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Bhuyan G, Rabha A. Can the analysis of chromatin texture and nuclear fractal dimensions serve as effective means to distinguish non-invasive follicular thyroid neoplasm with papillary-like nuclear features from other malignancies with follicular pattern in the thyroid?: a study. Ultrastruct Pathol 2024; 48:310-316. [PMID: 38828684 DOI: 10.1080/01913123.2024.2362758] [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: 05/05/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Thyroid carcinoma ranks as the 9th most prevalent global cancer, accounting for 586,202 cases and 43,636 deaths in 2020. Computerized image analysis, utilizing artificial intelligence algorithms, emerges as a potential tool for tumor evaluation. AIM This study aims to assess and compare chromatin textural characteristics and nuclear dimensions in follicular neoplasms through gray-level co-occurrence matrix (GLCM), fractal, and morphometric analysis. METHOD A retrospective cross-sectional study involving 115 thyroid malignancies, specifically 49 papillary thyroid carcinomas with follicular morphology, was conducted from July 2021 to July 2023. Ethical approval was obtained, and histopathological examination, along with image analysis, was performed using ImageJ software. RESULTS A statistically significant difference was observed in contrast (2.426 (1.774-3.412) vs 2.664 (1.963-3.610), p = .002), correlation (1.202 (1.071-1.298) vs 0.892 (0.833-0.946), p = .01), and ASM (0.071 (0.090-0.131) vs 0.044 (0.019-0.102), p = .036) between NIFTP and IFVPTC. However, morphometric parameters did not yield statistically significant differences among histological variants. CONCLUSION Computerized image analysis, though promising in subtype discrimination, requires further refinement and integration with traditional diagnostic parameters. The study suggests potential applications in scenarios where conventional histopathological assessment faces limitations due to limited tissue availability. Despite limitations such as a small sample size and a retrospective design, the findings contribute to understanding thyroid carcinoma characteristics and underscore the need for comprehensive evaluations integrating various diagnostic modalities.
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Affiliation(s)
- Geet Bhuyan
- Department of Pathology, Jorhat medical college and hospital, Jorhat, India
| | - Anjumoni Rabha
- Department of Psychiatry, Lakhimpur medical college and hospital, Lakhimpur, India
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Hernandez-Prera JC, Wenig BM. RAS-Mutant Follicular Thyroid Tumors: A Continuous Challenge for Pathologists. Endocr Pathol 2024:10.1007/s12022-024-09812-5. [PMID: 38888731 DOI: 10.1007/s12022-024-09812-5] [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] [Accepted: 05/20/2024] [Indexed: 06/20/2024]
Abstract
The classification of thyroid nodules, particularly those with a follicular growth pattern, has significantly evolved. These tumors, enriched with RAS or RAS-like mutations, remain challenging for pathologists due to variables such as nuclear atypia, invasion, mitotic activity, and tumor necrosis. This review addresses the histological correlates of benign, low-risk, and malignant RAS-mutant thyroid tumors, as well as some difficult-to-classify follicular nodules with worrisome features. One prototypical RAS-mutant nodule is non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The assessment of nuclear characteristics in encapsulated/well-demarcated non-invasive RAS-mutant follicular-patterned tumors helps distinguish between follicular thyroid adenoma (FTA) and NIFTP. Despite this straightforward concept, questions about the degree of nuclear atypia necessary for the diagnosis of NIFTP are common in clinical practice. The nomenclature of follicular nodules lacking clear invasive features with increased mitotic activity, tumor necrosis, and/or high-risk mutations (e.g., TERT promoter or TP53) remains debated. Invasion, particularly angioinvasion, is the current hallmark of malignancy in RAS-mutant follicular-patterned neoplasms, with follicular thyroid carcinoma (FTC) as the model. Assessing the tumor interface is critical, though full capsule evaluation can be challenging. Multiple levels and NRASQ61R-specific immunohistochemistry can aid in identifying invasion. Controversies around vascular invasion persist, with ancillary stains like CD31, ERG, and CD61 aiding in its evaluation. Moreover, the review highlights that invasive encapsulated follicular variant papillary thyroid carcinoma (IEFVPTC) is closely associated with FTC, suggesting the need for better nomenclature. The concept of "high-grade" differentiated carcinomas, applicable to FTC or IEFVPTC with necrosis and/or high mitotic activity, is also discussed.
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Affiliation(s)
- Juan C Hernandez-Prera
- Department of Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
| | - Bruce M Wenig
- Department of Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
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Williams MD, Liu Z, Rossi ED, Agarwal S, Ryška A, Ghuzlan AA, Bychkov A, Baloch Z, Chernock R, Chiosea SL, Cipriani NA, Erkilic S, Fridman M, Hang JF, Harahap AS, Jung CK, Kakudo K, Khalil M, Khanafshar E, Kumarasinghe P, Lloyd R, Nguyen TPX, Ocal IT, Prasad ML, Pusztaszeri M, Rana C, Sadow P, Sajed DP, Seethala R, Tallini G, Vuong HG, Yegen G, LiVolsi VA, Nikiforov YE. Seven years of Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP): Rate of Acceptance and Variation of Diagnostic Approaches Across Different Continents. J Clin Endocrinol Metab 2024:dgae354. [PMID: 38874075 DOI: 10.1210/clinem/dgae354] [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: 02/09/2024] [Indexed: 06/15/2024]
Abstract
CONTEXT Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a new entity replacing the diagnosis of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC). Significant variability in the incidence of NIFTP diagnosed in different world regions has been reported. OBJECTIVE To investigate the rate of adoption of NIFTP, change in practice patterns, and uniformity in applying diagnostic criteria among pathologists practicing in different regions. METHODS Two surveys distributed to pathologists of the International Endocrine Pathology Discussion Group with multiple-choice questions on NIFTP adoption into pathology practice and whole slide images of 5 tumors to collect information on nuclear score and diagnosis. Forty-eight endocrine pathologists, including 24 from North America, 8 from Europe, and 16 from Asia/Oceania completed the first survey and 38 the second survey. RESULTS A 94% adoption rate of NIFTP by the pathologists was found. Yet, the frequency of rendering NIFTP diagnosis was significantly higher in North America than in other regions (P = .009). While the highest concordance was found in diagnosing lesions with mildly or well-developed PTC-like nuclei, there was significant variability in nuclear scoring and diagnosing NIFTP for tumors with moderate nuclear changes (nuclear score 2) (case 2, P < .05). Pathologists practicing in North America and Europe showed a tendency for lower thresholds for PTC-like nuclei and NIFTP than those practicing in Asia/Oceania. CONCLUSION Despite a high adoption rate of NIFTP across geographic regions, NIFTP is diagnosed more often by pathologists in North America. Significant differences remain in diagnosing intermediate PTC-like nuclei and respectively NIFTP, with more conservative nuclear scoring in Asia/Oceania, which may explain the geographic differences in NIFTP incidence.
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Affiliation(s)
- Michelle D Williams
- Department of Anatomical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zhiyan Liu
- Department of Pathology, Shanghai Sixth People's Hospital, Shanghai 201306, China
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico "Agostino Gemelli"-IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Aleš Ryška
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, Hradec Kralove 50005, Czech Republic
| | - Abir Al Ghuzlan
- Department of Medical Biology and Pathology, Institute Gustave Roussy, Villejuif 94800, France
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba 296-8602, Japan
| | - Zubair Baloch
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Rebecca Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Simion L Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Nicole A Cipriani
- Department of Pathology, The University of Chicago, Chicago, IL 60637, USA
| | - Suna Erkilic
- Department of Pathology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey
| | - Michael Fridman
- Department of Oncology, Belarus Medical State University, Minsk 220116, Belarus
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Agnes Stephanie Harahap
- Department of Anatomical Pathology, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kennichi Kakudo
- Department of Pathology, Cancer Genome Center and Thyroid Disease Center, Izumi City General Hospital, Izumi, Osaka 594-0073, Japan
| | - Moosa Khalil
- Department of Pathology, University of Calgary, Calgary, Alberta T2N 2T9, Canada
| | - Elham Khanafshar
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Priyanthi Kumarasinghe
- Department of Pathology, University of Western Australia & Curtain Medical School, Perth, Western Australia 6102, Australia
| | - Ricardo Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | | | - Idris Tolgay Ocal
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Marc Pusztaszeri
- Department of Pathology, McGill University, Montreal, Quebec H3T 1E2, Canada
| | - Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow 226003, India
| | - Peter Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dipti P Sajed
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Raja Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Giovanni Tallini
- Anatomic Pathology-Department of Medical and Surgical Sciences (DIMEC), University of Bologna; Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero, University of Bologna, Bologna 40138, Italy
| | - Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Gülçin Yegen
- Department of Pathology, Medical Faculty of Istanbul, Istanbul University, 34093 Istanbul, Turkey
| | - Virginia A LiVolsi
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Xu B. Molecular alterations of follicular cell-derived thyroid neoplasms. DIAGNOSTIC HISTOPATHOLOGY 2023. [DOI: 10.1016/j.mpdhp.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Wong KS, Barletta JA. Challenges in Encapsulated Follicular-Patterned Tumors: How Much Is Enough? Evaluation of Nuclear Atypia, Architecture, and Invasion. Surg Pathol Clin 2023; 16:27-44. [PMID: 36739165 DOI: 10.1016/j.path.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thyroid pathology is notoriously fraught with high interobserver variability, and follicular-patterned tumors are among some of the most challenging to assess accurately and reproducibly. Given that encapsulated or well-circumscribed follicular-patterned tumors often have similar molecular profiles, that is, frequent RAS or RAS-like alterations, the diagnosis usually relies on histopathologic examination alone. Unfortunately, many of the features that are used for diagnosis and prognosis of these tumors have long been controversial and frequently debated topics, both due to their subjectivity and their evolving (or not yet resolved) definitions. In more recent years, the introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features has added further complexity to this discussion. In particular, the criteria and significance of nuclear features of papillary thyroid carcinoma, architectural patterns, and invasive growth still pose significant diagnostic challenges and confusion. This review explores some of the challenges in evaluating encapsulated follicular-patterned tumors, focusing on those histologic elements.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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6
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Melo M, Ventura M, Cardoso L, Gaspar da Rocha A, Paiva I, Sobrinho-Simões M, Soares P. Non-invasive follicular thyroid neoplasm with papillary-like nuclear feature: clinical, pathological, and molecular update 5 years after the nomenclature revision. Eur J Endocrinol 2023; 188:6992574. [PMID: 36655540 DOI: 10.1093/ejendo/lvad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/19/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
The term non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was proposed in 2016 and incorporated as a new entity in the World Health Organization (WHO) classification of tumours of endocrine organs in 2017. Since then, there has been debate regarding the histological criteria for the diagnosis, the need for molecular studies or the risk of lymph node metastasis or recurrence associated with this entity. Over the years, the concept of NIFTP evolved, now including both small (<1 cm) and large (>4 cm) tumours and oncocytic lesions. On the other hand, recent data on NIFTP in the setting of thyroid follicular nodular disease or frequent coexistence of malignant tumours raised concerns regarding the follow-up of these patients. Today, both pathologists and clinicians still face several challenges in the diagnosis, treatment, and follow-up of patients with NIFTP.
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Affiliation(s)
- Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Cancer Signalling & Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Cancer Signalling & Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Faculty of Medicine, Unit of Endocrinology, University of Coimbra, Coimbra, Portugal
| | - Mara Ventura
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Luís Cardoso
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Cancer Signalling & Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Cancer Signalling & Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Faculty of Medicine, Unit of Endocrinology, University of Coimbra, Coimbra, Portugal
| | - Adriana Gaspar da Rocha
- Cancer Signalling & Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Cancer Signalling & Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Public Health Unit, ACES Baixo Mondego, Coimbra, Portugal
| | - Isabel Paiva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Manuel Sobrinho-Simões
- Cancer Signalling & Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Cancer Signalling & Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Soares
- Cancer Signalling & Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Cancer Signalling & Metabolism, Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Halada S, Baran JA, Bauer AJ, Ricarte-Filho JC, Isaza A, Patel T, Franco AT, Mostoufi-Moab S, Adzick NS, Kazahaya K, Bhatti TR, Baloch Z, Surrey LF. Clinicopathologic Characteristics of Pediatric Follicular Variant of Papillary Thyroid Carcinoma Subtypes: A Retrospective Cohort Study. Thyroid 2022; 32:1353-1361. [PMID: 36103376 PMCID: PMC9700371 DOI: 10.1089/thy.2022.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Follicular patterned thyroid nodules with nuclear features of papillary thyroid carcinoma (PTC) encompass a range of diagnostic categories with varying risks of metastatic behavior. Subtypes include the invasive encapsulated follicular variant of PTC (Ienc-fvPTC) and infiltrative fvPTC (inf-fvPTC), with tumors lacking invasive features classified as noninvasive follicular thyroid neoplasms with papillary-like features (NIFTPs). This study aimed to report the clinical and histological features of pediatric cases meeting criteria for these histological subtypes, with specific focus on Ienc-fvPTC and inf-fvPTC. Methods: In this retrospective cohort study, pediatric patients with thyroid neoplasms showing follicular patterned growth and nuclear features of PTC noted on surgical pathology between January 2010 and January 2021 were retrospectively reviewed and classified according to the recent 2022 World Health Organization (WHO) criteria. Clinical and histopathologic parameters were described for NIFTP, Ienc-fvPTC, and inf-fvPTC subtypes, with specific comparison of Ienc-fvPTC and inf-fvPTC cases. Results: The case cohort included 42 pediatric patients, with 6 (14%), 25 (60%), and 11 (26%) patients meeting criteria for NIFTP, Ienc-fvPTC, and inf-fvPTC, respectively. All cases were rereviewed, and 5 patients originally diagnosed with Ienc-fvPTC before 2017 were reappraised as having NIFTPs. The NIFTP cases were encapsulated tumors without invasive features, lymph node or distant metastasis, or disease recurrence. Ienc-fvPTC tumors demonstrated clearly demarcated tumor capsules and capsular/vascular invasion, while inf-fvPTC tumors displayed infiltrative growth lacking a capsule. inf-fvPTC cases had increased prevalence of malignant preoperative cytology, lymph node metastasis, and distant metastasis (p < 0.01). These cases were treated with total thyroidectomy, lymph node dissection, and subsequent radioactive iodine therapy. Preliminary genetic findings suggest a predominance of fusions in inf-fvPTC cases versus point mutations in Ienc-fvPTC (p = 0.02). Conclusions: Pediatric NIFTP and fvPTC subtypes appear to demonstrate alignment between clinical and histological risk stratification, with indolent behavior in Ienc-fvPTC and invasive features in inf-fvPTC tumors.
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Affiliation(s)
- Stephen Halada
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Julia A. Baran
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julio C. Ricarte-Filho
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Amber Isaza
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Tasleema Patel
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Aime T. Franco
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Sogol Mostoufi-Moab
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
- Division of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N. Scott Adzick
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ken Kazahaya
- Department of Otorhinolaryngology: Head and Neck Surgery, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tricia R. Bhatti
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lea F. Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Worapongpaiboon R, Vongsaisuwon M. Breast metastasis of papillary thyroid carcinoma. BMJ Case Rep 2022; 15:e251081. [PMID: 35793844 PMCID: PMC9260778 DOI: 10.1136/bcr-2022-251081] [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] [Indexed: 11/03/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and regional neck metastasis is more common than distant metastasis. If present, metastasis most frequently occurs in lungs and bones. Follicular variant of papillary thyroid carcinoma (FVPTC) is a mixture of the classic and follicular thyroid carcinoma and metastasizes in the same fashion as the PTC with cervical lymph nodes as the most common site. A case of atypical presentation of FVPTC with rib metastasis is reported. We present a case of an old man with a left-sided palpable breast mass for 2 months in duration without breast pain. Initially, the breast mass was categorised as Breast Imaging Reporting and Data System (BI-RADS) 4a via ultrasonography. Subsequent immunohistochemistry demonstrated that the mass was metastatic thyroid cancer. Consequently, a CT scan revealed a tumour originating from the rib. The patient was finally diagnosed with metastatic FVPTC.
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Seok JY, Fan X. TROP-2 and 5hmC expression in follicular-patterned thyroid neoplasm emphasizing tiny well-formed papillae. Ann Diagn Pathol 2022; 57:151903. [PMID: 35121239 DOI: 10.1016/j.anndiagpath.2022.151903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Follicular-patterned thyroid neoplasms (FPTNs), characterized by predominantly follicular growth pattern, represent diverse pathological entities. We aimed to study the nuclear features and the immunoexpression of trophoblast cell-surface antigen 2 (TROP-2) and 5-hydroxymethylcytosine (5hmC) in FPTNs. DESIGN FPTNs were divided into 4 groups: I) noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), II) encapsulated follicular variant of papillary thyroid carcinoma (FVPTC) with capsular invasion, III) infiltrative FVPTC, and IV) PTC with a predominantly follicular pattern and well-formed papillae (<1%). Nuclear characteristics were evaluated by image analysis. TROP-2 and 5hmC immunostains were analyzed correlating with histological features using QuPath. RESULTS From the group I to II, III, and IV, there is a gradual increase in nuclear atypia in terms of the nuclear area, max caliper, perimeter, circularity, and hematoxylin OD means (corresponding to nuclear enlargement, membrane irregularity, and clearing). A similar trend is observed in the TROP-2 expression. 5hmC expression is highly preserved in groups I, II, and III in contrast to a significant loss in group IV. Group IV tumors show more frequent regional lymph node involvement and the highest BRAF V600E mutation rate. CONCLUSION Among FPTNs, group IV tumors exhibit the most advanced nuclear atypia, highest TROP-2 expression, significant 5HMC expression loss, frequent regional lymph node involvement, and the highest BRAF V600E mutation rate. Our data further support that the presence of any true papillae should be an exclusion criterion for NIFTP. Therefore, well-formed papillae even if very minute (<1% of the tumor) should not be overlooked.
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Affiliation(s)
- Jae Yeon Seok
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea; Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xuemo Fan
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Kholová I, Haaga E, Ludvik J, Kalfert D, Ludvikova M. Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP): Tumour Entity with a Short History. A Review on Challenges in Our Microscopes, Molecular and Ultrasonographic Profile. Diagnostics (Basel) 2022; 12:diagnostics12020250. [PMID: 35204341 PMCID: PMC8871310 DOI: 10.3390/diagnostics12020250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
Since Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) was introduced as a new thyroid tumour entity, many studies, and meta-analyses on diagnosing NIFTP have been published. NIFTP-revised histopathological criteria emerged in 2018. NIFTP is defined as a histological entity and its diagnosis requires a careful histological examination. Its molecular profile is similar to follicular-like tumours. Ultrasound features are unable to differentiate NIFTP. NIFTP is not a cytological diagnosis, but it influences the risk of malignancy in several categories of The Bethesda System for Reporting Thyroid Cytopathology terminology.
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Affiliation(s)
- Ivana Kholová
- Pathology, Fimlab Laboratories, Arvo Ylpön Katu 4, 33520 Tampere, Finland;
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Correspondence: ; Tel.: +358-3-311-74851
| | - Elina Haaga
- Pathology, Fimlab Laboratories, Arvo Ylpön Katu 4, 33520 Tampere, Finland;
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
| | - Jaroslav Ludvik
- Department of Imaging Methods, University Hospital Pilsen, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 30460 Pilsen, Czech Republic;
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, 15006 Prague, Czech Republic;
| | - Marie Ludvikova
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic;
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11
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Vignali P, Proietti A, Macerola E, Poma AM, Torregrossa L, Ugolini C, Basolo A, Matrone A, Rago T, Santini F, Elisei R, Materazzi G, Basolo F. Clinical-Pathological and Molecular Evaluation of 451 NIFTP Patients from a Single Referral Center. Cancers (Basel) 2022; 14:420. [PMID: 35053581 PMCID: PMC8773775 DOI: 10.3390/cancers14020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 12/10/2022] Open
Abstract
BACKGROUND Non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs) were introduced in thyroid pathology in 2016. NIFTPs are a group of follicular neoplasm with an indolent behaviour. In this study, we gathered a large retrospective cohort of NIFTPs and compared those presenting as solitary lesions and NIFTPs found in multifocal setting. METHODS A retrospective search of NIFTPs was performed, and the clinico-pathological features were recorded. For a subgroup of patients, pre-surgical ultrasound (US) evaluation, cytological diagnosis, and molecular analysis were available. RESULTS We collected 451 NIFTPs; 254 (56.3%) were truly solitary tumours, while 197 coexisted with one or more NIFTP/cancer. Contrasting unifocal and multifocal settings, NIFTPs size was the only significantly different parameter. Preoperatively, NIFTP nodules mostly showed low-risk US characteristics, indeterminate cytology and a RAS-like molecular profile. CONCLUSION NIFTPs often coexist with collateral thyroid tumours. However, no clinical-pathological differences can be observed between solitary and "multifocal" NIFTPs. Despite the well-established clinical indolence of NIFTP, a careful monitoring of the contralateral lobe should not be excluded.
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Affiliation(s)
- Paola Vignali
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
| | - Agnese Proietti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
| | - Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
| | - Anello Marcello Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
| | - Alessio Basolo
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.M.); (T.R.); (F.S.); (R.E.)
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.M.); (T.R.); (F.S.); (R.E.)
| | - Teresa Rago
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.M.); (T.R.); (F.S.); (R.E.)
| | - Ferruccio Santini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.M.); (T.R.); (F.S.); (R.E.)
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.M.); (T.R.); (F.S.); (R.E.)
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (P.V.); (A.P.); (E.M.); (A.M.P.); (L.T.); (C.U.); (G.M.)
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12
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Immunohistochemistry Helps to Distinguish Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features/Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma with Other Follicular Thyroid Lesions. Medicina (B Aires) 2021; 57:medicina57111246. [PMID: 34833464 PMCID: PMC8624760 DOI: 10.3390/medicina57111246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives: We aimed to assess the diagnostic value of various immunohistochemical (IHC) markers and panels for differentiation among benign follicular nodules (BFNs), noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), noninvasive encapsulated follicular variants of papillary thyroid carcinoma (NEFVPTCs), and infiltrative FVPTC (IFVPTC). Materials and Methods: Sixty-three cases were classified as BFNs, NIFTPs, NEFVPTCs, or IFVPTCs and were evaluated using the following markers: CK19, CD56, galectin-3, CITED1, HBME-1, VE1, and TROP-2. Results: The IHC results for NIFTP and NEFVPTC exhibited no statistically significant differences. In differentiating IFVPTCs from BFNs and NIFTPs/NEFVPTCs, galectin-3 and TROP-2 were the markers with the highest sensitivity plus high specificity, respectively. In various combinations, panel co-expression of two markers, including galectin-3 and/or HBME-1 and/or TROP-2, and the combination of galectin-3 and TROP-2 co-expression could achieve 100% in all aspects. In terms of discrimination of BFNs from NIFTP/NEFVPTC, CK19 was the single most sensitive marker (81.3%), while CD56 was the most specific (100%). The panel consisting of CK19 and/or HBME-1 exhibited the greatest sensitivity (96.9%), but the panel with CD56 and/or HBME-1 exhibited the greatest specificity (90.5%). Conclusions: Our results broaden the use of IHC markers for differential diagnoses among the four groups of follicular-based lesions. In addition, the similar IHC profiles of NIFTP and NEFVPTC also suggest the original criterion of <1% papillae within tumors, providing a reliable NIFTP diagnosis. Their close relationship may represent a spectrum of progressing neoplasia.
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13
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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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14
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Giani C, Torregrossa L, Ramone T, Romei C, Matrone A, Molinaro E, Agate L, Materazzi G, Piaggi P, Ugolini C, Basolo F, Ciampi R, Elisei R. Whole Tumor Capsule Is Prognostic of Very Good Outcome in the Classical Variant of Papillary Thyroid Cancer. J Clin Endocrinol Metab 2021; 106:e4072-e4083. [PMID: 34231847 DOI: 10.1210/clinem/dgab396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Tumor capsule integrity is becoming a relevant issue to predict the biological behavior of human tumors, including thyroid cancer. OBJECTIVE This work aims to verify whether a whole tumor capsule in the classical variant of papillary thyroid carcinoma (CVPTC) could have as a predictive role of a good outcome as for follicular variant (FVPTC). METHODS FVPTC (n = 600) and CVPTC (n = 554) cases were analyzed. We distinguished between encapsulated-FVPTC (E-FVPTC) and encapsulated-CVPTC (E-CVPTC) and, thereafter, invasive (Ei-FVPTC and Ei-CVPTC) and noninvasive (En-FVPTC and En-CVPTC) tumors, according to the invasion or integrity of the tumor capsule, respectively. Cases without a tumor capsule were indicated as invasive-FVPTC (I-FVPTC) and invasive-CVPTC (I-CVPTC). The subgroup of each variant was evaluated for BRAF mutations. RESULTS E-FVPTC was more frequent than E-CVPTC (P < .001). No differences were found between En-FVPTC and En-CVPTC or between Ei-FVPTC and Ei-CVPTC. After 18 years of follow-up, a greater number of not-cured cases were observed in Ei-CVPTC with respect to Ei-FVPTC, but not in En-CVPTC to En-FVPTC. Multivariate clustering analysis showed that En-FVPTC, En-CVPTC, and Ei-FVPTC have similar features but different from I-FVPTC and I-CVPTC and, to a lesser extent, from Ei-CVPTC. A total of 177 of 614 (28.8%) cases were BRAFV600E mutated, and 10 of 614 (1.6%) carried BRAF-rare alterations. A significantly higher rate of En-CVPTC (22/49, 44.9%) than En-FVPTC (15/195, 7.7%) (P < .0001) were BRAFV600E mutated. CONCLUSION En-CVPTC is less prevalent than En-FVPTC. However, it has good clinical/ pathological behavior comparable to En-FVPTC. This finding confirms the good prognostic role of a whole tumor capsule in CVPTC as well. New nomenclature for En-CVPTC, similar to that introduced for En-FVPTC (ie, noninvasive follicular thyroid neoplasm with papillary-like nuclear features; NIFTP) could be envisaged.
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Affiliation(s)
- Carlotta Giani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Pathology Unit, University Hospital of Pisa, Pisa, Italy
| | - Teresa Ramone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Cristina Romei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Eleonora Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Laura Agate
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Paolo Piaggi
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Pathology Unit, University Hospital of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Pathology Unit, University Hospital of Pisa, Pisa, Italy
| | - Raffaele Ciampi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy
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15
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Paja M, Zafón C, Iglesias C, Ugalde A, Cameselle-Teijeiro JM, Rodríguez-Carnero G, Fernández-Seara P, Anda E, Povoa A, Quiceno H, Sánchez-Gómez NM, González C, García-Pascual L, Gómez de la Riva I, Blanco C, Meizoso T, Riesco-Eizaguirre G, Capel I, Ortega MV, Mancha I, Chao M, Alcázar V, Roselló E, Maravall J, López-Agulló S, Pérez-Lázaro A, Meseguer P, Sanz J, Paricio JJ, Echeverría S, Castaño Á, Bella RM. Rate of non-invasive follicular thyroid neoplasms with papillary-like nuclear features depends on pathologist's criteria: a multicentre retrospective Southern European study with prolonged follow-up. Endocrine 2021; 73:131-140. [PMID: 33484411 DOI: 10.1007/s12020-021-02610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the rate of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in a multi-institutional series from the Iberian Peninsula and describing this NIFTP cohort. METHODS Retrospective study of papillary thyroid carcinoma (PTC) or well-differentiated tumours of uncertain malignant potential (WDT-UMP) diagnosed between 2005 and 2015 and measuring ≥5 mm in adult patients from 17 hospitals. Pathological reports were reviewed to determine the cases that fulfil the original criteria of NIFTP and histology was reassessed. Rates were correlated with the number of PTC and its follicular variant (FVPTC) of each institution. Demographic data, histology, management, and follow-up of the reclassified NIFTP cohort were recorded. RESULTS A total of 182 cases with NIFTP criteria were identified: 174/3372 PTC (rate: 5.2%; range: 0-12.1%) and 8/19 WDT-UMP (42.1%). NIFTP rate showed linear correlation with total PTC (p: 0.03) and FVPTC (p: 0.007) identified at each centre. Ultrasound findings were non-suspicious in 60.1%. Fine-needle cytology or core biopsy diagnoses were undetermined in 49.7%. Most patients were treated with total thyroidectomy. No case had nodal disease. Among patients with total thyroidectomy, 89.7% had an excellent response evaluated 1 year after surgery. There were no structural persistence or relapses. Five patients showed residual thyroglobulin after 90 months of mean follow-up. CONCLUSIONS NIFTP rate is low but highly variable in neighbouring institutions of the Iberian Peninsula. This study suggests pathologist's interpretation of nuclear alterations as the main cause of these differences. Patients disclosed an excellent outcome, even without using the strictest criteria.
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Affiliation(s)
- Miguel Paja
- Department of Endocrinology, Hospital Universitario Basurto, Bilbao, Spain.
| | - Carles Zafón
- Department of Endocrinology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmela Iglesias
- Department of Pathology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Aitziber Ugalde
- Department of Pathology, Hospital Universitario Basurto, Bilbao, Spain
| | | | - Gemma Rodríguez-Carnero
- Department of Endocrinology, Complejo Hospitalario Universitario Santiago de Compostela, La Coruña, Spain
| | | | - Emma Anda
- Department of Endocrinology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Antónia Povoa
- Department of Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Hernán Quiceno
- Department of Pathology, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Clarisa González
- Department of Pathology, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Luis García-Pascual
- Department of Endocrinology, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | | | - Concha Blanco
- Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Telma Meizoso
- Department of Pathology, Hospital General de Móstoles, Madrid, Spain
| | | | - Ismael Capel
- Department of Endocrinology, Corporació Parc Taulí, Sabadell, Spain
| | - María Victoria Ortega
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Isabel Mancha
- Department of Endocrinology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Montserrat Chao
- Department of Pathology, Hospital Universitario Severo Ochoa, Leganés, Spain
| | - Victoria Alcázar
- Department of Endocrinology, Hospital Universitario Severo Ochoa, Leganés, Spain
| | - Esther Roselló
- Department of Pathology, Hospital General Universitario de Castellón, Castellón, Spain
| | - Javier Maravall
- Department of Endocrinology, Hospital General Universitario de Castellón, Castellón, Spain
| | | | | | | | - Javier Sanz
- Department of Endocrinology, Hospital Lluís Alcanyís, Xàtiva, Spain
| | - Jose J Paricio
- Department of Pathology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Saioa Echeverría
- Department of Endocrinology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ángel Castaño
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Rosa M Bella
- Department of Pathology, Corporació Parc Taulí, Sabadell, Spain
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16
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Kuchareczko A, Kopczyński J, Kowalik A, Hińcza K, Płusa A, Góźdź S, Kowalska A. Are molecular tests necessary to diagnose NIFTP? Genes Cancer 2021; 12:39-50. [PMID: 33884105 PMCID: PMC8045962 DOI: 10.18632/genesandcancer.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/28/2021] [Indexed: 12/15/2022] Open
Abstract
In 2016, encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) was
reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear
features (NIFTP). In 2018 the criteria for NIFTP were widened by the inclusion of the
complete lack of papillae. Secondary criteria, which include molecular examination, are
helpful but not required for NIFTP diagnose. The aim of this study was to assess the molecular background of NIFTP and to answer the
question if the aplication of revised criteria for NIFTP diagnosis is associated with the
lack of oncogenic mutation. Repeat histopathological assessment of 1117 cases of papillary thyroid carcinoma (PTC)
from 2000-2016 was conducted. Using initial (2016) and revised (2018) diagnostic criteria,
NIFTP was diagnosed in 23 and 13 patients respectively. 50 tumor genes hotspots mutation
analysis was conducted. BRAFV600E mutations were detected in
patients who fulfilled only initial NIFTP criteria. Other high-risk mutations
(TP53) were found in both groups of patients. The application of restrictive, revised diagnostic criteria for NIFTP negates the need
for BRAFV600E examination, but these tumors still can harbor
other high-risk oncogenic mutations nonetheless. Thus, molecular examination should be
considered as a necessary step in NIFTP diagnostic process.
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Affiliation(s)
| | | | - Artur Kowalik
- Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland.,Division of Medical Biology, Institute of Biology, Jan Kochanowski University, Kielce, Poland
| | - Kinga Hińcza
- Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Agnieszka Płusa
- Department of Pathology, Holycross Cancer Centre, Kielce, Poland.,Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Clinical Oncology, Holycross Cancer Centre, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland.,Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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17
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Wang X, Zheng X, Zhu J, Li Z, Wei T. Radioactive iodine therapy may not improve disease-specific survival in follicular variant papillary thyroid cancer without distant metastasis: A propensity score-matched analysis. Head Neck 2021; 43:1730-1738. [PMID: 33559196 PMCID: PMC8248087 DOI: 10.1002/hed.26637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/20/2020] [Accepted: 01/21/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Whether radioactive iodine (RAI) therapy is effective in improving disease-specific survival (DSS) in patients with follicular variant papillary thyroid cancer (FVPTC) without distant metastasis remains unclear. METHODS Patients with FVPTC were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The Kaplan-Meier method and the Cox proportional hazards regression model were used to evaluate DSS. Propensity score-matched analysis was performed to reduce the influence of confounding bias. RESULTS RAI did not improve DSS, even in patients with aggressive features such as T4 classification (p = 0.658), extrathyroidal extension (p = 0.083), lateral lymph node metastasis (p = 0.544), and ≥5 metastatic lymph nodes (p = 0.599). CONCLUSION RAI did not affect DSS in patients with FVPTC without distant metastases in this SEER database study. Multicenter, prospective studies including recurrence and molecular information should be conducted to comprehensively evaluate the effects of RAI on FVPTC.
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Affiliation(s)
- Xiaofei Wang
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Zheng
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihui Li
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Wei
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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18
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Chen P, Pan L, Huang W, Feng H, Ouyang W, Wu J, Wang J, Deng Y, Luo J, Chen Y. BRAF V600E and lymph node metastases in papillary thyroid cancer. Endocr Connect 2020; 9:999-1008. [PMID: 33064665 PMCID: PMC7576641 DOI: 10.1530/ec-20-0420] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the relationship between the BRAF V600E mutation in lymph node metastasis (LNM) and its invasive characteristics in papillary thyroid cancer (PTC). MATERIAL AND METHODS A total of 373 PTC patients were enrolled in this study conducted at Zhujiang Hospital of Southern Medical University between January 2017 and December 2018. PTCs with cervical lymph node metastases were verified pathohistologically, and primary tumors and LNM were examined for the BRAF V600E mutation. Patients were excluded from the study if the BRAF V600E mutation was examined only in primary tumors or only in LNM. RESULTS Of the 373 patients examined, BRAF V600E mutation frequency in primary tumors was slightly higher than in LNM (81.5% vs 78.0%, P = 0.000), the intra-class correlation coefficient (ICC) was 0.865 (95% CI 0.835-0.890). The BRAF V600E mutation in both primary tumor and LNM negatively correlated with the size of the largest metastatic focus of LNM (Odds ratio, OR = 0.297, 95% CI 0.143-0.616, P = 0.001; OR = 0.242, 95% CI 0.119-0.492, P = 0.000, respectively). There was no relationship between BRAF V600E mutation in LNM and the number, extranodal extension or stage of LNM (P > 0.05). CONCLUSION The BRAF V600E mutation in LNM may not be related to the invasive characteristics of LNM in PTC.
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Affiliation(s)
- Pan Chen
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Liqin Pan
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wensi Huang
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Huijuan Feng
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
- Correspondence should be addressed to H Feng or W Ouyang: or
| | - Wei Ouyang
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
- Correspondence should be addressed to H Feng or W Ouyang: or
| | - Juqing Wu
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jing Wang
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yuying Deng
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jiaxin Luo
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yanying Chen
- Department of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
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19
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Canberk S. Precursor and borderline lesions of the thyroid (indolent lesions of epithelial origin): from theory to practice. Gland Surg 2020; 9:1724-1734. [PMID: 33224850 DOI: 10.21037/gs-20-429] [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] [Indexed: 12/12/2022]
Abstract
The precursor lesions of thyroid neoplasms can arise from either C cells or follicular cells. Although MTC has an established and recognized precursor lesion, the C-cell hyperplasia, the same does not occur for the follicular cell-derived tumors, which are much more frequent. One of the significant obstacles to recognizing follicular cell-derived precursor lesions (FCPL) is the lack of refinement of the morphological spectrum and biology of these putative premalignant lesions. What are the "gold standard" histological criteria in thyroid pathology to identify the progression of dysplasia to cancer? Diagnostical irreproducibility and misnomer in the terminology of some FCPLs have been lying behind the answer to this question. The last past decades' advances in molecular pathology allow us to transform the knowledge in thyroid pathology to cancer prevention and early detection, which will only be possible by improving our understanding of the nature of thyroid precursor and borderline lesions. This review, amassed with the augmented expertise of thyroid pathology documented in the literature, is an attempt at underlining the present understanding of precursor and borderline lesions of the thyroid, with a particular highlight on practice differences in Asian and Western geographies.
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Affiliation(s)
- Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Rua Alfredo Allen, 208 4200-135, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal.,Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313, Porto, Portugal
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20
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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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21
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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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22
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Hu D, Huang Y, Zeng W, Chen S, Huang Y, Li M, Long W, Huang J, Wei W, Zhang C, Liu Z, Guo L. Is a simplified TNM staging system more clinically relevant than the American Joint Committee on Cancer system for the follicular variant of papillary thyroid cancer? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:463. [PMID: 32395507 PMCID: PMC7210171 DOI: 10.21037/atm.2020.03.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Despite the recent release of the 8th edition of the American Joint Committee on Cancer (AJCC) staging manual, risk stratification for the follicular variant of papillary thyroid cancer (FVPTC), which is the second common variant of papillary thyroid carcinoma (PTC) after classical PTC, remains controversial. This study aimed to develop a more accurate and relevant staging system specifically for FVPTC. Methods Patients with FVPTC who were included in the Surveillance, Epidemiology, and End Results (SEER) open database between 2010 and 2015 were divided into 47 groups according to their TNM classifications and age. Subsequently, these 47 groups were categorized into appropriate stages based on Kaplan-Meier survival curves, mortality analyses, a Cox proportional hazards model, and clinical considerations. Results Our retrospective analysis of 17,628 cases yielded the following new staging classification: stage I, defined as age <55 years and any T/N/M or age ≥55 years and T1-3/any N/M0 (n=17,427, 98.85%); stage II, age ≥55 and T4/any N/M0 or age ≥55 and any T/N0/M1 (n=173, 0.99%); and stage III, age ≥55 and any T/N1/M1 (n=28, 0.16%). The overall mortality rates per 1,000-person-years were 4.135 [95% confidence interval (CI): 3.653–4.681], 71.193 (95% CI: 51.354–98.697), and 199.744 (95% CI: 115.983–343.997) for our new stages I, II, and III, respectively. The hazard ratios for the new stages II and III (reference: stage I) were 5.081 (95% CI: 3.110–8.301) and 21.690 (95% CI: 11.402–41.258), respectively. Conclusions Compared to the 8th edition of the AJCC staging system, our newly proposed system provided more accurate risk stratification for patients with FVPTC, as demonstrated by actual survival and mortality outcomes. This new model may thus help guide more personalized treatment for these patients.
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Affiliation(s)
- Di Hu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yueye Huang
- Department of Endocrinology and Metabolism and the Shanghai Research Center of Thyroid Diseases, The Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200125, China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Sichao Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yihui Huang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Man Li
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wei Long
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jianglong Huang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wei Wei
- Department of Pediatrics, St John Hospital and Medical Center, Detroit, MI, USA
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zeming Liu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Xu B, Ghossein RA. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): An Update. Head Neck Pathol 2020; 14:303-310. [PMID: 32124418 PMCID: PMC7235108 DOI: 10.1007/s12105-019-01124-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022]
Abstract
Based on evidence accumulated over the past three decades showing that noninvasive encapsulated follicular variant of papillary thyroid carcinoma has an indolent clinical behavior and a RAS-like molecular profile similar to follicular adenoma, the Endocrine Pathology Society working group in 2016 proposed to rename this entity as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)" in order to eliminate the term "carcinoma" from the diagnosis. It is a major evidence-based attempt initiated by an international group of endocrine pathologists to tackle the epidemic of thyroid cancer overdiagnosis and overtreatment. However, its creation and continuous existence are not without controversies. NIFTP has sparked a wave of follow up studies aiming to decipher the exact nature of this new entity. In this review, we summarize the rationale, diagnostic criteria, controversies and subsequent changes to the NIFTP concept, and their impact on patient care and pathology practice.
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Affiliation(s)
- Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA.
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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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Larouche V, Pusztaszeri MP, Filimon S, Payne R, Hier M, Tamilia M. Preoperative prediction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: a Canadian single-Centre experience. J Otolaryngol Head Neck Surg 2020; 49:1. [PMID: 31898554 PMCID: PMC6941342 DOI: 10.1186/s40463-019-0397-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background An international group of experts recommended reclassifying non-invasive follicular variant of papillary thyroid cancers (FVPTC) as ‘non-invasive follicular thyroid neoplasm with papillary-like nuclear features’ (NIFTP) in April 2016. The purpose of this study was to establish preoperative clinical, laboratory, ultrasonographic, and cytological variables, which can differentiate NIFTP from FVPTC. Methods We conducted a retrospective chart review of consecutive patients from a single institution evaluated between January 2012 and December 2017. 203 adult patients underwent lobectomy or total thyroidectomy for a FVPTC during that period. Each patient’s medical chart was reviewed and information on pre-operative variables was recorded. An expert pathologist reviewed all surgical specimens and reclassified a subset of FVPTC as NIFTP according to the specific criteria. Results Overall, 44 patients were included in the NIFTP group and 159 in the non-NIFTP group. Mean age was 50.1 years in the NIFTP group and 50.7 in the non-NIFTP group. Most patients were female (86.4% (38/44) in the NIFTP group vs 79.8% (127/159) in the non-NIFTP group). More patients underwent lobectomy in the NIFTP group (50% (22/44) vs 16.4% (26/159) in the non-NIFTP group, p = < 0.0001). Less patients received radioactive iodine in the NIFTP group (31.8% (14/44) vs 52.2% (83/159) in the non-NIFTP group, p = 0.0177). Preoperative thyroglobulin levels were lower in NIFTP patients (Median 25.55 mcg/L +/− 67.8 vs 76.06 mcg/L +/− 119.8 in Non-NIFTP, p = 0.0104). NIFTP nodules were smaller (Mean size 22.97 mm +/− 12.3 vs 25.88 mm +/− 11.2 for non-NIFTP, p = 0.0448) and more often solid than non-NIFTP (93.2% (41/44) vs 74.8% (119/159) for non-NIFTP, p = 0.0067). 2017 ACR TIRADS nodule category of 1–4 on ultrasound had a negative predictive value and a sensitivity of 100% for NIFTP. ROC Curve Analysis demonstrated that a preoperative thyroglobulin level of 31.3 mcg/L had a sensitivity of 75% and a specificity of 62.5% to differentiate NIFTP from non-NIFTP cancers. Conclusion Lower preoperative thyroglobulin levels, smaller nodule size, solid texture and 2017 ACR TIRADS Category of 1–4 are more strongly associated with NIFTP than FVPTC and can favour less invasive surgical options such as lobectomy.
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Affiliation(s)
- Vincent Larouche
- Division of Endocrinology and Metabolism, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada.
| | - Marc Philippe Pusztaszeri
- Division of Pathology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Sabin Filimon
- Internal Medicine Residency Training Program, McGill University, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Richard Payne
- Division of Oto-Rhino-Laryngology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Michael Hier
- Division of Oto-Rhino-Laryngology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Michael Tamilia
- Division of Endocrinology and Metabolism, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
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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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Xu B, Serrette R, Tuttle RM, Alzumaili B, Ganly I, Katabi N, Tallini G, Ghossein R. How Many Papillae in Conventional Papillary Carcinoma? A Clinical Evidence-Based Pathology Study of 235 Unifocal Encapsulated Papillary Thyroid Carcinomas, with Emphasis on the Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Thyroid 2019; 29:1792-1803. [PMID: 31452453 PMCID: PMC6918873 DOI: 10.1089/thy.2019.0328] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The percentage of papillae is a crucial criterion in differentiating noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) from papillary thyroid carcinomas (PTCs) and in subclassifying PTC into classic and follicular variant. Since the description of NIFTP, three studies have shown that the presence of any papillae may be associated with nodal metastasis, which led to modification of the NIFTP criterion from <1% papillae to no true papillae allowed. We aim at providing clinical evidence-based data on the impact that papillary growth has on nodal spread and tumor genotype in tumors previously diagnosed as encapsulated unifocal PTC. Methods: A meticulous histopathologic examination was performed on 235 cases previously diagnosed as unifocal encapsulated PTC (U-EPTC). One hundred of these cases were subjected to BRAFV600E and NRASQ61R immunohistochemistry. Results: In our cohort, 27 patients (12%) had lymph node metastasis (N1) at the time of initial resection. Overall, 89% of the tumors in the N1 group contained ≥50% papillae, compared with 13% in the N0/Nx group. Nodal metastases were only present in tumors with ≥1% papillae. In noninvasive U-EPTC (n = 161), N1 disease was seen only in tumors with ≥10% papillae. A higher percentage of papillae within the tumor also correlated with an increased frequency of BRAFV600E and decreased rate of NRASQ61R. None of the 26 NRAS-positive cases had nodal disease, including the invasive tumors. Among 216 patients with follow-up (median: 5.2 years), 3 patients (1.5%) had distant metastases, all detected at the initial presentation. All three tumors displayed 100% follicular growth, and capsular or vascular invasion. There was no locoregional recurrence in the entire cohort. Conclusion: In U-EPTC, there is a strong correlation between high percentage of papillary growth, presence of nodal metastasis, and BRAF+/RAS- genotype regardless of invasive status. Nodal metastases were not seen in tumors with <1% papillae irrespective of invasive status. These findings indicate that the initial criterion of <1% papillae is still valid for the diagnosis of NIFTP. Reinstituting this criterion will spare a carcinoma diagnosis and unnecessary therapy with its side effects on patients who have negligible clinical risk.
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Affiliation(s)
- Bin Xu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Rene Serrette
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - R. Michael Tuttle
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Bayan Alzumaili
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nora Katabi
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine-Anatomic Pathology, University of Bologna School of Medicine, Bologna, Italy
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
- Address correspondence to: Ronald Ghossein, MD, Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
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28
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Seo JY, Park JH, Pyo JY, Cha YJ, Jung CK, Song DE, Kwak JJ, Park SY, Na HY, Kim JH, Seok JY, Kim HS, Hong SW. A Multi-institutional Study of Prevalence and Clinicopathologic Features of Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) in Korea. J Pathol Transl Med 2019; 53:378-385. [PMID: 31634988 PMCID: PMC6877441 DOI: 10.4132/jptm.2019.09.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background In the present multi-institutional study, the prevalence and clinicopathologic characteristics of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were evaluated among Korean patients who underwent thyroidectomy for papillary thyroid carcinoma (PTC). Methods Data from 18,819 patients with PTC from eight university hospitals between January 2012 and February 2018 were retrospectively evaluated. Pathology reports of all PTCs and slides of potential NIFTP cases were reviewed. The strict criterion of no papillae was applied for the diagnosis of NIFTP. Due to assumptions regarding misclassification of NIFTP as non-PTC tumors, the lower boundary of NIFTP prevalence among PTCs was estimated. Mutational analysis for BRAF and three RAS isoforms was performed in 27 randomly selected NIFTP cases. Results The prevalence of NIFTP was 1.3% (238/18,819) of all PTCs when the same histologic criteria were applied for NIFTP regardless of the tumor size but decreased to 0.8% (152/18,819) when tumors ≥1 cm in size were included. The mean follow-up was 37.7 months and no patient with NIFTP had evidence of lymph node metastasis, distant metastasis, or disease recurrence during the follow-up period. A difference in prevalence of NIFTP before and after NIFTP introduction was not observed. BRAFV600E mutation was not found in NIFTP. The mutation rate for the three RAS genes was 55.6% (15/27). Conclusions The low prevalence and indolent clinical outcome of NIFTP in Korea was confirmed using the largest number of cases to date. The introduction of NIFTP may have a small overall impact in Korean practice.
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Affiliation(s)
- Ja Yeong Seo
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Park
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Yeon Pyo
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jin Cha
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Ja Kwak
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Yeon Seok
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soon Won Hong
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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The Association Among Quantitative Contrast-Enhanced Ultrasonography Features, Thyroid Imaging Reporting and Data System and BRAF V600E Mutation Status in Patients With Papillary Thyroid Microcarcinoma. Ultrasound Q 2019; 35:228-232. [DOI: 10.1097/ruq.0000000000000406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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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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Wang Y, Guan Q, Lao I, Wang L, Wu Y, Li D, Ji Q, Wang Y, Zhu Y, Lu H, Xiang J. Using deep convolutional neural networks for multi-classification of thyroid tumor by histopathology: a large-scale pilot study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:468. [PMID: 31700904 DOI: 10.21037/atm.2019.08.54] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background To explore whether deep convolutional neural networks (DCNNs) have the potential to improve diagnostic efficiency and increase the level of interobserver agreement in the classification of thyroid nodules in histopathological slides. Methods A total of 11,715 fragmented images from 806 patients' original histological images were divided into a training dataset and a test dataset. Inception-ResNet-v2 and VGG-19 were trained using the training dataset and tested using the test dataset to determine the diagnostic efficiencies of different histologic types of thyroid nodules, including normal tissue, adenoma, nodular goiter, papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC). Misdiagnoses were further analyzed. Results The total 11,715 fragmented images were divided into a training dataset and a test dataset for each pathology type at a ratio of 5:1. Using the test set, VGG-19 yielded a better average diagnostic accuracy than did Inception-ResNet-v2 (97.34% vs. 94.42%, respectively). The VGG-19 model applied to 7 pathology types showed a fragmentation accuracy of 88.33% for normal tissue, 98.57% for ATC, 98.89% for FTC, 100% for MTC, 97.77% for PTC, 100% for nodular goiter and 92.44% for adenoma. It achieved excellent diagnostic efficiencies for all the malignant types. Normal tissue and adenoma were the most challenging histological types to classify. Conclusions The DCNN models, especially VGG-19, achieved satisfactory accuracies on the task of differentiating thyroid tumors by histopathology. Analysis of the misdiagnosed cases revealed that normal tissue and adenoma were the most challenging histological types for the DCNN to differentiate, while all the malignant classifications achieved excellent diagnostic efficiencies. The results indicate that DCNN models may have potential for facilitating histopathologic thyroid disease diagnosis.
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Affiliation(s)
- Yunjun Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Iweng Lao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Li Wang
- Depertment of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yi Wu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Duanshu Li
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qinghai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yongxue Zhu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hongtao Lu
- Depertment of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Rosario PW. The Importance of Diagnosing Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) Based on the Defined Criteria. Ann Surg Oncol 2019; 26:2306-2307. [DOI: 10.1245/s10434-019-07354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Indexed: 11/18/2022]
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33
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Rosario PW, Mourão GF. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): a review for clinicians. Endocr Relat Cancer 2019; 26:R259-R266. [PMID: 30913533 DOI: 10.1530/erc-19-0048] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/07/2019] [Indexed: 12/13/2022]
Abstract
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an encapsulated or clearly delimited, noninvasive neoplasm with a follicular growth pattern and nuclear features of papillary thyroid carcinoma (PTC). It is considered a 'pre-malignant' lesion of the RAS-like group. Ultrasonography (US), cytology and molecular tests are useful to suspect thyroid nodules that correspond to NIFTP but there is wide overlap of the results with the encapsulated follicular variant of PTC (E-FVPTC). In these nodules that possibly or likely correspond to NIFTP, if surgery is indicated, lobectomy is favored over total thyroidectomy. The diagnosis of NIFTP is made after complete resection of the lesion by observing well-defined criteria. In the case of patients who received the diagnosis of FVPTC and whose pathology report does not show findings of malignancy (lymph node metastasis, extrathyroidal invasion, vascular/capsular invasion), if the tumor was encapsulated or well delimited, the slides can be revised by an experienced pathologist to determine whether the diagnostic criteria of NIFTP are met, but special attention must be paid to the adequate representativeness of the capsule and tumor. Since NIFTP is not 'malignant', tumor staging is not necessary and patients are not submitted to thyroid cancer protocols or guidelines. We believe that patients with NIFTP without associated malignancy and without nodules detected by US of the remnant lobe (if submitted to lobectomy) can be managed like those with follicular adenoma.
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34
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Sohn SY, Lee JJ, Lee JH. Molecular Profile and Clinicopathologic Features of Follicular Variant Papillary Thyroid Carcinoma. Pathol Oncol Res 2019; 26:927-936. [DOI: 10.1007/s12253-019-00639-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/11/2019] [Indexed: 12/30/2022]
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35
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Song YS, Won JK, Yoo SK, Jung KC, Kim MJ, Kim SJ, Cho SW, Lee KE, Yi KH, Seo JS, Park YJ. Comprehensive Transcriptomic and Genomic Profiling of Subtypes of Follicular Variant of Papillary Thyroid Carcinoma. Thyroid 2018; 28:1468-1478. [PMID: 30226444 DOI: 10.1089/thy.2018.0198] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Among subtypes of follicular variant of papillary thyroid carcinoma (FVPTC), encapsulated FVPTC (EFVPTC) shows more indolent behavior than infiltrative FVPTC (IFVPTC). In particular, noninvasive EFVPTC, now designated as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), tends to have an excellent prognosis. However, it remains unclear whether the molecular pathogenesis or signature of the various forms of FVPTC is different. By massively parallel sequencing analysis, this study comprehensively characterized the transcriptional and mutational landscape of FVPTC and established correlations with phenotypic subtypes. METHODS This study included 48 FVPTCs: 17 NIFTPs, 13 invasive EFVPTCs (I-EFVPTCs), and 18 IFVPTCs. For comparison, 55 classical papillary thyroid carcinomas (cPTCs) harboring a BRAFV600E mutation, six follicular adenomas (FAs), and 15 minimally invasive follicular thyroid carcinomas (miFTCs) with RAS mutations were also included. RESULTS In NIFTP, the BRAFV600E mutation was not found, but RAS and other alterations were present in 64.7% and 17.6% of cases, respectively. However, in I-EFVPTC and IFVPTC, the proportions of BRAFV600E mutation (38.5% and 38.9%, respectively) and of RAS mutations (38.5% and 38.9%, respectively) or other alterations (15.4% and 16.7%, respectively) were similar. On a molecular level, RAS-mutated FVPTCs were all RAS-like except for one IFVPTC case. Transcriptomic profiles of NIFTP, I-EFVPTC, and FA/miFTC were comparable, although the profile of RAS-mutated IFVPTC was altered to activate molecular pathways involved in cell adhesion and invasion. Interestingly, 80% of BRAFV600E-mutated I-EFVPTCs were also classified as RAS-like, whereas all BRAFV600E-mutated IFVPTCs were BRAF-like and indistinguishable from cPTC. Molecular pathways associated with cell adhesion and invasion were also differentially activated in BRAFV600E-mutated IFVPTC. CONCLUSIONS Molecular profiles of NIFTP and I-EFVPTC may be shared with FA/miFTC, while IFVPTC seems to be associated with a similar profile as cPTC. Activation of cell adhesion and invasion pathways may play a key role in the development of invasive phenotypes of FVPTC.
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Affiliation(s)
- Young Shin Song
- 1 Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
| | - Jae-Kyung Won
- 2 Department of Pathology, and Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
| | - Seong-Keun Yoo
- 3 Genomic Medicine Institute, Medical Research Center; Seoul, Korea
- 4 Interdisciplinary Program in Bioinformatics; Seoul National University , Seoul, Korea
| | - Kyeong Cheon Jung
- 2 Department of Pathology, and Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
| | - Min Joo Kim
- 1 Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
| | - Su-Jin Kim
- 5 Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
| | - Sun Wook Cho
- 1 Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
| | - Kyu Eun Lee
- 3 Genomic Medicine Institute, Medical Research Center; Seoul, Korea
- 5 Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
| | - Ka Hee Yi
- 6 Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center , Seoul, Korea
| | - Jeong-Sun Seo
- 3 Genomic Medicine Institute, Medical Research Center; Seoul, Korea
- 4 Interdisciplinary Program in Bioinformatics; Seoul National University , Seoul, Korea
| | - Young Joo Park
- 1 Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Korea
- 3 Genomic Medicine Institute, Medical Research Center; Seoul, Korea
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Cho H, Kim JY, Oh YL. Diagnostic value of HBME-1, CK19, Galectin 3, and CD56 in the subtypes of follicular variant of papillary thyroid carcinoma. Pathol Int 2018; 68:605-613. [DOI: 10.1111/pin.12729] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/30/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Haeyon Cho
- Department of Pathology and Translational Genomics; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Ji-Ye Kim
- Department of Pathology; National Cancer Center; Goyang Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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37
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Affiliation(s)
- Gilbert H Daniels
- 1 Thyroid Unit, Cancer Center and Department of Medicine , Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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