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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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Rullo E, Minelli G, Bosco D, Nardi F, Ascoli V. Evaluation of the Italian cytological subclassification of thyroid indeterminate nodules into TIR-3A and TIR-3B: a retrospective study of 290 cases with histological correlation from a single institution. J Endocrinol Invest 2018; 41:531-538. [PMID: 28948534 DOI: 10.1007/s40618-017-0763-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/13/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE The Italian consensus to classify thyroid cytology has provided a standardized reporting scheme, including the subdivision of indeterminate for malignancy TIR-3 category into TIR-3A (low-risk) and TIR-3B (high-risk). We aimed to present our experience on this subclassification by evaluating risks of malignancy and the validity in sorting nodules with dissimilar risks. Another aim was to compare our performance against the Bethesda system. METHODS Fine-needle aspirates of 290 TIR-3 that underwent thyroid surgery at our hospital (2008-2013) were reviewed and divided into TIR-3A or TIR-3B, and AUS/FLUS or FN/SFN. Cytological diagnoses were then correlated to histology. Results were evaluated using univariate analysis. RESULTS The subclassification into TIR-3A and TIR-3B differentiated hyperplastic nodules (p = 0.000) but not adenomas (p = 0.090). Rates of malignancy were significantly different between TIR-3A (10.2%) and TIR-3B (43.8%); TIR-3B malignancies were often papillary carcinomas (83%). TIR-3A/TIR-3B accounted for high sensitivity (84.5%; CI 79.7-88.4%), accuracy (64.1%; CI 58.6-69.6%) and NPV (89.8%; CI 85.6-93.0%) as opposed to modest specificity (55.8%; CI 49.9-61.6%) and PPV (43.8%; CI 38.1-49.8%). The rate of malignancy in AUS-FLUS was higher than in TIR-3A (p = 0.007), whereas it was not different between FN/SFN and TIR-3B (p = 0.337). Sensitivity of the Bethesda system was significantly lower respect to the Italian system. CONCLUSIONS The study supports the Italian consensus showing a different risk of malignancy for TIR-3A as compared to TIR-3B. TIR-3A/TIR-3B subclassification is valid to sort out benign nodules (high NPV) and malignancies (high sensitivity) but not adenomas (modest specificity, low PPV). In our experience, sensitivity is the main difference between Italian and Bethesda systems.
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Affiliation(s)
- E Rullo
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Università Sapienza, Viale Regina Elena, 324, 00161, Rome, Italy
| | - G Minelli
- Unità di Statistica, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - D Bosco
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Università Sapienza, Viale Regina Elena, 324, 00161, Rome, Italy
| | - F Nardi
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Università Sapienza, Viale Regina Elena, 324, 00161, Rome, Italy
| | - V Ascoli
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Università Sapienza, Viale Regina Elena, 324, 00161, Rome, Italy.
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Baser H, Topaloglu O, Tam AA, Alkan A, Kilicarslan A, Ersoy R, Cakir B. Comparing Clinicopathologic and Radiographic Findings Between TT-UMP, Classical, and Non-Encapsulated Follicular Variants of Papillary Thyroid Carcinomas. Endocr Pathol 2016; 27:233-42. [PMID: 27256097 DOI: 10.1007/s12022-016-9437-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thyroid tumors of uncertain malignant potential (TT-UMP) comprise an accepted subgroup of follicular-patterned thyroid tumors for which benignancy or malignancy cannot be precisely assessed. We aimed to evaluate the demographic characteristics, ultrasound (US) findings, and cytological results of patients with TT-UMP and compare these findings to a classical variant of papillary thyroid carcinoma (CV-PTC) and non-encapsulated follicular variant of PTC (NEFV-PTC) patients; we also evaluated the immunohistochemical characteristics of patients with TT-UMP. Twenty-four patients with TT-UMP, 672 with CV-PTC, and 132 with NEFV-PTC were included in the study. Mean longitudinal nodule size and median nodule volume were higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p < 0.001 and p < 0.001 for CV-PTC; p < 0.001 and p = 0.008 for NEFV-PTC). The presence of halo and peripheral vascularization was observed more frequently in the TT-UMP group than in the CV-PTC group (p = 0.002 and p = 0.024). Benign and follicular neoplasm/suspicious for follicular neoplasm cytological results were higher in the TT-UMP group than in the CV-PTC group (p = 0.030 and p = 0.001). US findings were similar between TT-UMP and NEFV-PTC groups (all, p > 0.05). However, none of the patients with TT-UMP were called malignant; 105 patients (31.2 %) of CV-PTC and 11 patients (9.5 %) of NEFV-PTC (infiltrative FV) were classified as malignant cytologically. Tumor size was higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p < 0.001 and p = 0.006). In the TT-UMP group, positive expression of HBME-1, CK-19, and Gal-3 was found in 50, 33.3, and 25 % of patients, respectively. This study demonstrated that none of the TT-UMP patients were evaluated as malignant in preoperative cytology. However, patients with TT-UMP had higher nodule and tumor sizes than CV-PTC and NEFV-PTC patients; US features were similar between NEFV-PTC and TT-UMP patients.
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Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
| | - Oya Topaloglu
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Abbas Ali Tam
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Afra Alkan
- Faculty of Medicine, Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey
| | - Aydan Kilicarslan
- Faculty of Medicine, Department of Pathology, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
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Kakudo K, Kameyama K, Hirokawa M, Katoh R, Nakamura H. Subclassification of follicular neoplasms recommended by the Japan thyroid association reporting system of thyroid cytology. Int J Endocrinol 2015; 2015:938305. [PMID: 25722720 PMCID: PMC4334867 DOI: 10.1155/2015/938305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/17/2015] [Accepted: 01/18/2015] [Indexed: 12/30/2022] Open
Abstract
Background. The Japan Thyroid Association recently published guidelines for clinical practice for the management of thyroid nodules, which include a diagnostic system for reporting thyroid fine needle aspiration cytology. It is characterized by the subclassification of follicular neoplasms, which is different from other internationally accepted reporting systems. Materials and Methods. This study examined observer variability in the subclassification of follicular neoplasms among 4 reviewers using Papanicolaou-stained smear samples from 20 surgically treated patients with indeterminate cytology. Results. The favor malignant subcategory had high predictive value of malignancy (risk of malignancy: 60-75%) and good agreement among the 4 reviewers (κ = 0.7714). Conclusion. These results clearly confirmed that the risk stratification of follicular neoplasms, which was adapted from cytology practice of high-volume thyroid centers in Japan, can provide clinically helpful information to estimate the risk of malignancy and to triage patients for surgery.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kinki University Faculty of Medicine, Otoda-cho 1248-1, Ikoma, Nara 630-0293, Japan
- *Kennichi Kakudo:
| | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | | | - Ryohei Katoh
- Department of Human Pathology, Yamanashi University School of Medicine, Yamanashi 409-3898, Japan
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