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Kaçar Özkara S, Turan G. Detailed fine needle aspiration cytopathology findings of noninvasive follicular thyroid neoplasm with papillary-like nuclear features with nuclear grading correlated to that of biopsy and Bethesda category and systematic review. Diagn Cytopathol 2023; 51:758-771. [PMID: 37688282 DOI: 10.1002/dc.25219] [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: 06/03/2023] [Revised: 07/26/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) poses diagnostic challenge in fine needle aspiration cytopathology (FNAC). We aimed first to document our FNAC Bethesda categories (BCs) for all of our NIFTPs and compare our findings with those in the literature with series containing at least 14 cases each. METHODS Cases with final histopathological diagnoses of NIFTP and their preoperative FNAC were retrieved from 2006 to 2022 and our cytopathological BCs were documented. Then the slides were re-reviewed in a blinded manner for detailed classification and the results of both the BCs and blinded reclassification were compared with series in the literature for both BCs and detailed cytopathological review of the cases. RESULTS Thyroid FNACs of 43 out of 86 patients with final NIFTP diagnoses were obtained. Females composed 72.1% (F/M: 31/12); mean age and mean tumor diameter was 47.6 (19-72 years) and 23.4 mm (7-60 mm), respectively. Totally 81.4% (35/43) were classified in the "indeterminate" diagnostic categories; namely 44.2% (19/43) were reported as atypia of undetermined significance (AUS; BC III), 20.9% (9/43) were follicular neoplasm (FN; BC IV), and 16.3% (7/43) were suspicious for malignancy (SM; BC V). No patient was diagnosed as positive for malignancy (BC VI), preoperatively. Detailed cytomorphologic reevaluation revealed heterogeneous cytopathologic findings and nuclear grade (especially nuclear enlargement, membrane irregularity and elongation) significantly increased with respect to BCs. Systematic review confirmed extremely heterogeneous cytomorphologic nature of NIFTP. CONCLUSIONS NIFTPs were categorized most frequently as AUS, followed by FN and SM on FNAC. Our re-review were not able to specify features solely unique to NIFTP alone but may distinguish these cases from classic papillary thyroid carcinoma.
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Affiliation(s)
| | - Gupse Turan
- Pathology Department, Medical Faculty, Kocaeli University, Kocaeli, Turkey
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Kakudo K, Jung CK, Liu Z, Hirokawa M, Bychkov A, Vuong HG, Keelawat S, Srinivasan R, Hang JF, Lai CR. The Asian Thyroid Working Group, from 2017 to 2023. J Pathol Transl Med 2023; 57:289-304. [PMID: 37981725 PMCID: PMC10660359 DOI: 10.4132/jptm.2023.10.04] [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: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 11/21/2023] Open
Abstract
The Asian Thyroid Working Group was founded in 2017 at the 12th Asia Oceania Thyroid Association (AOTA) Congress in Busan, Korea. This group activity aims to characterize Asian thyroid nodule practice and establish strict diagnostic criteria for thyroid carcinomas, a reporting system for thyroid fine needle aspiration cytology without the aid of gene panel tests, and new clinical guidelines appropriate to conservative Asian thyroid nodule practice based on scientific evidence obtained from Asian patient cohorts. Asian thyroid nodule practice is usually designed for patient-centered clinical practice, which is based on the Hippocratic Oath, "First do not harm patients," and an oriental filial piety "Do not harm one's own body because it is a precious gift from parents," which is remote from defensive medical practice in the West where physicians, including pathologists, suffer from severe malpractice climate. Furthermore, Asian practice emphasizes the importance of resource management in navigating the overdiagnosis of low-risk thyroid carcinomas. This article summarizes the Asian Thyroid Working Group activities in the past 7 years, from 2017 to 2023, highlighting the diversity of thyroid nodule practice between Asia and the West and the background reasons why Asian clinicians and pathologists modified Western systems significantly.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Cancer Genome Center and Thyroid Disease Center, Izumi City General Hospital, Izumi, Osaka, Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Zhiyan Liu
- Department of Pathology, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Somboon Keelawat
- Special Task Force for Activating Research (STAR), Department of Pathology, Chulalongkorn University, Bangkok, Thailand
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Antonia TD, Maria LI, Ancuta-Augustina GG. Preoperative evaluation of thyroid nodules - Diagnosis and management strategies. Pathol Res Pract 2023; 246:154516. [PMID: 37196471 DOI: 10.1016/j.prp.2023.154516] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
Thyroid cancer is the most common endocrine malignancy, with increasing incidence over the past few decades. Fine needle aspiration (FNA) biopsy is the gold standard for preoperative diagnosis of thyroid malignancies. Nevertheless, this method renders indeterminate results in up to 30% of the cases. Therefore, these patients are often referred to unnecessary surgery to establish the diagnosis. To improve the accuracy of preoperative diagnosis, several other ways, such as ultrasonography, elastography, immunohistochemical analysis, genetic testing, and core needle biopsy, have been developed and can be used either in association with or as an alternative to FNA. This review aims to evaluate all these diagnostic tools to determine the most appropriate way of managing thyroid nodules and subsequently improve the selection of cases referred to surgery.
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Affiliation(s)
- Tapoi Dana Antonia
- Carol Davila University of Medicine and Pharmacy, Department of Pathology, Bucharest, Romania; University Emergency Hospital, Department of Pathology, Bucharest, Romania
| | - Lambrescu Ioana Maria
- Carol Davila University of Medicine and Pharmacy, Department of Cellular and Molecular Biology and Histology, Bucharest, Romania; Victor Babes National Institute of Pathology, Bucharest, Romania.
| | - Gheorghisan-Galateanu Ancuta-Augustina
- Carol Davila University of Medicine and Pharmacy, Department of Cellular and Molecular Biology and Histology, Bucharest, Romania; CI Parhon National Institute of Endocrinology, Bucharest, Romania
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Rana C, Nigam N, Agarwal S, Mishra P, Singh A, Bychkov A. Cytological evaluation of thyroid nodules in children and young adults: a multi-institutional experience. Endocrine 2023; 80:580-588. [PMID: 36604406 DOI: 10.1007/s12020-022-03297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The utility of the Bethesda system for reporting thyroid cytopathology is debatable in determining the risk of malignancy in pediatric patients. Moreover, the upper age limit for defining the pediatric group has varied across different studies. The aim of this study is to compare the risk of malignancy (ROM) and risk of neoplasia (RON) across different Bethesda categories between the pediatric, young adult, and adult patients. METHODS This is a retrospective multi-institutional study performed in three Indian hospitals. ROM was calculated and compared across Bethesda categories in adult (>18 years) and pediatric age groups (≤18 years), with a subgroup analysis in young adults (19-21 years). RESULTS Thyroid nodules from a total of 5958 patients were subjected to fine needle aspiration. Of these 199 were pediatric (3.3%) and follow-up histology was available in 2276. The ROM and RON rates, including overall ROM/RON, were significantly higher in pediatric age group as compared to adults. Overall ROM of suspicious for malignancy and malignant categories was higher in children as compared to adults. The overall surgical resection rates were also higher in pediatric patients (45.2% vs. 35.7%; p < 0.01). The similar trend of increased ROM, RON and resection rates was seen among young adults as compared to adult age group. CONCLUSION Thyroid nodules presenting in children are more likely to be malignant than those in adults. Importantly, the young adult group behaved in a similar manner with regard to surgical resection rates, ROM and RON to pediatric.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neha Nigam
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Science, New Delhi, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Akanksha Singh
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
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Amita K, Rakshitha HB, Sanjay M, Kalappa P. Cytological Features of "Non-Invasive Follicular Tumour with Papillary like Nuclear Features" - A Single Institutional Experience in India. J Cytol 2023; 40:28-34. [PMID: 37179965 PMCID: PMC10167831 DOI: 10.4103/joc.joc_192_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 10/17/2022] [Accepted: 02/01/2023] [Indexed: 05/15/2023] Open
Abstract
Background The term noninvasive follicular tumor with papillary-like nuclear features (NIFTP) was introduced as a surrogate for noninvasive encapsulated follicular variant of papillary thyroid carcinoma with a defined set of histopathologic criteria. There are very few studies depicting the cytological cues for the diagnosis of NIFTP. The objective of the study was to determine the spectrum of cytological features in fine needle aspiration cytology (FNAC) smears of cases histopathologically diagnosed as NIFTP. Methods This was a retrospective cross-sectional study conducted over a duration of four years between January 2017 and December 2020. All surgically resected cases (n-21), who met the diagnostic criteria of NIFTP on histopathology and who underwent preoperative FNAC were included and reviewed in the study. Results Out of a total of 21 cases, at FNAC, diagnosis of benign, suspicious for malignancy, follicular variant of papillary thyroid carcinoma, and classic papillary thyroid carcinoma (PTC) was rendered in 14 (66.6%), 2 (9.5%), 2 (9.5%), and 3 (14.28%), respectively. Scanty cellularity was noted in 12 (57.1%) cases. Papillae, sheets, and microfollicles were seen in 1 (4.7%), 10 (47.6%), and 13 (61.9%) cases, respectively. Nucleomegaly, nuclear membrane irregularities, nuclear crowding, and overlapping were seen in 7 (33.3%), 9 (42.8%), and 9 (42.8%), respectively. Nucleoli, nuclear grooving, and inclusions were seen in 3 (14.2%) 10 (47.6%), and 5 (23.8%) cases, respectively. Conclusion At FNAC, NIFTP can be found in every category of The Bethesda System for Reporting Thyroid cytopathology (TBSRTC). Nuclear membrane irregularities, nuclear grooving, mild nuclear crowding, and overlapping were noted in a modest number of cases. However, the absence or rare occurrence of features such as papillae, inclusions, nucleoli, and metaplastic cytoplasm may help prevent an overdiagnosis of malignancy.
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Affiliation(s)
- K Amita
- Professor, Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
| | - HB Rakshitha
- Associate Professor, Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
| | - M Sanjay
- Associate Professor, Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
| | - Prashantha Kalappa
- Professor, Centre for Research and Innovation, Department of Chemistry, Adichunchanagiri School of Natural Sciences, Adichunchanagiri University, BG Nagara, Nagamangala Taluk, Mandya District, Karnataka, India
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Lee BWW, Bundele MM, Tan R, Fu EWZ, Chew AS, Wong JSH, Siew CCH, Lim BSP, Dalan R, Lim MY, Gan YJ, Li H. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:903-910. [PMID: 34985102 DOI: 10.47102/annals-acadmedsg.2021243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) on the risk of malignancy (ROM) in fine-needle aspiration cytology (FNAC) per The Bethesda System for Reporting Thyroid Cytopathology has not been well reported in Singapore. METHODS We retrospectively identified 821 thyroid nodules with preoperative FNAC from 788 patients out of 1,279 consecutive thyroidectomies performed between January 2010 and August 2016 in a tertiary general hospital in Singapore. Possible cases of NIFTP were reviewed for reclassification and the impact of NIFTP on ROM was analysed. RESULTS The incidence of NIFTP was 1.2% (10 out of 821). If NIFTP is considered benign, ROM in Bethesda I through VI were 8.6%, 3.5%, 26.3%, 20.0%, 87.7%, 97.0% versus 8.6%, 4.2%, 28.1%, 26.7%, 89.2% and 100% if NIFTP is considered malignant. Eight patients with NIFTP had follow-up of 15 to 110 months. One had possible rib metastasis as evidenced by I131 uptake but remained free of structural or biochemical disease during a follow-up period of 110 months. None had lymph node metastasis at presentation, nor locoregional or distant recurrence. CONCLUSION Classifying NIFTP as benign decreased ROM in Bethesda II through VI, but the benignity of NIFTP requires more prospective studies to ascertain. The impact of NIFTP on ROM in our institution also appears to be lower than that reported in the Western studies.
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Affiliation(s)
- Bryan Wei Wen Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Caulley L, Eskander A, Yang W, Auh E, Cairncross L, Cho NL, Golbon B, Iyer S, Liu JC, Lee PJ, Lindeman B, Meltzer C, Molin N, Moore A, Noel J, Nozolino H, Pasternak J, Price B, Ramsay T, Rolighed L, Sajisevi M, Sharma A, Sinclair C, Sorensen M, Tae K, Tang AL, Tsao G, Williams M, Wrenn S, Xing MH, Zafereo M, Stack BC, Randolph G, Davies L. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg 2021; 148:99-106. [PMID: 34817546 DOI: 10.1001/jamaoto.2021.3277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment. Objective To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size. Design, Setting, and Participants This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. Main Outcomes and Measures Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. Results Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]). Conclusions and Relevance Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lydia Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Jeffrey C Liu
- Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Paul J Lee
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenessa Lindeman
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | | | - Nicole Molin
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alessandra Moore
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Halie Nozolino
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendon Price
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mirabelle Sajisevi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Meredith Sorensen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Santa Rosa, California
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean Wrenn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer Foundation, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Greg Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Louise Davies
- VA Outcomes Group, White River Junction, Vermont.,Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Haaga E, Kalfert D, Ludvíková M, Kholová I. Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis. Acta Cytol 2021; 66:85-105. [PMID: 34781293 DOI: 10.1159/000519757] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A low-risk thyroid tumour, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced in 2016. NIFTP criteria require a thorough histological examination to rule out capsular and lymphovascular invasion, which denies the possibility of preoperative cytological diagnosis. Nevertheless, since the adoption of the new entity, the cytology of NIFTP has been a subject of interest. OBJECTIVES The present systematic review and meta-analysis investigate the cytological diagnosis of NIFTP. METHOD An online PubMed literature search was conducted between March 1, 2020, and June 30, 2020, for all original articles considering the cytology of histologically proven NIFTP. The studies including data on fine needle aspiration specimens classified by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) categories, risk of malignancy (ROMs) in the TBSRTC categories, and cytomorphological features of NIFTP were included in the meta-analysis. Non-English studies and case reports were excluded. The data were tabulated and statistical analysis was performed with Open Meta-Analyst program. RESULTS Fifty-eight studies with a total of 2,553 NIFTP cases were included in the study. The pooled prevalence of NIFTP cases was calculated among 25,892 surgically resected cases from 20 studies and the results show that NIFTP consisted 4.4% (95% confidence interval [CI]: 3.5-5.4%) of all cases. Most of the NIFTP cases (79.0%) belonged to the intermediate categories of TBSRTC. The pooled distribution of NIFTP cases in each TBSRTC category was 1.3% (95% CI: 0.8-1.7%) in non-diagnostic (ND), 8.9% (95% CI: 6.9-10.8%) in benign, 29.2% (95% CI: 25.0-33.4%) in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 24.2% (95% CI: 19.6-28.9%) in follicular neoplasm (FN), 19.5% (95% CI: 16.1-22.9%) in suspicious for malignancy (SM), and 6.9% (95% CI: 5.2-8.7%) in malignant. Compared to pre-NIFTP era, the pooled risk differences of ROM were reduced by 2.4% in ND, 2.7% in benign, 8.2% in AUS/FLUS, 8.2% in FN, 7.3% in SM, and 1.1% in the malignant category. The cytomorphological features of NIFTP were similar to follicular variant of papillary thyroid carcinoma (FVPTC) but lesser to papillary thyroid carcinoma (PTC). CONCLUSIONS Based on our results, NIFTP remains a histological diagnosis. Although cytomorphological features cannot be used in differentiating NIFTP from FVPTC, they may guide in separating NIFTP from PTC. Features such as papillae, microfollicles, giant cells, psammoma bodies, and the amount of papillary-like nuclear features should be taken into account when suspicious of NIFTP. NIFTP should not have papillae or psammoma bodies, and giant cells were rarely observed.
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Affiliation(s)
- Elina Haaga
- Pathology, Fimlab Laboratories, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czechia
| | - Marie Ludvíková
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
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9
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Rana C, Vuong HG, Nguyen TQ, Nguyen HC, Jung CK, Kakudo K, Bychkov A. The Incidence of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Meta-Analysis Assessing Worldwide Impact of the Reclassification. Thyroid 2021; 31:1502-1513. [PMID: 34060946 DOI: 10.1089/thy.2021.0158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification has significantly influenced the field of thyroidology. However, the extent of this impact depends upon the incidence of NIFTP in a given population. In this meta-analysis, we aimed to obtain robust information about the actual incidence of NIFTP worldwide by reviewing the published data. Methods: Comprehensive literature search was performed using electronic databases of PubMed and Web of Science over a five-year period (January 1, 2016, to January 30, 2021). The incidence of NIFTP was calculated by dividing the number of NIFTPs by the number of papillary thyroid carcinomas (PTCs). Meta-analysis of proportion and their 95% confidence interval [CI] were pooled using the random-effect model. Heterogeneity across the included studies was assessed using I2 statistics. Egger's regression test and funnel plot of estimates were used to evaluate the publication bias. p-Value <0.05 was considered significant. Results: From 505 publications, we included 50 studies, all retrospective, with 100,780 PTCs and 3990 NIFTP from 92 institutions worldwide. The overall incidence of NIFTP was 6.0% [CI 4.4-8.2] among PTCs or thyroid malignancies with a high level of heterogeneity among the included studies (I2 = 98.6%). NIFTP incidence was largely similar in North America and Europe (9.3% vs. 9.6%), with a significantly lower overall rate in Asia (2.1%). There was a significant decline in the reported incidence of NIFTP in non-Asian studies published after 2017 (p = 0.002). On applying our data on global thyroid cancer statistics, this reclassification would affect ∼30,881 patients annually, with a lower impact in Asia compared with North America and Europe. Conclusions: This comprehensive meta-analysis confirms that the worldwide NIFTP incidence is much lower than estimated initially. The NIFTP rates are significantly lower in Asian compared with North American and European countries. Apart from geography, NIFTP rates are significantly influenced by the nature of study, type of database used for sample collection, and the diagnostic criteria used. Introduction of NIFTP may potentially spare over 30,000 patients worldwide annually from clinical and psychological consequences of a thyroid cancer diagnosis.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Huy Gia Vuong
- Department of Neurosurgery, Oklahoma University of Health Sciences Center, Oklahoma City, Oklahoma, USA
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Thu Quynh Nguyen
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hoang Cong Nguyen
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Rana C, Ramakant P, Goel D, Singh A, Singh K, Babu S, Mishra A. Effect of the Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP) Nomenclature Revision on Indian Thyroid Fine-Needle Aspiration Practice. Am J Clin Pathol 2021; 156:320-327. [PMID: 33608707 DOI: 10.1093/ajcp/aqaa241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To analyze risk of malignancy (ROM) in Bethesda categories (BCs) and the impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification on malignancy risk and surgical outcome. METHODS In this retrospective study based on fine-needle aspiration samples with histologic follow-up, ROM was analyzed in BCs. Possible cases of NIFTP were reviewed, followed by the analysis of impact of this reclassification on ROM in BCs. RESULTS The incidence of NIFTP was 6.9% among excised thyroid nodules and 16.8% among all resected neoplastic lesions. ROM for BCs I to VI was 37.5%, 9.6%, 40.0%, 46.5%, 88.8%, and 96.8%, respectively. Risk of neoplasia was 50.0%, 13.8%, 55.0%, 71.2%, 88.8%, and 96.8% respectively. When NIFTPs were considered nonmalignant lesions, ROM decreased by 6.3%, 4.3%, 20%, 19.1%, 22.5%, and 1.5% in each Bethesda category (I-VI), respectively. Inability to diagnose NIFTP preoperatively led to overtreatment in 16.2%. CONCLUSIONS Prevalence of NIFTP in Asian countries may be higher than expected. Substantial cases of NIFTP have a benign preoperative cytology; hence, cases of follicular adenoma and adenomatous colloid nodule should be included in the review. NIFTP reclassification has significantly reduced the ROM in indeterminate BCs, suggesting diagnostic lobectomy rather than total thyroidectomy. Countries should establish their own malignancy risk range and parameters.
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Affiliation(s)
| | - Pooja Ramakant
- Endocrine Surgery, King George’s Medical University, Lucknow, India
| | | | | | | | | | - Anand Mishra
- Endocrine Surgery, King George’s Medical University, Lucknow, India
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11
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Xu XM, Angelova E, Clement CG. Outcome of atypia of undetermined significance/follicular lesion of undetermined significance in thyroid fine-needle aspirations: A six-year institutional experience. Diagn Cytopathol 2021; 49:915-920. [PMID: 33973739 DOI: 10.1002/dc.24771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is one of six diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (BSRTC). The goal of our study is to assess the outcome of cases classified as AUS/FLUS at our institution. METHODS AUS/FLUS cases were identified by computer searching of the thyroid fine-needle aspiration (FNA) cases performed between 2010 and 2016. Outcomes were categorized as: follow-up surgery, repeat FNA or no follow-up available. Demographics, ultrasound findings and FNA diagnostic criteria were reviewed for AUS/FLUS cases with follow-up surgical pathology diagnosis. RESULTS Our AUS/FLUS thyroid FNA rate was 6% (117 out of 1984 FNAs). Only 15% of the AUS/FLUS cases had repeat FNA, while 41% underwent surgery. The risk of malignancy (ROM) for cases with follow-up surgery was 17%. When considering all AUS/FLUS cases, the ROM was 7%. Statistically, benign neoplasms were more likely to be single lesions on ultrasound comparing to malignant neoplasms, and to exhibit architectural atypia as opposed to non-neoplastic lesions on FNA. The malignancy rates among patients that directly went to surgical resection (17%) and patients having repeat FNA after the first AUS/FLUS diagnosis followed by surgery (29%) was not significantly different. However, repeat FNA was able to reclassify the majority of cases into more definitive categories. CONCLUSION The outcome of the thyroid FNAs diagnosed as AUS/FLUS in our institution meets the benchmark statistics for AUS/FLUS rate and ROM. This study constitutes a valuable quality assurance measure and serves as a baseline for subsequent quality improvement.
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Affiliation(s)
- Xiao-Meng Xu
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Evgeniya Angelova
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Cecilia G Clement
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
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12
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Vuong HG, Suzuki A, Na HY, Tuyen PV, Khuy DM, Nguyen HC, Jitpasutham T, Abelardo A, Amano T, Park SY, Jung CK, Hirokawa M, Katoh R, Kakudo K, Bychkov A. Application of the Bethesda System for Reporting Thyroid Cytopathology in the Pediatric Population. Am J Clin Pathol 2021; 155:680-689. [PMID: 33269383 DOI: 10.1093/ajcp/aqaa182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. METHODS Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries. RESULTS Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories. CONCLUSIONS Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Pham Van Tuyen
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Doan Minh Khuy
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Hiep Canh Nguyen
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Tikamporn Jitpasutham
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Agustina Abelardo
- Department of Pathology, College of Medicine University of Philippines Manila, Manila, Philippines
- Department of Laboratories, Philippine General Hospital Medical Center, Manila, Phillipines
| | | | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | | | - Ryohei Katoh
- Department of Pathology, Ito Hospital, Tokyo, Japan
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Osaka, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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13
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El Hag IA, Johnston J, Alessa E, Al Shammari M. Revised Bethesda System for Reporting Thyroid Cytology: Lessons learned from an appraisal of 5 years of experience in a central hospital. Cytopathology 2021; 32:482-492. [PMID: 33772905 DOI: 10.1111/cyt.12970] [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: 11/19/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Bethesda System for Reporting Thyroid Cytology (BSFRTC) is widely adopted in the management of thyroid nodules. The system was updated in 2017, and its impact is the subject of this paper. METHODS All thyroid fine needle aspirations from 2016-2020 using the BSFRTC, with follow-up surgical pathology, were reviewed. The risk of neoplasia (RON), risk of malignancy (ROM), RON/ROM ratio, and surgical follow-up rate were determined for each diagnostic category with cytohistological correlation. ROM was calculated in two separate manners, with non-invasive follicular tumours with papillary-like nuclear features (NIFTP) counted as malignant or non-malignant. Sensitivity, specificity, negative and positive predictive values were determined for indeterminate categories: atypia of undetermined significance (AUS), suspicious for follicular neoplasm (SFN), and suspicious for malignancy (SFM). RESULTS RON, ROM, and the surgical follow-up rate increased steadily from the benign through intermediate to malignant categories. The omission of NIFTP from malignant lesions reduced the calculated ROM in indeterminate categories and improved the stratification between AUS and SFN. ROM in AUS was distinct from SFN. AUS has a well-balanced sensitivity and specificity favouring a screening rather than a diagnostic category. The calculated RON/ROM was significantly higher in AUS (1.56), compared to SFN (1.03) and SM (1.05), in agreement with current BSRTC management recommendations. CONCLUSIONS AUS is an important screening category and should remain with the addition of subcategorisation. RON and surgical follow-up rates are essential quality indicators. The RON/ROM ratio could be utilised to determine appropriate management for each diagnostic category on an institutional basis.
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Affiliation(s)
- Imad A El Hag
- Department of Pathology, Security Force Hospital, Riyadh, Saudi Arabia
| | - Jon Johnston
- Department of Pathology, Security Force Hospital, Riyadh, Saudi Arabia
| | - Ebtehal Alessa
- Department of Pathology, Security Force Hospital, Riyadh, Saudi Arabia
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14
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Jung CK, Bychkov A, Song DE, Kim JH, Zhu Y, Liu Z, Keelawat S, Lai CR, Hirokawa M, Kameyama K, Kakudo K. Molecular Correlates and Nuclear Features of Encapsulated Follicular-Patterned Thyroid Neoplasms. Endocrinol Metab (Seoul) 2021; 36:123-133. [PMID: 33677934 PMCID: PMC7937839 DOI: 10.3803/enm.2020.860] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Assessing nuclear features is diagnostically challenging in the aspect of thyroid pathology. The aim of this study was to determine whether pathologists could distinguish BRAF-like and RAS-like nuclear features morphologically and identify morphological features to differentiate thyroid tumors with RAS-like mutations from encapsulated papillary thyroid carcinoma (PTC) with predominant follicular growth and BRAFV600E mutation. METHODS Representative whole slide images of 16 encapsulated thyroid tumors with predominant follicular growth were reviewed by 12 thyroid pathologists using a web browser-based image viewer. Total nuclear score was calculated from semi-quantitatively scored eight nuclear features. The molecular profile of RAS and BRAF genes was determined by Sanger sequencing. RESULTS Total nuclear score ranging 0 to 24 could differentiate BRAF-like tumors from RAS-like tumors with a cut-off value of score 14. The interobserver agreement was the highest for the assessment of nuclear pseudoinclusions (NPIs) but the lowest for nuclear elongation and sickle-shaped nuclei. NPIs were found in tumors with BRAFV600E mutation, but not in tumors with RAS-like mutations. Total nuclear scores were significantly higher for tumors with BRAFV600E than for those with RAS-like mutations (P<0.001). CONCLUSION Our results suggest that NPIs and high nuclear scores have diagnostic utility as rule-in markers for differentiating PTC with BRAFV600E mutation from benign or borderline follicular tumors with RAS-like mutations. Relaxation of rigid criteria for nuclear features resulted in an overdiagnosis of PTC. Immunostaining or molecular testing for BRAFV600E mutation is a useful adjunct for cases with high nuclear scores to identify true PTC.
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Affiliation(s)
- Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Yun Zhu
- Department of Pathology, Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Zhiyan Liu
- Department of Pathology, Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chiung-Ru Lai
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
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15
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Bai Y, Kakudo K, Jung CK. Updates in the Pathologic Classification of Thyroid Neoplasms: A Review of the World Health Organization Classification. Endocrinol Metab (Seoul) 2020; 35:696-715. [PMID: 33261309 PMCID: PMC7803616 DOI: 10.3803/enm.2020.807] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
Advances in medical sciences and evidence-based medicine have led to momentous changes in classification and management of thyroid neoplasms. Much progress has been made toward avoiding overdiagnosis and overtreatment of thyroid cancers. The new 2017 World Health Organization (WHO) classification of thyroid neoplasms updated the diagnostic criteria and molecular and genetic characteristics reflecting the biology and behavior of the tumors, and newly introduced the category of borderline malignancy or uncertain malignant potential. Some neoplasms were subclassified, renamed, or redefined as a specific entity. This review introduces changes in the fourth edition WHO classification of thyroid tumors and updates the contemporary diagnosis and classification of thyroid tumors. We also discuss several challenges with the proposal of new diagnostic entities, since they have unique histopathologic and molecular features and clinical relevance.
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Affiliation(s)
- Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing,
China
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi,
Japan
- Department of Human Pathology, Wakayama Medical University, Graduate School of Medicine, Wakayama,
Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, The Catholic University of Korea, Seoul,
Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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16
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Guleria P, Mani K, Agarwal S. Indian experience of AUS/FLUS diagnosis: is it different from rest of Asia and the West?-A systematic review and meta-analysis. Gland Surg 2020; 9:1797-1812. [PMID: 33224856 DOI: 10.21037/gs-20-392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous subcategory of the Bethesda system for thyroid cytopathology with laid down permissible limits of frequency and risk of malignancy (ROM). Due to differences in thyroid clinical practice worldwide, variations have been found in frequency, resection rates (RR) and ROM. Therefore, this systematic review and meta-analysis of AUS/FLUS across different regions was conducted and comparison of data from India was done with the rest of Asia and the West. Methods We searched PubMed and Google search engines from January 2009-Dec 2019 using terms "AUS Thyroid" and "FLUS Thyroid". Meta-analysis was performed using DerSimonian-Laird method and 95% confidence intervals were calculated using random effects model. Independent samples t-test was used to compare frequency, RR, and ROM of AUS/FLUS between India, rest of Asia and the West. Results Out of 15,000 studies on internet, 60 (18 Indian, 12 Asian and 30 Western) were included. Total aspirates were 201,657; 14,279 Indian, 62,448 Asian, 124,930 Western. Pooled estimates were: frequency 7.3% (6.3-8.3%), RR 41.9% (37.4-46.6%), ROM 33.3% (26.8-39.9%). Pooled prevalence of rate did not vary significantly across the three regions. Pooled prevalence of RR was highest in India (52.9%) and lowest in rest of Asia (26.5%); of ROM was highest in Asia (45.9%), lowest in the West (26.3%) (P<0.01). Statistical analysis demonstrated publication bias, limited to Indian and Western studies. Papillary thyroid carcinoma was the most common surgical diagnosis (87.9%; 1,082/1,231). Conclusions This meta-analysis showed differences in thyroid clinical practice followed in India, rest of Asia and the West. Although pooled prevalence of rate of AUS/FLUS was similar across the three, pooled RR and ROM varied. AUS/FLUS nodules were more frequently resected in Indian and Western studies than in rest of Asia. ROM was higher than recommended values in all three areas, being intermediate for India.
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Affiliation(s)
- Prerna Guleria
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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17
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Kakudo K. Asian and Western practice in thyroid pathology: similarities and differences. Gland Surg 2020; 9:1614-1627. [PMID: 33224839 DOI: 10.21037/gs-2019-catp-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan.,Cytopathology Laboratory, Okamoto Thyroid Clinic, Osaka, Japan.,Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Japan.,Department of Human Pathology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
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18
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Kumarasinghe MP. Standardisation of thyroid cytology terminology and practice: are modifications necessary?-a narrative review. Gland Surg 2020; 9:1639-1647. [PMID: 33224841 DOI: 10.21037/gs-2019-catp-25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Universally accepted guidelines for diagnosis and management of any disease are desirable. Standardization of thyroid cytology reporting is aimed at guiding and improving clinical decision-making and management. However, socio-economic, and local factors and differences in disease prevalence and patterns require modification to suit local settings. 'One size fit all' approach is not possible for any disease diagnosis or management. The same concept is applicable in diagnosis and management of thyroid nodules. An additional special issue is the well-known high inter and intra-observer variability in the histological and cytological diagnosis of thyroid neoplasms. Despite this, thyroid cytology has a very significant influence in the management of thyroid diseases. An approach based on common principals with appropriate modifications that suits countries or continents is desirable and sustainable. The principals of TBSRTC have served as a framework for similar tiered classifications for reporting thyroid cytopathology. This article discusses globally available professional guidelines based on a common framework with appropriate modifications, with the universal aim of risk stratification of thyroid nodules.
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Affiliation(s)
- M Priyanthi Kumarasinghe
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Discipaline of Pathology and Laboratory Medicine, University of Western Australia, QEII Medical Centre, Nedlands, Australia
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19
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Ooi LY, Nga ME. Atypia of undetermined significance/follicular lesion of undetermined significance: Asian vs. non-Asian practice, and the Singapore experience. Gland Surg 2020; 9:1764-1787. [PMID: 33224854 DOI: 10.21037/gs-20-555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Bethesda System for Reporting Thyroid Cytopathology has paved the way for comparisons of the practice of thyroid cytology in many different regions. However, there have been comparatively few studies documenting differences between Asian and non-Asian practice. Here, we aim to compare a few key parameters between the two regions, focusing on the indeterminate category of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS). We compared its incidence, resection rates (RRs), risk of malignancy (ROM), rate of repeat fine needle aspiration (rFNA), ROMs of cytomorphologic subcategories of nuclear atypia (AUS-N) vs. architectural atypia (AUS-A), and, finally, the incidence of papillary thyroid carcinoma (PTC) vs. follicular neoplasms (FNs) in resected AUS/FLUS cases in Asian and non-Asian regions. Where possible, these metrics were compared with the Singapore experience from a tertiary referral institution. While the incidence of AUS/FLUS was similar in both regions, we found geographical differences in the RRs and ROMs, which may reflect a higher collective threshold for surgery in Asian countries. However, both cohorts showed higher ROMs in the AUS-N subcategory as compared to the AUS-A subcategory, supporting the subclassification of the AUS/FLUS based on the presence of nuclear atypia. We also observed a higher incidence of AUS-N coupled with a higher incidence of PTC in resected AUS/FLUS nodules in Asian cohorts, while AUS-A and follicular-patterned neoplasms featured more prominently in the non-Asian cohorts. These incidences may account for the starkly different molecular approaches that we noted-in Asian (chiefly Korean and Chinese) centers, BRAF mutational analysis was favored, while gene panels and gene expression classifiers were more frequently applied in non-Asian centers (chiefly in the United States of America). Overall, the data from Singapore appears more closely aligned to non-Asian trends, despite its geographical location in Southeast Asia and its predominantly Asian population. We conclude that there is significant heterogeneity in the outcomes of the AUS/FLUS categories between and within regions, which is only partially explained by regional variations, and may also reflect different regional diagnostic and management practices. This highlights the importance of understanding the local context in the interpretation of indeterminate Bethesda categories, rather than adopting a "one-size fits all" approach.
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Affiliation(s)
- Li Yin Ooi
- Department of Pathology, National University Hospital, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
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20
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Chen CC, Hang JF, Liu CY, Wang YH, Lai CR. Thyroid fine-needle aspiration cytology in Taiwan: a nationwide survey and literature update. J Pathol Transl Med 2020; 54:361-366. [PMID: 32854487 PMCID: PMC7483030 DOI: 10.4132/jptm.2020.07.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023] Open
Abstract
In Taiwan, thyroid fine-needle aspiration cytology is easily accessible and reliable for evaluating thyroid nodules. The sonographic pattern plays a major role and is the deciding factor for aspiration. We conducted a nationwide survey in 2017 and it revealed that 31% of laboratories had adopted The Bethesda System for Reporting Thyroid Cytopathology. There was a relatively high unsatisfactory rate (24.04%) and low rates of indeterminate diagnoses, including atypia of undetermined significance/follicular lesions of undetermined significance: 4.87%, and follicular neoplasm/suspicious for a follicular neoplasm: 0.35%. Moreover, the risks of malignancy in benign, atypia of undetermined significance, and suspicious for a follicular neoplasm were relatively high. These may reflect strict diagnostic criteria for indeterminate categories and better patient selection for surgery. Improvements in specimen sampling and continuing education programs are crucial. Newly-developed thyroid cytology technologies, such as immunocytochemistry, molecular testing, and computerized cytomorphometry, may further facilitate cytology diagnoses.
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Affiliation(s)
- Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City, Taiwan.,College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yeh-Han Wang
- Department of Anatomic Pathology, Taipei Institute of Pathology, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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21
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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.
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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.
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22
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Linhares SM, Whitfield BW, Lee AF, Gordillo D, Picado O, Jeraq M, Farrá JC, Lew JI. Impact of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features on Revised Bethesda System Malignancy Rates at a Single Institution. J Surg Res 2020; 255:152-157. [PMID: 32563006 DOI: 10.1016/j.jss.2020.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) standardizes thyroid cytopathology reporting in six tier diagnostic categories. In recent years, noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This study examines the impact of NIFTP on the BSRTC risk of malignancy (ROM). METHODS This was a retrospective review of prospectively collected data from 565 patients who underwent fine needle aspiration and thyroidectomy at a single institution. ROM for each Bethesda category was analyzed and calculated with NIFTP classified as a malignant and nonmalignant lesion. Absolute and relative differences between ROM were compared. RESULTS Of 565 patients, 19 were Bethesda I, 159 were Bethesda II, 178 were Bethesda III, 46 were Bethesda IV, 42 were Bethesda V, and 121 were Bethesda VI. ROM differences with NIFTP classified as malignant versus nonmalignant for each class were as follows: Bethesda I, no change; Bethesda II, 18%-14%; Bethesda III, 55%-48%; Bethesda IV, 50%-35%; Bethesda V, 93%-91%; and Bethesda VI, 99%-98%. Absolute ROM differences for each category were as follows: Bethesda I, 0%; Bethesda II, 4%; Bethesda III, 7%; Bethesda IV, 15%; Bethesda V, 2%; and Bethesda VI, 1%. CONCLUSIONS A decreasing trend in absolute and relative ROM was seen in Bethesda II, III, and IV categories; however, exclusion of NIFTP as a malignant lesion did not significantly alter the ROM of BSRTC categories. Surgeons should assess their respective institution's experiences with NIFTP and the BSRTC.
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Affiliation(s)
- Samantha M Linhares
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
| | - Bryan W Whitfield
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Amy F Lee
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Daniela Gordillo
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Omar Picado
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Mohammed Jeraq
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Josefina C Farrá
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - John I Lew
- Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
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Kopczyński J, Suligowska A, Niemyska K, Pałyga I, Walczyk A, Gąsior-Perczak D, Kowalik A, Hińcza K, Mężyk R, Góźdź S, Kowalska A. Did Introducing a New Category of Thyroid Tumors (Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features) Decrease the Risk of Malignancy for the Diagnostic Categories in the Bethesda System for Reporting Thyroid Cytopathology? Endocr Pathol 2020; 31:143-149. [PMID: 32236858 DOI: 10.1007/s12022-020-09619-0] [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: 12/23/2022]
Abstract
In 2016, Nikiforov et al. (JAMA Oncol 2:1023-1029, 2016) proposed replacing the term "non-invasive encapsulated follicular variant of papillary thyroid carcinoma" (FVPTC) with the term "non-invasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP). In 2018, to avoid the misdiagnosis of papillary thyroid cancer as NIFTP, the authors proposed changes to the criteria for NIFTP classification. Some previous studies evaluated the impact of NIFTP on the risk of malignancy (ROM) in the fine-needle aspiration cytology (FNAC) diagnostic categories according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). However, little is known about the influence of an NIFTP diagnosis on ROM on the basis of the revised criteria. The aim of this study was to assess the influence of NIFTP on ROM using the revised diagnostic criteria. The present study included 998 thyroid nodules that were diagnosed and resected at the same medical center. All specimens with a diagnosis of cancer were reviewed to identify NIFTP according to the revised 2018 criteria. Additionally, molecular diagnostics were performed to detect the BRAF p.V600E mutation and TERT promoter mutations in all the NIFTP cases. The number of cases that met the revised criteria was determined, and the ROM was calculated in each of the FNAC diagnostic categories. Only five cases (2.3% of all papillary thyroid carcinoma diagnoses) were considered NIFTP, according to the 2018 criteria. With respect to the FNAC category, one case was a follicular neoplasm or suspicious for a follicular neoplasm (FN/SFN), three cases were suspicious for malignancy (SM), and one case was malignant (M). The ROM decreased in each of the Bethesda categories (0.7% in FN/SFN, 4.3% in SM, and 0.5% in M) when a diagnosis of NIFTP was taken into account. These reductions were not statistically significant. These data indicate that the NIFTP entity has very little impact on ROM for the diagnostic categories of the Bethesda system.
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Affiliation(s)
- Janusz Kopczyński
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | - Agnieszka Suligowska
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland.
| | - Kornelia Niemyska
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | - Iwona Pałyga
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Agnieszka Walczyk
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Danuta Gąsior-Perczak
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Center, Kielce, Poland
| | - Kinga Hińcza
- Department of Molecular Diagnostics, Holycross Center, Kielce, Poland
| | - Ryszard Mężyk
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Stanisław Góźdź
- Oncology Clinic, Holycross Cancer Center, Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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24
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Elliott Range D, Jiang XS. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in The Bethesda System for the Reporting of Thyroid Cytopathology. Diagn Cytopathol 2020; 48:531-537. [PMID: 32167682 DOI: 10.1002/dc.24405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 02/20/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Bethesda System for the Reporting of Thyroid Cytopathology (TBSRTC) is used to categorize and diagnose thyroid nodules by fine needle aspiration biopsy (FNAB). Each category in TBSRTC is associated with an estimated risk of malignancy (ROM). A subset of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (niEFVPTC) was reclassified as a nonmalignant tumor: noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). We studied the impact of this reclassification on the reported ROM in TBSRTC. MATERIAL AND METHODS We searched our institutional files for thyroid FNAB with surgical follow-up. ROM for each TBSRTC category was calculated. Subsequently, cases of niEFVPTC were reviewed and reclassified as NIFTP, if appropriate. ROM for each category was then recalculated after the reclassification. RESULTS Twenty-six NIFTP were identified; the corresponding FNABs were distributed among all six TBSRTC categories. The majority of NIFTP FNAB were in the AUS/FLUS and suspicious for malignancy (SUSP) categories, 12 (46.2%) and 8 (30.8%), respectively. While the ROM changed for all diagnostic categories, the greatest change in ROM after reclassification was seen in these two categories. Absolute ROM for AUS/FLUS decreased from 25.0% to 21.0% and SUSP, from 71.7% to 58.3%, changes that were statistically significant. CONCLUSIONS The reclassification of niEFVPTC to NIFTP has significantly impacted the ROM in the TBSRTC at our institution. While there was a decrease in ROM for all categories, the greatest reduction to ROM was in the categories of AUS/FLUS and FN. These changes to the ROM should help guide surgical approach moving forward.
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Affiliation(s)
| | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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25
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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.
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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
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26
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Park JL, Jeon S, Seo EH, Bae DH, Jeong YM, Kim Y, Bae JS, Kim SK, Jung CK, Kim YS. Comprehensive DNA Methylation Profiling Identifies Novel Diagnostic Biomarkers for Thyroid Cancer. Thyroid 2020; 30:192-203. [PMID: 31797753 DOI: 10.1089/thy.2019.0011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: There are no reliable biomarkers to accurately differentiate indolent thyroid tumors from more aggressive thyroid cancers. This study aimed to develop new DNA methylation markers for diagnosis and recurrence risk stratification of papillary thyroid carcinoma (PTC). Methods: Thyroid tumor-specific DNA methylation profiling was investigated in 34 fresh frozen tissues, which included nontumor (n = 7), noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP, n = 6) and PTC (n = 21), using the Illumina HumanMethylation EPIC array. We performed a genome-wide assessment of thyroid tumor-specific differentially methylated CpG sites in the discovery set, then validated the top candidate markers in an independent set of 293 paraffin tissue samples comprised of follicular adenoma (FA, n = 61), Hürthle cell adenoma (HA, n = 24), NIFTP (n = 56), PTC (n = 120), follicular thyroid carcinoma (n = 27), and Hürthle cell carcinoma (n = 5), by pyrosequencing. Results: Three selected markers (cg10705422, cg17707274, and cg26849382) differentiated nonmalignant (FA, HA, and NIFTP) tumors from differentiated thyroid cancers with area under the receiver operating characteristic curve of 0.83, 0.83, and 0.80, respectively. Low DNA methylation levels for three markers were significantly associated with recurrent or persistent disease (odds ratio (OR) = 3.860 [95% confidence interval (CI) 1.194-12.475]) and distant metastasis (OR = 4.009 [CI 1.098-14.632]) in patients with differentiated thyroid cancer. A subgroup analysis for the validation set showed that PTC patients with low DNA methylation levels more frequently had aggressive histology, extrathyroidal extension, lymph node metastasis, BRAFV600E mutations, and recurrent or persistent disease than those with high levels of methylation markers. All PTC patients who developed disease recurrence had low DNA methylation levels for three markers. Conclusions: DNA methylation levels of three markers can be useful for differentiating differentiated thyroid cancer from nonmalignant follicular thyroid lesions, and may serve as prognostic biomarkers for predicting recurrent or persistent disease after surgery for differentiated thyroid cancer.
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Affiliation(s)
- Jong-Lyul Park
- Genome Editing Research Center; Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
- Personalized Genomic Medicine Research Center; Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
- Department of Functional Genomics, University of Science and Technology, Daejeon, Republic of Korea
| | - Sora Jeon
- Department of Biomedicine and Health Sciences, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Cancer Research Institute; College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Hye Seo
- Genome Editing Research Center; Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
- Department of Functional Genomics, University of Science and Technology, Daejeon, Republic of Korea
| | - Dong Hyuck Bae
- Genome Editing Research Center; Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
- Department of Functional Genomics, University of Science and Technology, Daejeon, Republic of Korea
| | - Young Mun Jeong
- Department of Biomedicine and Health Sciences, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yourha Kim
- Department of Biomedicine and Health Sciences, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Cancer Research Institute; College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja Seong Bae
- Department of Cancer Research Institute; College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seon-Kyu Kim
- Department of Functional Genomics, University of Science and Technology, Daejeon, Republic of Korea
| | - Chan Kwon Jung
- Department of Cancer Research Institute; College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Hospital Pathology; The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Sung Kim
- Genome Editing Research Center; Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
- Personalized Genomic Medicine Research Center; Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
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27
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Maletta F, Falco EC, Gambella A, Metovic J, Papotti M. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: From Echography to Genetic Profile. TOHOKU J EXP MED 2020; 252:209-218. [PMID: 33087681 DOI: 10.1620/tjem.252.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In thyroid pathology, the great variety of types and the wide range of aggressiveness of thyroid cancers complicate both diagnosis and management. In 2016, a subset of noninvasive encapsulated follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid tumor with papillary-like nuclear features (NIFTP) to reduce overtreatment of this low-risk tumor that follows a benign course after surgery. Starting from a paradigmatic clinical case, in this short review, we will summarize the ultrasonography, cytological, histological and molecular features of this new entity. In the preoperative settings, the recognition of some peculiar elements may only suggest the possibility of a NIFTP, thus favoring a less aggressive surgical approach. However, the diagnosis of NIFTP can only be made after complete resection of the lesion by detecting well-defined inclusion and exclusion histopathological criteria. Since NIFTP is not 'malignant,' surgery may be considered curative with no further treatment or surveillance needed. NIFTP-related issues, including nodule size, multifocality, oncocytic changes, heterogeneous incidence across different geographical areas and its occurrence in the pediatric age, will be discussed.
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Affiliation(s)
- Francesca Maletta
- Pathology Unit, Department of Laboratory Medicine, AOU Città della Salute e della Scienza di Torino
| | | | | | - Jasna Metovic
- Pathology Unit, Department of Oncology, University of Turin
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin
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Zhu Y, Song Y, Xu G, Fan Z, Ren W. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC): A report of 2,781 cases in a Chinese population. Chin J Cancer Res 2020; 32:140-148. [PMID: 32410792 PMCID: PMC7219100 DOI: 10.21147/j.issn.1000-9604.2020.02.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the diagnostic utility of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) at Peking University Cancer Hospital, the incidence of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and the impact of reclassification on cytopathological outcomes. Methods We performed a retrospective study of thyroid fine-needle aspiration (FNA) cases between April 2014 and March 2019. The FNA results were classified according to TBSRTC. Post-surgery histological findings were followed up. Results A total of 2,781 thyroid FNAs were performed. The incidences of the 6 diagnostic categories (DCs I-VI) were 14.8%, 17.1%, 15.8%, 2.3%, 11.6% and 38.5%, respectively. A total of 1,122 patients (40.3%) had corresponding histological results. NIFTP accounted for 0.4% of papillary thyroid carcinoma (PTC) cases, and there was no significant difference in the risk of malignancy (ROM) for each TBSRTC DC between "NIFTP=carcinoma (Ca)" and "NIFTP≠Ca". When "NIFTP=Ca", the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of TBSRTC were 98.0%, 84.0%, 99.4%, 58.3%, and 97.5%, respectively. When "NIFTP≠Ca", the sensitivity, specificity, PPV, NPV and accuracy of the TBSRTC were 98.1%, 81.5%, 99.3%, 61.1%, and 97.5%, respectively. Conclusions TBSRTC is effective in the preoperative diagnosis of thyroid nodules in Peking University Cancer Hospital. The impact of the reclassification of NIFTP on cytopathological outcomes is limited because of its low incidence, and the revised ROMs are not suitable for Asian patients.
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Affiliation(s)
| | | | | | - Zhihui Fan
- Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing 100142, China
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29
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Vuong HG, Ngo HTT, Bychkov A, Jung CK, Vu TH, Lu KB, Kakudo K, Kondo T. Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta-analysis. Cancer Cytopathol 2019; 128:238-249. [PMID: 31883438 DOI: 10.1002/cncy.22228] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Abstract
There is increasing evidence showing that clinicians employ different management strategies in their use of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this meta-analysis, we investigated the differences in diagnosis frequency, resection rate (RR), and risk of malignancy (ROM) between Western (ie, American and European) and Asian cytopathology practices. We searched PubMed and Web of Science from January 2010 to January 2019. Proportion and 95% CIs were calculated using a random-effect model. We used independent sample t tests to compare frequencies, RR, and ROM between Western and Asian practices. We analyzed a total of 38 studies with 145,066 fine-needle aspirations. Compared with Asian practice, Western series had a significantly lower ROM in most of TBSRTC categories, whereas the RR was not statistically different. Focusing on indeterminate nodules, the RR in Western series was significantly higher (51.3% vs 37.6%; P = .048), whereas the ROM was significantly lower (25.4% vs 41.9%; P = .002) compared with those in Asian series. The addition of Asian cohorts increased ROM for most of diagnostic categories compared with the original TBSRTC. In conclusion, this study demonstrates a difference in Western and Asian thyroid cytology practice, especially regarding the indeterminate categories. Lower RR and higher ROM suggest that Asian clinicians adopt a more conservative approach, whereas immediate diagnostic surgery is favored in Western practice for indeterminate nodules. The addition of Asian series into a meta-analysis of TBSRTC altered ROM for several categories, which should be considered in future revisions of TBSRTC.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Hanh Thi Tuyet Ngo
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa City, Japan.,Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Trang Huyen Vu
- Department of Pathology, Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Kim Bach Lu
- Department of Pathology, Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Kennichi Kakudo
- Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Japan
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Huhtamella R, Kholová I. Thyroid Bethesda Category AUS/FLUS in Our Microscopes: Three-Year-Experience and Cyto-Histological Correlation. Cancers (Basel) 2019; 11:cancers11111670. [PMID: 31661800 PMCID: PMC6895794 DOI: 10.3390/cancers11111670] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/20/2022] Open
Abstract
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) introduced a new category: Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS) comprising of heterogenous lesions with a lesser degree of atypia. Its routine use is a bit controversial. The study cohort included AUS/FLUS thyroid cytopathological diagnoses signed out at Fimlab Laboratories from the period of 1 October 2013 to 31 December 2016. We analyzed all the AUS/FLUS cases, their cytology subclassification, and their cyto-histological correlation, when available. In total, there were 331 AUS/FLUS cases from 252 patients. The mean age was 59.8 years and there were 196 females and 56 males. Repeated AUS/FLUS was diagnosed in 75 (29.8%) cases. Out of 252 patients, 118 (46.8%) were operated on. Sixty-eight were operated on after the first AUS/FLUS diagnosis, 46 after 2 AUS/FLUS diagnoses, and 4 after 3 AUS/FLUS diagnoses. In total, there were 37 (14.7%) malignancies and 40 benign tumors. The risk of malignancy for AUS/FLUS (14.7%) is in agreement with the original TBSRTC risk of malignancy. The risk of neoplasia was 30.6% in our series.
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Affiliation(s)
- Roope Huhtamella
- Department of Pathology, Fimlab Laboratories, 33520 Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland.
| | - Ivana Kholová
- Department of Pathology, Fimlab Laboratories, 33520 Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland.
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31
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Bongiovanni M, Faquin WC, Giovanella L, Durante C, Kopp P, Trimboli P. Impact of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) on risk of malignancy in patients undergoing lobectomy/thyroidectomy for suspected malignancy or malignant fine-needle aspiration cytology findings: a systematic review and meta-analysis. Eur J Endocrinol 2019; 181:389-396. [PMID: 31340203 PMCID: PMC7494014 DOI: 10.1530/eje-19-0223] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The second version of The Bethesda System for Reporting Thyroid Cytopathology endorsed the introduction of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as a distinct entity with low malignant potential into clinical practice. Consequently, the risk of malignancy (ROM) of cytological diagnoses has changed, but the magnitude of the change remains uncertain. The present systematic review was undertaken to obtain more robust information about the true impact of NIFTP on the ROM among patients undergoing surgery following a fine-needle aspiration cytology (FNAC) diagnosis of suspicious for malignancy (Bethesda V) or malignant (Bethesda VI). As they are managed surgically, these two diagnostic categories are the primary entities that are clinically impacted by the advent of NIFTP. DESIGN Systematic review and meta-analysis. METHODS A comprehensive literature search of online databases was performed in November 2018. The search was conducted looking for data of histologically proven NIFTP with preoperative FNAC. RESULTS One-hundred fifty-seven articles were identified and nine were included in the study. Overall, there were 13,752 thyroidectomies with a cancer prevalence of 45.7%. When NIFTP was considered non-malignant, the pooled risk difference for ROM was 5.5%. Applying meta-analysis, the pooled prevalence of NIFTP among nodules with FNAC of Bethesda V or Bethesda VI was 14 and 3%, respectively. CONCLUSION This meta-analysis shows that the inclusion of NIFTP leads to a reduction in the ROM for the Bethesda V and Bethesda VI FNAC diagnostic categories by 14 and 3%, respectively. Clinicians should be aware of these data to avoid overtreatment.
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Affiliation(s)
- Massimo Bongiovanni
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Cosimo Durante
- Dipartimento di Medicina Traslazionale e di Precisione, Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | - Peter Kopp
- Service of Endocrinology, Diabetology and Metabolism, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Ruanpeng D, Cheungpasitporn W, Thongprayoon C, Hennessey JV, Shrestha RT. Systematic Review and Meta-analysis of the Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Cytological Diagnosis and Thyroid Cancer Prevalence. Endocr Pathol 2019; 30:189-200. [PMID: 31338752 DOI: 10.1007/s12022-019-09583-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A re-named diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) likely impacts the prevalence of thyroid cancer and risk of malignancy in populations based on the established Bethesda System of Reporting Thyroid Cytopathology (TBSRTC). This study was done to investigate the prevalence and cytological distribution of NIFTP. PRISMA guided systematic review was done from a database search of Pubmed, EMBASE, and Medline using the search terms "non-invasive follicular thyroid neoplasm with papillary-like nuclear features", "non-invasive follicular variant of papillary carcinoma", "niftp", and "Bethesda" until November 2018. Original articles with surgically proven diagnoses of NIFTP using strict NIFTP criteria were included. Twenty-nine studies with 1563 cases of NIFTP were included. The pooled prevalence of NIFTP in cases which would be classified previously as the follicular variant of papillary thyroid cancer (FVPTC) and papillary thyroid cancer (PTC) were 43.5% (95% CI 33.5-54.0%) and 4.4% (95% CI 2.0-9.0%) respectively. The pooled TBSRTC distribution of cases diagnosed as NIFTP was: from the non-diagnostic category 3.6% (95% CI 2.4-5.3%), benign 10.0% (95% CI 7.2-13.6%), AUS/FLUS 34.2% (95% CI 28.2-40.8%), FN/SFN 22.7% (95% CI 17.2-29.4%), suspicious for malignancy 22.4% (95% CI 17.7-27.9%), and malignant 7.5% (95% CI 4.2-12.9%). While a significant reduction in FVPTC prevalence is anticipated, a modest reduction of PTC prevalence is also expected with adoption of the NIFTP terminology that would be distributed mainly among lesions classified as indeterminate thyroid nodules. Further studies are needed to identify unique clinical characteristics of these lesions preoperatively.
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MESH Headings
- Biopsy, Fine-Needle/standards
- Biopsy, Fine-Needle/statistics & numerical data
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/epidemiology
- Carcinoma, Papillary, Follicular/pathology
- Cell Nucleus/pathology
- Cytodiagnosis/methods
- Cytodiagnosis/standards
- Cytodiagnosis/statistics & numerical data
- Diagnosis, Differential
- Guideline Adherence/standards
- Guideline Adherence/statistics & numerical data
- Humans
- Predictive Value of Tests
- Prevalence
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/epidemiology
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Nodule/diagnosis
- Thyroid Nodule/epidemiology
- Thyroid Nodule/pathology
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Affiliation(s)
- Darin Ruanpeng
- Department of Medicine, University Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Wisit Cheungpasitporn
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - James V Hennessey
- Department of Endocrinology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, GZ-6, 02215, MA, USA
| | - Rupendra T Shrestha
- Department of Medicine, University Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA.
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Guleria P, Agarwal S, Iyer VK, Jain D, Mathur SR, Yadav D. Subcategorisation of AUS/FLUS thyroid lesions as per the 2017 Bethesda System for Reporting Thyroid Cytopathology: a retrospective study from a tertiary care centre analysing risk of malignancy (ROM) of the different subcategories. J Clin Pathol 2019; 72:771-777. [DOI: 10.1136/jclinpath-2019-205985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 01/21/2023]
Abstract
AimsThe 2017 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) recommends subclassification of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) into six subcategories. The present study evaluates the risk of malignancy (ROM) and risk of neoplasm (RON) among these.MethodsAll thyroid aspirates reported as AUS/FLUS over a 4.5-year period, with available histology, were reviewed and subclassified as per TBSRTC. ROM and RON were calculated and compared.ResultsOf 2554 thyroid aspirates, 281 (11.0%) were AUS/FLUS. Eighty-one with available histology were evaluated. ROM was 51.8%. Cytologic and architectural atypia (AUS-C&A) was the most prevalent (62.9%), followed by Hürthle cell type (19.6%), AUS-A (11.1%), AUS-not otherwise specified (NOS) (7.4%), cytologic atypia (AUS-C) (4.9%) and atypical lymphoid cells (1.2%). Papillary thyroid carcinoma (PTC) and adenomatous goitre (AG) were the most common histological diagnoses (27% each). On histology, AUS-C had 2/4 PTC and 2/4 AG on histology. AUS-A had 4/9 follicular neoplasm (FN) and 2/9 non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) while AUS C&A had 18/51 PTC, 13/51 AG, 11/51 NIFTP and 5/51 FN. ROM and RON were similar across subcategories, ROM was the highest for AUS-C&A (58.8%), AUS-C (50%) and AUS-NOS (50%). NIFTP reclassification as non-malignant reduced ROM to 35.8% (absolute reduction of 16% and a relative decrease of 31%) with the greatest relative decrease seen in AUS-A (50%), followed by AUS-C&A (37%), and none in others.ConclusionsAUS/FLUS subcategorisation helped to indicate risk for the more likely neoplasm, whether PTC or FN. ROM was the highest for cases with cytological atypia but did not differ significantly across different subcategories. NIFTP changed the ROM of AUS-A and AUS-C&A, since both NIFTP and FN have microfollicles.
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Bongiovanni M, Bellevicine C, Troncone G, Sykiotis GP. Approach to cytological indeterminate thyroid nodules. Gland Surg 2019; 8:S98-S104. [PMID: 31475096 DOI: 10.21037/gs.2018.12.06] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The indeterminate thyroid nodules diagnosed by fine-needle aspiration cytology (FNAC)represents a problem for both cytopathologists and clinicians. The former sometimes use this diagnostic category as a sort of basket, putting in cases that they do not know exactly how to classify. The latter are faced with a highly variable risk of malignancy and consequently the management remains a challenge. On the histopathological side, the new WHO classification of tumors of the thyroid introduced the concept of tumors with uncertain and low malignant potential, and the concept of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), whose prognosis and management are still to be completely elucidated. While the risk of malignancy of the indeterminate diagnostic category has decreased due to the re-classification of certain types of papillary thyroid carcinomas of the follicular variant into a low malignant potential form (the NIFTP), cases diagnosed cytologically as indeterminate will probably increase in the future to avoid false positive diagnosis. Thus, the indeterminate thyroid diagnostic category still remains a challenge, both at the diagnostic level and for its management. The new version of the Bethesda system for reporting thyroid cytopathology suggests managing these patients with a repeat FNA, diagnostic lobectomy and/or molecular testing.
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Affiliation(s)
- Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Claudio Bellevicine
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Gerasimos P Sykiotis
- Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
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Indeterminate nodules by the Bethesda system for reporting thyroid cytopathology in Israel: Frequency, and risk of malignancy after reclassification of follicular thyroid neoplasm with papillary-like features. Eur J Surg Oncol 2019; 45:1182-1187. [DOI: 10.1016/j.ejso.2019.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
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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.
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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.
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Abstract
Thyroid cancers of follicular cell derivation provide excellent phenotype-genotype correlations. Current morphologic classifications are complex and require simplification. Benign adenomas have follicular or papillary architecture and bland cytology. Well-differentiated thyroid carcinomas exhibit follicular architecture, expansile growth, and variable cytologic atypia and invasiveness; low-risk tumors have excellent prognosis after surgical resection whereas widely-invasive and angioinvasive tumors warrant total thyroidectomy and radioablation. Papillary carcinoma is less differentiated; indolent microcarcinomas can be managed by active surveillance, whereas clinical lesions with local or distant spread require therapy. Progression gives rise to poorly differentiated and anaplastic carcinomas that are less common but far more aggressive.
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Affiliation(s)
- Sylvia L Asa
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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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
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Bongiovanni M, Giovanella L, Romanelli F, Trimboli P. Cytological Diagnoses Associated with Noninvasive Follicular Thyroid Neoplasms with Papillary-Like Nuclear Features According to the Bethesda System for Reporting Thyroid Cytopathology: A Systematic Review and Meta-Analysis. Thyroid 2019; 29:222-228. [PMID: 30426887 DOI: 10.1089/thy.2018.0394] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The recent introduction of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) in the World Health Organization classification of thyroid tumors has significantly modified the risk of malignancy of cytological diagnoses. In fact, while this tumor was previously classified as a carcinoma (the encapsulated, noninvasive form follicular variant of papillary thyroid carcinoma), it is now considered a neoplasm with low malignant potential. Given that the cytological features of NIFTP are not specific and overlap with other pathologic entities, there is no specific cytological diagnostic category for NIFTP. To obtain more robust information about the cytological findings associated with NIFTP, published articles were systematically reviewed, and a meta-analysis of the data was conducted. METHODS The review was conducted according to PRISMA guidelines. A comprehensive literature search of the PubMed/MEDLINE and Scopus databases was conducted using a combination of terms "noninvasive," "encapsulated," "follicular variant," "NIFTP," and "thyroid cancer." The search was updated to June 2018, and references of the retrieved articles were also screened. Only original articles reporting the classification of histologically proven NIFTPs with cytological findings according to The Bethesda System for Reporting Thyroid Cytopathology were eligible for inclusion. RESULTS The literature search revealed 117 articles, of which 15 were included in the study. All studies were retrospective. A total of 915 NIFTP cases were retrieved. The incidence of cases cytologically classified according to the Bethesda system was as follows: non-diagnostic 3%, benign 10%, atypia of undetermined significance or follicular lesion of undetermined significance 30%, follicular neoplasm or suspicious for a follicular neoplasm 21%, suspicious for malignancy 24%, and malignant 8%. Mild heterogeneity between the studies was found. Publication bias was absent. CONCLUSIONS This meta-analysis shows that the cytological diagnoses associated with NIFTP by fine-needle aspiration cytology includes a wide spectrum of findings. The majority of cases are cytologically indeterminate, and the remainder may be read as non-diagnostic, benign, or malignant. In order to develop an accurate presurgical diagnosis of these cases, further cytological and/or molecular characteristics need to be identified.
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Affiliation(s)
- Massimo Bongiovanni
- 1 Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | - Luca Giovanella
- 2 Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Pierpaolo Trimboli
- 2 Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Agarwal S, Bychkov A, Jung CK, Hirokawa M, Lai C, Hong S, Kwon HJ, Rangdaeng S, Liu Z, Su P, Kakudo K, Jain D. The prevalence and surgical outcomes of Hürthle cell lesions in FNAs of the thyroid: A multi‐institutional study in 6 Asian countries. Cancer Cytopathol 2019; 127:181-191. [DOI: 10.1002/cncy.22101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/30/2018] [Accepted: 12/18/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Shipra Agarwal
- Department of Pathology All India Institute of Medical Sciences New Delhi India
| | - Andrey Bychkov
- Department of Pathology Kameda Medical Center Kamogawa Chiba Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine The Catholic University of Korea Seoul South Korea
| | | | - Chiung‐Ru Lai
- Department of Pathology Taipei Veterans General Hospital Taipei Taiwan
| | - SoonWon Hong
- Department of Pathology Yonsei University, College of Medicine Seoul South Korea
| | - Hyeong Ju Kwon
- Department of Pathology Yonsei University, College of Medicine Seoul South Korea
| | - Samreung Rangdaeng
- Department of Pathology, Faculty of Medicine Chiang Mai University Chiang MaiThailand
| | - Zhiyan Liu
- Department of Pathology, School of Basic Medical Sciences Cheeloo College of Medicine, Shandong University Shandong China
- Department of Pathology Qilu Hospital of Shandong University Shandong China
| | - Peng Su
- Department of Pathology Qilu Hospital of Shandong University Shandong China
| | - Kennichi Kakudo
- Department of Pathology Nara Hospital, Kindai University Faculty of Medicine Nara Japan
| | - Deepali Jain
- Department of Pathology All India Institute of Medical Sciences New Delhi India
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Shrestha RT, Ruanpeng D, Hennessey JV. Cytomorphology of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features and the Impact of New Nomenclature on Molecular Testing. Med Sci (Basel) 2019; 7:E15. [PMID: 30678281 PMCID: PMC6410294 DOI: 10.3390/medsci7020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022] Open
Abstract
The re-naming of noninvasive follicular variant papillary thyroid cancer to the apparently non-malignant, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) impacts the prevalence of malignancy rates, thereby affecting mutation frequency in papillary thyroid cancer. Preoperative assessment of such nodules could affect management in the future. The original publications following the designation of the new nomenclature have been extensively reviewed. With the adoption of NIFTP terminology, a reduction in the follicular variant of papillary thyroid cancer (FVPTC) prevalence is anticipated, as is a modest reduction of papillary thyroid cancer (PTC) prevalence that would be distributed mainly across indeterminate thyroid nodules. Identifying NIFTP preoperatively remains challenging. RAS mutations are predominant but the presence of BRAF V600E mutation has been observed and could indicate inclusion of the classical PTC. The histological diagnosis of NIFTP to designate low-risk encapsulated follicular variant papillary thyroid cancers (EFVPTCs) would impact malignancy rates, thereby altering the mutation prevalence. The histopathologic criteria have recently been refined with an exclusion of well-formed papillae. The preoperative identification of NIFTP using cytomorphology and gene testing remains challenging.
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Affiliation(s)
- Rupendra T Shrestha
- University of Minnesota Twin Cities, Department of Medicine, Minneapolis, MN 55455, USA.
| | - Darin Ruanpeng
- University of Minnesota Twin Cities, Department of Medicine, Minneapolis, MN 55455, USA.
| | - James V Hennessey
- Division of Endocrinology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, GZ-6, Boston, MA 02215, USA.
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42
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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.
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43
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Bychkov A, Jung CK, Liu Z, Kakudo K. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features in Asian Practice: Perspectives for Surgical Pathology and Cytopathology. Endocr Pathol 2018; 29:276-288. [PMID: 29476382 PMCID: PMC6097061 DOI: 10.1007/s12022-018-9519-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was initiated and promoted by pathologists. Recent Asian studies added new knowledge to the existing literature to aid a better understanding of NIFTP. Our original data and the results of a meta-analysis suggest that the initial rate of NIFTP has been overestimated, averaging 9.1% (95% confidence interval [CI] 6.0-12.7%) of all papillary thyroid cancers worldwide. The incidence of NIFTP in the Asian population (1.6%, 95% CI 0.9-2.5%; 7 studies) is significantly lower than that reported in the non-Asian series (13.3%, 95% CI 9.0-18.3%; 18 studies). Such difference could be attributed to various perceptions of histological diagnostic thresholds, different nature of papillary thyroid carcinoma, and different approaches in the management of thyroid nodules. The active surveillance for indeterminate nodules and NIFTP, largely represented in the indeterminate cytologic categories, promoted by Japanese institutions establishes a new paradigm to reduce overtreatment of these patients. The lower prevalence of NIFTP in the Asian series indicates a low impact on the risk of malignancy in cytopathology, as it was demonstrated in our original multi-institutional cohort of thyroid nodules, and may predict a low impact on the performance of commercial molecular tests. Several Korean studies addressed the issue of BRAF mutation in NIFTP, which prompted the current refinement of the diagnostic criteria for NIFTP. Our survey of Asian pathologists found that the term NIFTP has not been universally adopted in the local practice. Endocrine pathologists must promote the new entity through provision of educational activities.
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Affiliation(s)
- Andrey Bychkov
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Zhiyan Liu
- Department of Pathology, Shandong University School of Basic Medical Sciences, Jinan, Shandong, 250012, China
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kindai University Faculty of Medicine, Nara, 630-0293, Japan.
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Kakudo K, El-Naggar AK, Hodak SP, Khanafshar E, Nikiforov YE, Nosé V, Thompson LDR. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in thyroid tumor classification. Pathol Int 2018; 68:327-333. [PMID: 29675873 DOI: 10.1111/pin.12673] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Kennichi Kakudo
- Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Nara-ken, Japan
| | - Adel K El-Naggar
- Department of Pathology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Steven P Hodak
- Division of Endocrinology and Metabolism, New York University School of Medicine, New York, New York, USA
| | - Elham Khanafshar
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vania Nosé
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lester D R Thompson
- Southern California Permanente Medical Group, Woodland Hills, California, USA
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45
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Bychkov A, Kakudo K, Hong S. Current Practices of Thyroid Fine-Needle Aspiration in Asia: A Missing Voice. J Pathol Transl Med 2017; 51:517-520. [PMID: 29046516 PMCID: PMC5700885 DOI: 10.4132/jptm.2017.09.27] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Andrey Bychkov
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan
| | - SoonWon Hong
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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