting more out of molecular testing for indeterminate thyroid nodules. Cancer Cytopathol 2019; 127:555-556. [PMID: 31237737 DOI: 10.1002/cncy.22129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Trevor E Angell
- Division of Endocrinology, Diabetes, and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
19
|
Rossi ED, Faquin WC, Baloch Z, Fadda G, Thompson L, Larocca LM, Pantanowitz L. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): Update and Diagnostic Considerations-a Review. Endocr Pathol 2019; 30:155-162. [PMID: 30953289 PMCID: PMC7477663 DOI: 10.1007/s12022-019-9574-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Advances in our understanding of thyroid lesions, especially those entities with an indolent behavior, has led clinicians to question the most appropriate surgical management of such thyroid nodules. Several studies have shown that the non-invasive encapsulated follicular variant of papillary thyroid carcinomas (NI-EFVPC) exhibits poor histopathologic diagnostic reproducibility and have been over-treated as conventional thyroid cancer. In 2015, an international thyroid working group re-evaluated NI-EFVPC and its diagnostic criteria. The new terminology of "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) was accordingly introduced to replace NI-EFVPC. The literature has emphasized that NIFTPs are biologically similar to follicular adenomas lacking lymph node metastases and/or recurrence. While the definition of NIFTP is based on specific morphological parameters, recent studies have questioned whether the criterion allowing less than 1% of true papillae should be revised to a total absence of papillae. The motivation for this revision is the rare finding, in some studies, of lymph nodes with metastatic NIFTP. This review evaluates the existing published series of NIFTP cases, clinical consequences of NIFTP, and emerging changes in the diagnostic criteria for NIFTP. The introduction of NIFTP has resulted in significant impact on the clinical management of thyroid nodules. Recent revisions in the morphological criteria for NIFTP emphasize the need to adhere to very stringent histomorphologic criteria when making a diagnosis of NIFTP. The adoption of NIFTP terminology instead of NI-EFVPC is associated with conservative lobectomy without radioactive iodine treatment in the majority of cases.
Collapse
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology- Fondazione Policlinico Universitario A.Gemelli-IRCCS, Largo Agostino Gemelli, 8-00168, Rome, Italy.
| | - William C Faquin
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Guido Fadda
- Division of Anatomic Pathology and Histology- Fondazione Policlinico Universitario A.Gemelli-IRCCS, Largo Agostino Gemelli, 8-00168, Rome, Italy
| | - Lester Thompson
- Pathology Department, Woodland Hills Medical Center, Woodland Hills, Los Angeles, CA, USA
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology- Fondazione Policlinico Universitario A.Gemelli-IRCCS, Largo Agostino Gemelli, 8-00168, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA
| |
Collapse
|
20
|
Geramizadeh B, Maleki Z. Non-invasive follicular thyroid neoplasm with papillary-like nuclearfeatures (NIFTP): a review and update. Endocrine 2019; 64:433-440. [PMID: 30868412 DOI: 10.1007/s12020-019-01887-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/25/2019] [Indexed: 12/22/2022]
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.
Collapse
Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns-Hopkins Hospital, Baltimore, USA.
| |
Collapse
|
21
|
Nishino M, Krane JF. Role of Ancillary Techniques in Thyroid Cytology Specimens. Acta Cytol 2019; 64:40-51. [PMID: 30947167 DOI: 10.1159/000496502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 01/11/2023]
Abstract
Ancillary molecular testing has emerged as a promising way to refine the preoperative risk stratification of thyroid nodules with indeterminate fine needle aspiration (FNA) biopsy results. Commercially available molecular tests for thyroid FNAs include those that analyze samples for mutations and gene fusions, gene expression alterations, microRNA expression alterations, chromosomal copy number alterations, or a combination thereof. This review summarizes the performance characteristics of the most current iterations of three tests currently marketed for cytologically indeterminate thyroid nodules: ThyroSeq v3, ThyGeNEXT/ThyraMIR, and Afirma Gene Sequencing Classifier.
Collapse
Affiliation(s)
- Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA,
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Liu Z, Bychkov A, Jung CK, Hirokawa M, Sui S, Hong S, Lai C, Jain D, Canberk S, Kakudo K. Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features in Asian practice. Pathol Int 2019; 69:202-210. [DOI: 10.1111/pin.12779] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Zhiyan Liu
- Department of PathologySchool of Basic Medical SciencesCheeloo College of MedicineShandong University Shandong China
- Department of PathologyQilu Hospital of Shandong University Shandong China
| | - Andrey Bychkov
- Department of PathologyFaculty of MedicineChulalongkorn University Bangkok Thailand
- Department of PathologyKameda Medical Center Kamogawa Japan
| | - Chan Kwon Jung
- Department of Hospital PathologyCollege of MedicineThe Catholic University of Korea Seoul South Korea
| | | | - Shaofeng Sui
- Department of Occupational and Environmental Health Monitoring and AssessmentShandong Center for Disease Control and Prevention Jinan China
| | - SoonWon Hong
- Department of PathologyYonsei University College of Medicine Seoul South Korea
| | - Chiung‐Ru Lai
- Department of PathologyTaipei Veterans General Hospital Taipei Taiwan
| | - Deepali Jain
- Department of PathologyAll India Institute of Medical Sciences New Delhi India
| | - Sule Canberk
- Cancer Signalling & MetabolismInstituto de Investigação e Inovação em SaúdeUniversidade do Porto Rua Alfredo Allen Porto Portugal
- Pathology & CytopathologyAcıbadem University Kerem Aydinlar Campus Block‐B, Ataşehir/İstanbul‐Turkey
| | - Kennichi Kakudo
- Faculty of MedicineDepartment of PathologyNara HospitalKindai University Nara Japan
| |
Collapse
|
23
|
Legesse T, Parker L, Heath J, Staats PN. Distinguishing non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) from classic and invasive follicular-variant papillary thyroid carcinomas based on cytologic features. J Am Soc Cytopathol 2019; 8:11-17. [PMID: 30929754 DOI: 10.1016/j.jasc.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/18/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION An international panel recently recommended reclassification of non-invasive follicular variant of papillary thyroid carcinoma (PTC) to non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). NIFTPs have little or no risk of recurrence and can be treated with lobectomy alone. Preoperative distinction of NIFTP from PTC will help avoid overtreatment. MATERIALS AND METHODS All thyroid tumors with a histologic diagnosis of PTC and preceding diagnostic cytology (n = 299) over a 5-year period were identified. Cases meeting criteria for NIFTP were reclassified as such. All NIFTP cases with available cytology (n = 6) and a similar number of randomly selected invasive follicular variant of papillary thyroid carcinoma (IFVPTC; n = 9) and classic PTC (cPTC, n = 11) were evaluated for 18 cytologic features. RESULTS A total of 35 (12%) lesions were reclassified as NIFTP, 194 (65%) were cPTC, and 70 (23%) were IFVPTC. The NIFTPs had a preceding cytologic interpretation of benign (31%), atypia of undetermined significance (34%), follicular neoplasm (9%), suspicious for malignancy (12%), or malignant (14%). Cytologically, NIFTP was distinguished from cPTC by absence of any architectural features in all 6 cases, and by absence of pseudoinclusions (P < 0.001) and multinucleated giant cells (P = 0.027) in nearly all. Nuclear pseudoinclusions (P = 0.001), marginal micronucleoli (P = 0.018), irregular branching sheets (P = 0.025), and linear arrangement (P = 0.025) favored IFVPTC over NIFTP. CONCLUSIONS NIFTPs were originally assigned to a variety of cytologic categories. There are several cytologic differences between NIFTP and cPTC or IFVPTC. Our findings support restricting the definitive diagnosis of PTC to cases with architectural features of PTC and/or intranuclear pseudoinclusions.
Collapse
Affiliation(s)
- Teklu Legesse
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Lynnette Parker
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathon Heath
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
24
|
Nishino M. How is noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) shaping the way we interpret thyroid cytology? J Am Soc Cytopathol 2019; 8:1-4. [PMID: 30929753 DOI: 10.1016/j.jasc.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
25
|
Abstract
Genomic, clinical, and pathologic studies have prompted a more risk-stratified approach to the management of patients with thyroid nodules. The recent nomenclature change concerning noninvasive follicular thyroid neoplasm with papillary-like nuclear features reflects the clinical trend toward conservative treatment choices for carefully selected low-risk thyroid neoplasms. These developments have occurred in parallel with a growing array of molecular tests intended to improve clinical triage for patients with indeterminate fine needle aspiration diagnoses. This review discusses the implications of the nomenclature revision on the interpretation of thyroid fine needle aspiration and updates available ancillary molecular tests for thyroid fine needle aspirations.
Collapse
Affiliation(s)
- Michiya Nishino
- Department of Pathology, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Jeffrey F Krane
- Department of Pathology, Harvard Medical School and Brigham and Women's Hospital, 75 Francis Street, Amory 3, Boston, MA 02115, USA
| |
Collapse
|
26
|
Ng Kee Kwong F, Fenlon C, van der Horst C. What is the risk of an overdiagnosis of malignancy in the preoperative assessment of noninvasive follicular thyroid neoplasm with papillary-like nuclear features? A review of the cytology and ultrasonography of 12 cases. Cytopathology 2018; 30:122-124. [PMID: 30320951 DOI: 10.1111/cyt.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Clare Fenlon
- Queen Elizabeth University Hospital, Glasgow, UK
| | | |
Collapse
|
27
|
Ferris RL, Nikiforov Y, Terris D, Seethala RR, Ridge JA, Angelos P, Duh Q, Wong R, Sabra MM, Fagin JA, McIver B, Bernet VJ, Harrell RM, Busaidy N, Cibas ES, Faquin WC, Sadow P, Baloch Z, Shindo M, Orloff L, Davies L, Randolph GW. AHNS Series: Do you know your guidelines? AHNS Endocrine Section Consensus Statement: State-of-the-art thyroid surgical recommendations in the era of noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Head Neck 2018; 40:1881-1888. [PMID: 29947030 PMCID: PMC6175359 DOI: 10.1002/hed.25141] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 01/31/2023] Open
Abstract
The newly introduced pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) will result in less bilateral thyroid surgery as well as deescalation in T4 suppressive and radioactive iodine treatment. Although, NIFTP is a nonmalignant lesion that has nuclear features of some papillary malignancies, the challenge for the surgeon is to identify a lesion as possibly NIFTP before the pathologic diagnosis. NIFTP, due to its reduction of overall rates of malignancy, will result in the initial surgical pendulum swinging toward lobectomy instead of initial total thyroidectomy. This American Head and Neck Society endocrine section consensus statement is intended to inform preoperative evaluation to attempt to identify those patients whose final pathology report may ultimately harbor NIFTP and can be offered a conservative surgical plan to assist in cost-effective, optimal management of patients with NIFTP.
Collapse
Affiliation(s)
- Robert L. Ferris
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Yuri Nikiforov
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Davis Terris
- Department of Otolaryngology ‐ Head and Neck SurgeryAugusta UniversityAugustaGeorgia
| | - Raja R. Seethala
- Department of PathologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - J. Andrew Ridge
- Department of Surgical OncologyFox Chase Cancer CenterPhiladelphiaPennsylvania
| | - Peter Angelos
- Department of SurgeryUniversity of Chicago Medical CenterChicagoIllinois
| | - Quan‐Yang Duh
- Department of SurgeryUniversity of California San FranciscoSan FranciscoCalifornia
| | - Richard Wong
- Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Mona M. Sabra
- Department of EndocrinologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - James A. Fagin
- Department of EndocrinologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Bryan McIver
- Department of Head and Neck ‐ Endocrine OncologyMoffitt Cancer CenterTampaFlorida
| | - Victor J. Bernet
- Department of EndocrinologyMayo Clinic JacksonvilleJacksonvilleFlorida
| | - R. Mack Harrell
- Department of EndocrinologyMemorial Regional HospitalHollywoodFlorida
| | - Naifa Busaidy
- Department of Endocrine NeoplasiaMD Anderson Cancer Center; HoustonTexas
| | - Edmund S. Cibas
- Department of PathologyBrigham and Women's HospitalBostonMassachusetts
| | - William C. Faquin
- Department of PathologyMassachusetts General HospitalBostonMassachusetts
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
| | - Peter Sadow
- Department of PathologyMassachusetts General HospitalBostonMassachusetts
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
| | - Zubair Baloch
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Maisie Shindo
- Department of OtolaryngologyOregon Health Science UniversityPortlandOregon
| | - Lisa Orloff
- Department of OtolaryngologyStanford UniversityStanfordCalifornia
| | - Louise Davies
- Department of Otolaryngology and AudiologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Gregory W. Randolph
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusetts
| |
Collapse
|
28
|
Kakudo K. How to handle borderline/precursor thyroid tumors in management of patients with thyroid nodules. Gland Surg 2018; 7:S8-S18. [PMID: 30175059 DOI: 10.21037/gs.2017.08.02] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Thyroid carcinomas originating from follicular cells have the prognosis of heterogeneous diseases, but pathologists classify them all as malignant disease. Epidemiologists have issued a stern warning regarding over-diagnosis and overtreatment of patients with indolent thyroid tumors that cause no harm to the patients. Review of the literature revealed that there were several proposals of borderline/precursor tumors to some indolent thyroid carcinomas. Thyroid tumor of uncertain malignant potential (UMP) was first proposed by Williams for encapsulated follicular pattern thyroid tumors to solve problems due to observer variation. Rosai et al. proposed to rename papillary microcarcinoma (PMC) to papillary micro-tumor as the overwhelming majority of them are of no clinical significance. Liu et al. proposed well-differentiated tumor with uncertain behavior (WDT-UB) which covered WDT of UMP (WDT-UMP) and non-invasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). The EFVPTC without invasion was renamed as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) by an international panel of pathologists. A new prognostic classification of thyroid tumors was proposed by Kakudo et al., in which extremely low risk tumors were grouped in a borderline tumors category. The borderline/precursor thyroid tumors included encapsulated tumors [capsular invasion only follicular carcinoma, encapsulated papillary carcinoma without invasion, WDT-UMP and follicular tumor of UMP (FT-UMP)] and non-encapsulated tumors (PMC). The UMP and NIFTP were incorporated in the 4th edition WHO classification of thyroid tumors as a new tumor entity in chapter 2-2A: other encapsulated follicular patterned thyroid tumors. Their behavior codes were decided to be 1 (borderline or uncertain behavior), and not 0 (benign), 2 (in situ carcinoma) or 3 (malignant). These borderline/precursor thyroid tumors are indolent tumors biologically and should be treated more conservatively than as previously recommended for thyroid follicular cell carcinomas [total thyroidectomy (TTX) followed by radio-active iodine (RAI) treatment] by western clinical guidelines.
Collapse
Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Kindai University Faculty of Medicine, Nara Hospital, Nara, Japan
| |
Collapse
|
29
|
Han K, Ha HJ, Kong JS, Kim JS, Myung JK, Koh JS, Park S, Shin MS, Song WT, Seol HS, Lee SS. Cytological Features That Differentiate Follicular Neoplasm from Mimicking Lesions. J Pathol Transl Med 2018; 52:110-120. [PMID: 29374960 PMCID: PMC5859246 DOI: 10.4132/jptm.2018.01.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background It is difficult to correctly diagnose follicular neoplasms (FNs) on fine-needle aspiration cytology (FNAC) because it shares many cytological features with other mimicking lesions. The aim of this study was to identify the cytological features that differentiate FNs from mimicking lesions. Methods We included the cytological slides from 116 cases of thyroid FN diagnosed on FNAC, and included their subsequent histological diagnoses. We evaluated the cytological architectural pattern and nuclear features of the lesions according to their histological groups. Results The final histological diagnoses of the 116 cases varied, and included 51 FNs (44%), 47 papillary thyroid carcinomas (40%) including follicular variant, and seventeen cellular nodular hyperplasias (15%). Regardless of the final histological diagnosis, microfollicular pattern was observed in most cases. On the other hand, trabecular pattern was identified in 34% of FNs, but not in any other lesions. Additionally, elongated nuclei and ground glass chromatin were found in only some papillary thyroid carcinomas. Conclusions This study shows that the trabecular pattern is a representative cytological feature of FNs that can be used to distinguish FNs from mimicking lesions. In addition, nuclear shape and chromatin pattern can be used to further confirm the diagnosis of FNs from mimicking lesions through FNAC.
Collapse
Affiliation(s)
- Kanghee Han
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Hwa-Jeong Ha
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Joon Seog Kong
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Jung-Soon Kim
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Jae Kyung Myung
- Laboratory of Radiation Pathology, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Jae Soo Koh
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Sunhoo Park
- Laboratory of Radiation Pathology, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Myung-Soon Shin
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Woo-Tack Song
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Hye Sil Seol
- Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| | - Seung-Sook Lee
- Laboratory of Radiation Pathology, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Korea
| |
Collapse
|
30
|
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 2017; 46:139-147. [PMID: 29193910 DOI: 10.1002/dc.23863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/18/2017] [Accepted: 11/06/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The noninvasive encapsulated follicular variant of papillary carcinoma (nEFVPTC) has recently been reclassified to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)," removing this entity from the malignant category. This re-categorization has had major implications for clinical management. NIFTP has overlapping cytohistologic features with papillary thyroid carcinoma (PTC) and with follicular adenomas (FA), but sonographic data comparing NIFTP to PTC and FA is lacking. Our study examines the sonographic features of NIFTP as compared with PTC and FA. METHODS Ultrasound scans and Doppler blood flow from subjects who had pre-surgical sonograms and fine needle aspiration biopsies with final surgical pathology diagnoses of NIFTP/nEFVPTC, classical PTC, and FA between 01/2013-08/2016 were assessed. Sonographic and Doppler features as well as Bethesda System (TBS) diagnoses were recorded and analyzed. RESULTS 40 NIFTP, 58 classical PTC, and 23 FA cases were included. The most common NIFTP pre-surgical TBS cytology diagnosis was Atypia of Undetermined Significance (AUS/FLUS) (40%). NIFTP cases predominantly displayed wider-than-tall shape (100%), smooth borders (75%), occurrence in multinodular glands (82.5%), heterogeneous echogenicity (50%), both perinodular and intranodular Doppler flow patterns (70%), minimal Doppler flow grade (62.5%), and no calcifications (90%). CONCLUSIONS Our study demonstrates that NIFTP, PTC, and FA display several distinguishing and overlapping sonographic and Doppler features. Sonographic features appear to complement cytology findings and may help raise pre-operative concern for NIFTP in the proper clinical setting, potentially leading to a more conservative management approach.
Collapse
Affiliation(s)
- Tamar C Brandler
- Department of Pathology, New York University School of Medicine, New York
| | - Joseph Yee
- Department of Radiology, New York University School of Medicine, New York
| | - Fang Zhou
- Department of Pathology, New York University School of Medicine, New York
| | - Margaret Cho
- Department of Pathology, New York University School of Medicine, New York
| | - Joan Cangiarella
- Department of Pathology, New York University School of Medicine, New York
| | - Xiao-Jun Wei
- Department of Pathology, New York University School of Medicine, New York
| | - Melissa Yee-Chang
- Department of Pathology, New York University School of Medicine, New York
| | - Wei Sun
- Department of Pathology, New York University School of Medicine, New York
| |
Collapse
|
31
|
Kakudo K, Higuchi M, Hirokawa M, Satoh S, Jung CK, Bychkov A. Thyroid FNA cytology in Asian practice-Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas. Cytopathology 2017; 28:455-466. [DOI: 10.1111/cyt.12491] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 01/31/2023]
Affiliation(s)
- K. Kakudo
- Department of Pathology; Kindai University Faculty of Medicine; Ikoma Japan
| | - M. Higuchi
- Department of Clinical Laboratory; Kuma Hospital; Kobe Japan
| | - M. Hirokawa
- Department of Diagnostic Pathology; Kuma Hospital; Kobe Japan
| | - S. Satoh
- Endocrine Surgery; Yamashita Thyroid Hospital; Fukuoka Japan
| | - C. K. Jung
- Department of Hospital Pathology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - A. Bychkov
- Department of Pathology; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| |
Collapse
|
32
|
Abstract
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid fine-needle aspiration (FNA) specimens. The 2017 revision reaffirms that every thyroid FNA report should begin with one of six diagnostic categories, the names of which remain unchanged since they were first introduced: (i) nondiagnostic or unsatisfactory; (ii) benign; (iii) atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS); (iv) follicular neoplasm or suspicious for a follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. There is a choice of two different names for some of the categories. A laboratory should choose the one it prefers and use it exclusively for that category. Synonymous terms (e.g., AUS and FLUS) should not be used to denote two distinct interpretations. Each category has an implied cancer risk that ranges from 0% to 3% for the "benign" category to virtually 100% for the "malignant" category, and, in the 2017 revision, the malignancy risks have been updated based on new (post 2010) data. As a function of their risk associations, each category is linked to updated, evidence-based clinical management recommendations. The recent reclassification of some thyroid neoplasms as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has implications for the risk of malignancy, and this is accounted for with regard to diagnostic criteria and optional notes. Such notes can be useful in helping guide surgical management.
Collapse
Affiliation(s)
- Edmund S Cibas
- 1 Departments of Pathology, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts
| | - Syed Z Ali
- 2 Department of Pathology, The Johns Hopkins Medical Institutions , Baltimore, Maryland
| |
Collapse
|
33
|
Abstract
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid fine-needle aspiration (FNA) specimens. The 2017 revision reaffirms that every thyroid FNA report should begin with 1 of 6 diagnostic categories, the names of which remain unchanged since they were first introduced: (1) Nondiagnostic or Unsatisfactory; (2) Benign; (3) Atypia of Undetermined Significance (AUS) or Follicular Lesion of Undetermined Significance (FLUS); (4) Follicular Neoplasm or Suspicious for a Follicular Neoplasm; (5) Suspicious for Malignancy; and (6) Malignant. There is a choice of two different names for some of the categories: a laboratory should choose the one it prefers and use it exclusively for that category; synonymous terms (eg, AUS and FLUS) should not be used to denote 2 distinct interpretations. Each category has an implied cancer risk that ranges from 0% to 3% for the "Benign" category to virtually 100% for the "Malignant" category, and, in the 2017 revision, the malignancy risks have been updated based on new (post 2010) data. As a function of their risk associations, each category is linked to updated, evidence-based clinical management recommendations. The recent reclassification of some thyroid neoplasms as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has implications for the risk of malignancy, and this is accounted for with regard to diagnostic criteria and optional notes. Such notes can be useful in helping guide surgical management.
Collapse
Affiliation(s)
- Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
34
|
Mito JK, Alexander EK, Angell TE, Barletta JA, Nehs MA, Cibas ES, Krane JF. A modified reporting approach for thyroid FNA in the NIFTP era: A 1-year institutional experience. Cancer Cytopathol 2017; 125:854-864. [DOI: 10.1002/cncy.21907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Jeffrey K. Mito
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Erik K. Alexander
- Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Trevor E. Angell
- Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Justine A. Barletta
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Matthew A. Nehs
- Department of Surgery; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Edmund S. Cibas
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Jeffrey F. Krane
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| |
Collapse
|
35
|
Hahn SY, Shin JH, Oh YL, Kim TH, Lim Y, Choi JS. Role of Ultrasound in Predicting Tumor Invasiveness in Follicular Variant of Papillary Thyroid Carcinoma. Thyroid 2017; 27:1177-1184. [PMID: 28699414 DOI: 10.1089/thy.2016.0677] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Follicular variant of papillary thyroid carcinoma (FVPTC) is traditionally divided into infiltrative and encapsulated types. Adding to this classification, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) represents a reclassification of a subset of cases (encapsulated tumors without lymphovascular or capsular invasion). The purpose of this study was to assess the role of ultrasound (US) in predicting tumor invasiveness in FVPTC. METHODS From January 2014 to May 2016, preoperative US examinations were performed on 151 patients with 152 FVPTCs who underwent surgery. Based on a pathologic analysis, the FVPTCs were categorized into three groups: NIFTP, invasive encapsulated FVPTC (iE-FVPTC), or infiltrative FVPTC (I-FVPTC). Each nodule was categorized based on the US pattern according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and the American Thyroid Association (ATA) guidelines. The correlation between tumor invasiveness and the K-TIRADS or ATA category was investigated using Spearman's rank correlation coefficient. RESULTS Among the 152 FVPTCs, there were 48 (31.6%) NIFTPs, 60 (39.5%) iE-FVPTCs, and 44 (28.9%) I-FVPTCs. US characteristics of the FVPTCs differed significantly according to tumor invasiveness (p ≤ 0.030). Tumor invasiveness showed a significant positive correlation with K-TIRADS (tumors of all sizes: r = 0.591, p < 0.001; tumors ≥1.0 cm: r = 0.427, p < 0.001) and ATA categories (tumors of all sizes: r = 0.532, p < 0.001; tumors ≥1.0 cm: r = 0.466, p < 0.001). According to both K-TIRADS and ATA guidelines for all-sized tumors, the most common subtype was NIFTP in low-suspicion nodules (52.6% and 51.6%), iE-FVPTC in intermediate-suspicion nodules (52.7% and 54.2%), and I-FVPTC in high-suspicion nodules (82.5% and 69.4%). After surgery, lymph node metastases were confirmed in two (4.2%) NIFTP cases, three (5.0%) iE-FVPTC cases, and eight (18.2%) I-FVPTC cases (p = 0.001). The results of the BRAF mutation analysis were not significantly different between the groups (p = 0.507). CONCLUSIONS Increasing tumor invasiveness from NIFTP to iE-FVPTC to I-FVPTC is positively correlated with the level of suspicion on US using both K-TIRADS and ATA guidelines.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/secondary
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnostic imaging
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/secondary
- Carcinoma, Papillary, Follicular/surgery
- Female
- Humans
- Lymphatic Metastasis
- Male
- Middle Aged
- Neoplasm Invasiveness/diagnostic imaging
- Neoplasm Invasiveness/pathology
- Practice Guidelines as Topic
- Retrospective Studies
- Seoul
- Tertiary Care Centers
- Thyroid Cancer, Papillary
- Thyroid Gland/diagnostic imaging
- Thyroid Gland/pathology
- Thyroid Gland/surgery
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/secondary
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Tumor Burden
- Ultrasonography
- Ultrasonography, Doppler
- Young Adult
Collapse
Affiliation(s)
- Soo Yeon Hahn
- 1 Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Jung Hee Shin
- 1 Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Young Lyun Oh
- 2 Department of Pathology, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Tae Hyuk Kim
- 3 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Yaeji Lim
- 4 Department of Statistics, Pukyong National University , Busan, Korea
| | - Ji Soo Choi
- 1 Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| |
Collapse
|
36
|
Onenerk AM, Pusztaszeri MP, Canberk S, Faquin WC. Triage of the indeterminate thyroid aspirate: What are the options for the practicing cytopathologist? Cancer Cytopathol 2017; 125:477-485. [PMID: 28609009 DOI: 10.1002/cncy.21828] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 12/26/2022]
Abstract
Fine-needle aspiration (FNA) plays a key role in the early evaluation of patients with thyroid nodules; however, from 15% to 30% of FNA specimens are cytologically indeterminate. Molecular testing has proven useful when applied to indeterminate thyroid FNAs, and its use has been endorsed in the American Thyroid Association guidelines. In addition to the noncommercial ("in-house") application of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF), rat sarcoma (RAS), rearranged in transformation/papillary thyroid carcinoma (RET/PTC), and peroxisome proliferator-activated receptor γ/paired box gene 8 (PPARγ/PAX8) testing, there are currently 3 commercially available molecular panels that vary in their relative reported performances, strengths, and limitations. Here, we discuss the role of molecular testing for indeterminate thyroid aspirates, taking into consideration the recent reclassification of the encapsulated follicular variant of papillary thyroid carcinoma (PTC) as "noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP)." Cancer Cytopathol 2017;125(6 suppl):477-85. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Ayse M Onenerk
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marc P Pusztaszeri
- Department of Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - Sule Canberk
- Acibadem University, Department of Pathology, Istanbul, Turkey
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
37
|
Ohori NP, Wolfe J, Carty SE, Yip L, LeBeau SO, Berg AN, Schoedel KE, Nikiforov YE, Seethala RR. The influence of the noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) resection diagnosis on the false‐positive thyroid cytology rate relates to quality assurance thresholds and the application of NIFTP criteria. Cancer Cytopathol 2017; 125:692-700. [DOI: 10.1002/cncy.21892] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 01/21/2023]
Affiliation(s)
- N. Paul Ohori
- Department of PathologyUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Jenna Wolfe
- Department of PathologyUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Sally E. Carty
- Division of Endocrine SurgeryUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Linwah Yip
- Division of Endocrine SurgeryUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Shane O. LeBeau
- Division of EndocrinologyUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Aaron N. Berg
- Department of PathologyUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Karen E. Schoedel
- Department of PathologyUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Yuri E. Nikiforov
- Department of PathologyUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| | - Raja R. Seethala
- Department of PathologyUniversity of Pittsburgh Medical Center‐PresbyterianPittsburgh Pennsylvania
| |
Collapse
|
38
|
Glomski K, Nosé V, Faquin WC, Sadow PM. Metastatic Follicular Thyroid Carcinoma and the Primary Thyroid Gross Examination: Institutional Review of Cases from 1990 to 2015. Endocr Pathol 2017; 28:177-185. [PMID: 28444500 DOI: 10.1007/s12022-017-9483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnosis of follicular-patterned carcinomas, including follicular thyroid carcinoma, oncocytic (Hürthle cell) carcinoma, and the encapsulated follicular variant of papillary thyroid carcinoma, requires evidence of capsular and/or vascular invasion. With minimally invasive carcinomas classified often within less than a millimeter of tissue segregating them from adenomas and non-invasive follicular thyroid neoplasms with papillary-like nuclear features, opinions vary internationally over how much of the capsule to submit in order to deem it well enough represented, considering that even if grossly entirely submitted in microcassettes, without leveling through each tissue block, the capsule is truly never entirely examined microscopically. Here, we retrospectively examine submission practices and outcomes at a single, high-volume institution over a 25-year period. Our results indicate that the vast majority of lesions with poor outcomes are those with wide invasion, and tumors lacking gross evidence of capsular perturbation rarely lead to recurrence or metastasis, an unsurprising result that should prompt re-evaluation of our grossing methods and approach to follicular-patterned tumors in a time of cost restraint, molecular diagnostics, and low biological potential of encapsulated, circumscribed neoplasia of the thyroid.
Collapse
Affiliation(s)
- Krzysztof Glomski
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Vania Nosé
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - William C Faquin
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
| | - Peter M Sadow
- Pathology Service, WRN219, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Pathology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
| |
Collapse
|
39
|
Yang GCH, Fried KO, Scognamiglio T. Sonographic and cytologic differences of NIFTP from infiltrative or invasive encapsulated follicular variant of papillary thyroid carcinoma. Diagn Cytopathol 2017; 45:533-541. [DOI: 10.1002/dc.23709] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Grace C. H. Yang
- Department of Pathology and Laboratory Medicine; Weill Medical College of Cornell University; New York
| | | | - Theresa Scognamiglio
- Department of Pathology and Laboratory Medicine; Weill Medical College of Cornell University; New York
| |
Collapse
|
40
|
Zhao L, Dias-Santagata D, Sadow PM, Faquin WC. Cytological, molecular, and clinical features of noninvasive follicular thyroid neoplasm with papillary-like nuclear features versus invasive forms of follicular variant of papillary thyroid carcinoma. Cancer Cytopathol 2017; 125:323-331. [DOI: 10.1002/cncy.21839] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Liena Zhao
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Dora Dias-Santagata
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Peter M. Sadow
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - William C. Faquin
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| |
Collapse
|
41
|
Zhou AG, Bishop JA, Ali SZ. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). J Am Soc Cytopathol 2017; 6:211-216. [PMID: 31043245 DOI: 10.1016/j.jasc.2017.06.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/29/2022]
Abstract
Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a new term replacing what was previously known as non-invasive encapsulated follicular variant of papillary thyroid carcinoma (FVPTC). These tumors show benign/indolent clinical behavior when compared with invasive FVPTC, which led to their reclassification as a "non-malignant" neoplasm. NIFTP shares essentially similar cytomorphologic features as FVPTC, and can only be definitively diagnosed on surgical excision specimens. This article provides an update on morphologic characteristics of NIFTP, along with pertinent molecular studies and management algorithms.
Collapse
Affiliation(s)
- Amy G Zhou
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|