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Burgwardt N, Healy JM, Menendez A, Regan M, Moote D, Bilbao N, Riba-Wolman R, Brimacombe M, Finck C. Validating the Modified McGill Thyroid Nodule Score for Assessment of Preoperative Risk of Pediatric Thyroid Malignancy. J Pediatr Surg 2024; 59:1394-1398. [PMID: 38614945 DOI: 10.1016/j.jpedsurg.2024.03.037] [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: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well-differentiated thyroid cancer in adults. It was developed by a multidisciplinary team using established evidence-based risk factors for thyroid cancer. The modified McGill Thyroid Nodule Score (mMTNS) was developed to predict malignancy risk in children. A pilot study suggested the mMTNS was able to assess malignancy risk in children with indeterminate cytology on fine needle aspiration (FNA). This study seeks to validate these findings. METHODS Retrospective chart review identified subjects who underwent FNA biopsy and subsequent resection. Each patient was assigned a score to compare to final pathology. Statistical analysis was performed with SPSS. All tests were 2-tailed and statistical significance defined p < 0.05. Logistic regression used to determine predictive values of scores. RESULTS 46 patients ≤21 years of age underwent resection of a thyroid nodule. Female predominance of 85% (n = 39). 78% (n = 36) of patients had palpable nodule. 65% (n = 30) found to have benign pathology and 35% (n = 16) found to have malignancy. Malignant nodules associated with greater mean mMTNS compared to benign [13.63 vs 7.23]. An mMTNS greater >12 had sensitivity of 86.7%, specificity of 90.3%, positive predictive value of 81.3%, and negative predictive value of 93.3%. CONCLUSION Our data suggests the mMTNS continues to be a useful adjunct in predicting malignancy risk of pediatric thyroid nodules. An mMTNS >12 has a high risk for malignancy, which can aid in counseling and clinical decision making, particularly when there is indeterminate cytology on FNA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicolle Burgwardt
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA.
| | - James M Healy
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Ana Menendez
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Maia Regan
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Douglas Moote
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Nordie Bilbao
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Rebecca Riba-Wolman
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Michael Brimacombe
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Christine Finck
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
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2
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Campennì A, Torregrossa L, Ruggeri RM, Ovčariček PP, Siracusa M, Giovanella L. Nodal metastasis in noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Endocrine 2024; 85:142-145. [PMID: 38340243 DOI: 10.1007/s12020-024-03719-1] [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: 12/20/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
The term noninvasive tumor with a follicular growth pattern and nuclear features of papillary thyroid cancer (NIFTP) is used to describe a tumor currently considered as a pre-malignant lesion for which a conservative therapeutic approach (i.e., lobectomy without radioiodine therapy) is strongly suggested. However, some patients with NIFTP and loco-regional or distant metastases have been already reported. We present an adult male patient with a final histological diagnosis of NIFTP and lymph node metastasis noted at post-therapy whole-body scintigraphy performed some days after radioiodine therapy.
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Affiliation(s)
- Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Clinical Area, University of Pisa, Pisa, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Human Pathology of Adulthood and Childhood DETEV "G. Barresi", Endocrinology Unit, University of Messina, 98125, Messina, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Massimiliano Siracusa
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Turner N, Hamidi S, Ouni R, Rico R, Henderson YC, Puche M, Alekseev S, Colunga-Minutti JG, Zafereo ME, Lai SY, Kim ST, Cabanillas ME, Nurieva R. Emerging therapeutic options for follicular-derived thyroid cancer in the era of immunotherapy. Front Immunol 2024; 15:1369780. [PMID: 38868771 PMCID: PMC11167082 DOI: 10.3389/fimmu.2024.1369780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 06/14/2024] Open
Abstract
Although most follicular-derived thyroid cancers are well differentiated and have an overall excellent prognosis following treatment with surgery and radioiodine, management of advanced thyroid cancers, including iodine refractory disease and poorly differentiated/undifferentiated subtypes, is more challenging. Over the past decade, better understanding of the genetic drivers and immune milieu of advanced thyroid cancers has led to significant progress in the management of these patients. Numerous targeted kinase inhibitors are now approved by the U.S Food and Drug administration (FDA) for the treatment of advanced, radioiodine refractory differentiated thyroid cancers (DTC) as well as anaplastic thyroid cancer (ATC). Immunotherapy has also been thoroughly studied and has shown promise in selected cases. In this review, we summarize the progress in the understanding of the genetic landscape and the cellular and molecular basis of radioiodine refractory-DTC and ATC, as well as discuss the current treatment options and future therapeutic avenues.
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Affiliation(s)
- Naimah Turner
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sarah Hamidi
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rim Ouni
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rene Rico
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying C. Henderson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria Puche
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Biology, College of Science and Engineering, Houston Christian University, Houston, TX, United States
| | - Sayan Alekseev
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Program of Biology, College of Sciences, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Jocelynn G. Colunga-Minutti
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Program of Immunology, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (GSBS), Houston, TX, United States
| | - Mark E. Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sang T. Kim
- Department of Rheumatology, Allergy and Immunology, Yale University, New Haven, CT, United States
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roza Nurieva
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Program of Immunology, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (GSBS), Houston, TX, United States
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4
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Fatourechi V. Follow-up and Outcomes of 186 Patients With Follicular Cell-Derived Thyroid Cancer Seen at a Referral Center by One Thyroidologist in 2015. Endocr Pract 2024; 30:450-455. [PMID: 38461879 DOI: 10.1016/j.eprac.2024.03.002] [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: 11/15/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To study the profile, management, and outcomes of follicular cell-derived thyroid cancer (FCDTC) before publication of the 2016 American Thyroid Association guidelines recommending less-aggressive thyroid cancer procedures. METHODS Patients with FCDTC were seen by one thyroidologist at Mayo Clinic during the 2015 calendar year. Patients underwent surgical procedures for FCDTC in 2015 or earlier at Mayo Clinic or another institution. Follow-up data were collected from January 1, 2016, through July 20, 2022. Outcomes measured included tumor characteristics, treatment methods, adverse effects, diagnostic imaging methods, and primary tumor/metastasis status at the last follow-up. RESULTS Of 186 included patients, 85 had total or near-total thyroidectomy. Bilateral disease was present in 35.5% of these patients, and contralateral involvement would have been missed by lobectomy for 9 (10%) patients with low-risk thyroid cancer. Additionally, 57% had positive neck lymph nodes identified during their surgical procedure, 25% (21% in central compartment) of which were undetected by preoperative ultrasonography. At the last follow-up, 65.6% of patients had no evidence of disease and 10.7% had distant metastases. CONCLUSION This report outlines the profile and outcomes of patients with FCDTC who were treated at a referral center before the revised 2016 American Thyroid Association guidelines. Lobectomy for low-risk FCDTC may miss some cancer in the contralateral lobe. However, the clinical importance of these missed microcarcinomas is unclear. Preoperative ultrasonography effectively predicts lateral, but not central compartment, nodal metastases.
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Affiliation(s)
- Vahab Fatourechi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.
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Guyétant S. Cas no 2. Carcinome papillaire de la thyroïde de sous type folliculaire, encapsulé, invasif. Ann Pathol 2024; 44:101-105. [PMID: 38341313 DOI: 10.1016/j.annpat.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Serge Guyétant
- Service d'anatomie pathologique et plateforme de génétique moléculaire des cancers, hôpital Trousseau, CHRU de Tours, UMR INRAE ISP 1282, université de Tours, Tours, France.
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6
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Guyétant S, Decaussin Petrucci M, Leteurtre E. [Novelties of the 2022 WHO classification of thyroid neoplasms]. Ann Pathol 2024; 44:5-19. [PMID: 37778914 DOI: 10.1016/j.annpat.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Serge Guyétant
- Service d'anatomie pathologique et plateforme de génétique moléculaire des cancers, CHRU de Tours, UMR INRAE ISP 1282, université de Tours, hôpital Trousseau, Tours, France.
| | - Myriam Decaussin Petrucci
- EA 3738, service d'anatomie pathologique, centre hospitalier Lyon Sud, université Lyon 1, hospices civils de Lyon, Lyon, France
| | - Emmanuelle Leteurtre
- Inserm, CNRS, UMR9020-U1277, CANTHER, Cancer Heterogeneity Plasticity and Resistance to Therapies, CHU de Lille, University Lille, 59000 Lille, France
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7
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Yamamoto FM, Liano LC, Camilo-Júnior DJ, Xavier-Junior JCC. Digital analyses of nuclear features can help discriminate among non-invasive follicular thyroid neoplasm with papillary-like nuclear features, papillary thyroid carcinoma follicular subtype, and follicular carcinoma in cytological specimens. Cytopathology 2024; 35:98-104. [PMID: 37688777 DOI: 10.1111/cyt.13305] [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: 07/03/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND As it stands, the diagnosis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is primarily based on histological analysis. We hypothesised that computerised analysis of nuclear images of cytological specimens could be used to differentiate NIFTP from papillary thyroid carcinoma follicular subtype (PTCFS) and follicular carcinoma (FC), influencing patient management. METHODS We employed a retrospective analytical observational study based on nuclear morphometric variables of cytological material from thyroid nodules classified as PTCFS, NIFTP, or FC. Five cases of each entity were analysed. Cytological slides were photographed, and 1170 cells for each entity were analysed digitally. The captured images were evaluated (blindly) using the ImageJ software package. The morphometric evaluation included area, perimeter, width, height, and circularity. Numerical variables were expressed as mean, median, minimum, and maximum (min; max) values. Kruskal-Wallis and Dunn's tests were used with a 5% significance level. RESULTS Regarding nuclear analysis, all variables differed among the three groups (p < 0.001). Given the interdependence among the variables, these data indicated that nuclear size was greatest in the NIFTP group, followed by FC and PTCFS. DISCUSSION/CONCLUSION Our analysis of the digital images, with a focus on nuclear parameters, found significantly difference among cytological specimens from cases of NIFTP, PTCFS and FC. Thus, this tool has the potential to provide additional information that may help in the diagnosis of NIFTP, even during the preoperative period. Additional studies are needed to create protocols, evaluate the applicability of nuclear morphological and morphometric parameters-focusing on digital pathology-and create algorithms and tools to assist cytopathologists with their diagnostic routines.
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Affiliation(s)
| | - Leonardo Carnevalli Liano
- School of Medicine, Centro Universitário Católico Salesiano Auxilium (Unisalesiano), Araçatuba, Brazil
| | | | - José Cândido Caldeira Xavier-Junior
- School of Medicine, São Paulo State University, Botucatu, Brazil
- School of Medicine, Centro Universitário Católico Salesiano Auxilium (Unisalesiano), Araçatuba, Brazil
- Pathology Institute of Araçatuba, Araçatuba, Brazil
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8
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Rangel-Pozzo A, Dos Santos FF, Dettori T, Giulietti M, Frau DV, Galante PAF, Vanni R, Pathak A, Fischer G, Gartner J, Caria P, Mai S. Three-dimensional nuclear architecture distinguishes thyroid cancer histotypes. Int J Cancer 2023; 153:1842-1853. [PMID: 37539710 DOI: 10.1002/ijc.34667] [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: 12/29/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Abstract
Molecular markers can serve as diagnostic tools to support pathological analysis in thyroid neoplasms. However, because the same markers can be observed in some benign thyroid lesions, additional approaches are necessary to differentiate thyroid tumor subtypes, prevent overtreatment and tailor specific clinical management. This applies particularly to the recently described variant of thyroid cancer referred to as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This variant has an estimated prevalence of 4.4% to 9.1% of all papillary thyroid carcinomas worldwide. We studied 60 thyroid lesions: 20 classical papillary thyroid carcinoma (CPTC), 20 follicular variant of PTC (FVPTC) and 20 NIFTP. We examined morphological and molecular features to identify parameters that can differentiate NIFTP from the other PTC subtypes. When blindly investigating the nuclear architecture of thyroid neoplasms, we observed that NIFTP has significantly longer telomeres than CPTC and FVPTC. Super-resolved 3D-structured illumination microscopy demonstrated that NIFTP is heterogeneous and that its nuclei contain more densely packed DNA and smaller interchromatin spaces than CPTC and FVPTC, a pattern that resembles normal thyroid tissue. These data are consistent with the observed indolent biological behavior and favorable prognosis associated with NIFTP, which lacks BRAFV600E mutations. Of note, next-generation thyroid oncopanel sequencing was unable to distinguish the thyroid cancer histotypes in our study cohort. In summary, our data suggest that 3D nuclear architecture can be a powerful analytical tool to diagnose and guide clinical management of NIFTP.
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Affiliation(s)
- Aline Rangel-Pozzo
- CancerCare Manitoba Research Institute, CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
| | - Filipe F Dos Santos
- Centro de Oncologia Molecular, Hospital Sirio-Libanes, Sao Paulo, Brazil
- Department of Biochemistry, Chemistry Institute, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tinuccia Dettori
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Matteo Giulietti
- Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Pedro A F Galante
- Centro de Oncologia Molecular, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Roberta Vanni
- University of Cagliari, Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Alok Pathak
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Gabor Fischer
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John Gartner
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paola Caria
- Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Sabine Mai
- CancerCare Manitoba Research Institute, CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
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Alzahrani AS. Clinical use of Molecular Data in Thyroid Nodules and Cancer. J Clin Endocrinol Metab 2023; 108:2759-2771. [PMID: 37200449 DOI: 10.1210/clinem/dgad282] [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: 04/12/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
Over the past 3 decades, advances in the molecular genetics of thyroid cancer (TC) have been translated into diagnostic tests, prognostic markers, and therapeutic agents. The main drivers in differentiated TC pathogenesis are single-point mutations and gene fusions in components of the Mitogen-activated protein kinase (MAPK) and phosphoinositide-3-kinase-protein kinase B/Akt (PI3K/Akt) pathways. Other important genetic alterations in the more advanced types of TC include TERT promoter, TP53, EIF1AX, and epigenetic alterations. Using this knowledge, several molecular tests have been developed for cytologically indeterminate thyroid nodules. Currently, 3 commercially available tests are in use including a DNA/RNA-based test (ThyroSeq v.3), an RNA-based test (Afirma Gene Sequencing Classifier), and a hybrid DNA/miRNA test, ThyGeNEXT/ThyraMIR. These tests are mostly used to rule out malignancy in Bethesda III and IV thyroid nodules because they all have high sensitivities and negative predictive values. Their common use, predominantly in the United States, has resulted in a significant reduction in unnecessary thyroid surgeries for benign nodules. Some of these tests also provide information on the underlying molecular drivers of TC; this may support decision making in initial TC management planning, although this practice has not yet been widely adopted. More importantly, molecular testing is essential in patients with advanced disease before using specific mono-kinase inhibitors (eg, selpercatinib for RET-altered TC) because these drugs are ineffective in the absence of a specific molecular target. This mini-review discusses the utilization of molecular data in the clinical management of patients with thyroid nodules and TC in these different clinical situations.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine and Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
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10
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Bikas A, Ahmadi S, Pappa T, Marqusee E, Wong K, Nehs MA, Cho NL, Haase J, Doherty GM, Sehgal K, Barletta JA, Alexander EK, Landa I. Additional Oncogenic Alterations in RAS-Driven Differentiated Thyroid Cancers Associate with Worse Clinicopathologic Outcomes. Clin Cancer Res 2023; 29:2678-2685. [PMID: 37260297 PMCID: PMC10524472 DOI: 10.1158/1078-0432.ccr-23-0278] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE RAS mutations occur across the spectrum of thyroid neoplasms, and more tools are needed for better prognostication. The objective of this study was to evaluate how additional genetic events affecting key genes modify prognosis in patients with RAS-mutant thyroid cancers, and specifically differentiated thyroid cancers (DTC). EXPERIMENTAL DESIGN We performed a clinical-genomic analysis of consecutive patients with DTC, poorly differentiated (PDTC), or anaplastic thyroid cancer (ATC) between January 2014 and December 2021, in whom a custom-targeted next-generation sequencing assay was performed. Patients harboring RAS mutations were included, and we compared their clinical features and outcomes based upon the presence of additional oncogenic alterations. RESULTS Seventy-eight patients were identified, with 22% (17/78) harboring a driver RAS mutation plus an additional oncogenic alteration. All six (100%) ATCs had an additional mutation. Compared with DTCs harboring a solitary RAS mutation, patients with DTC with RAS and additional mutation(s) were more likely to be classified as American Thyroid Association high-risk of recurrence (77% vs. 12%; P < 0.001) and to have larger primary tumors (4.7 vs. 2.5 cm; P = 0.002) and advanced stage (III or IV) at presentation (67% vs. 3%; P < 0.001). Importantly, over an average 65-month follow-up, DTC-specific-mortality was more than 10-fold higher (20% vs. 1.8%; P = 0.011) when additional mutations were identified. CONCLUSIONS Identification of key additional mutations in patients with RAS-mutant thyroid cancers confers a more aggressive phenotype, increases mortality risk in DTC, and can explain the diversity of RAS-mutated thyroid neoplasia. These data support genomic profiling of DTCs to inform prognosis and clinical decision-making.
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Affiliation(s)
- Athanasios Bikas
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Sara Ahmadi
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Theodora Pappa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
| | - Ellen Marqusee
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Kristine Wong
- Harvard Medical School, Boston Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston Massachusetts
| | - Matthew A. Nehs
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Nancy L. Cho
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Jacob Haase
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Gerard M. Doherty
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Kartik Sehgal
- Harvard Medical School, Boston Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
| | - Justine A. Barletta
- Harvard Medical School, Boston Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston Massachusetts
| | - Erik K. Alexander
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Iñigo Landa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
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11
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Ni X, Xu S, Zhang B, Zhan W, Zhou W. Clinical and Sonographic Features of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features: A Retrospective Study. Ultrasound Q 2023; 39:23-31. [PMID: 35001029 PMCID: PMC9997632 DOI: 10.1097/ruq.0000000000000586] [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: 12/11/2020] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study was designed to investigate the clinical and sonographic features of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) as compared with classical papillary thyroid carcinoma (cPTC), follicular adenoma (FA), and follicular thyroid carcinoma (FTC). A total of 178 patients were enrolled in this study. The clinical characteristics and sonographic features of thyroid nodules were compared between NIFTP and cPTC or FA/FTC. All nodules were reclassified according to the Thyroid Ultrasound Imaging Reporting and Data System and American Thyroid Association guidelines classification. The mean size of NIFTP was 29.91 ± 14.71 mm, which was larger than that of cPTC ( P = 0.000). Significant difference was found in lymph node metastases between NIFTP and cPTC ( P = 0.000). Most NIFTPs showed solid composition, hypoechoic echogenicity, smooth margin, wider than tall shape, none echogenic foci, absence of halo, and perinodular vascularity, which were similar with FA and FTC. Compared with NIFTP, hypoechoic and very hypoechoic, taller than wide, irregular margin, punctate echogenic foci, absence of halo, and low vascularity were more commonly observed in cPTC. There were statistical differences both in American College of Radiology Thyroid Ultrasound Imaging Reporting and Data System and in American Thyroid Association classification between NIFTP and cPTC ( P < 0.05), but there were no significant differences between NIFTP and FTC/FA ( P > 0.05). The ultrasonographic characteristics of NIFTP were obviously different from cPTC but overlapped with FTC and FA. Ultrasound could help increase preoperative attention of NIFTP in an appropriate clinical setting, which may lead to a more conservative treatment approach.
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Affiliation(s)
| | | | - Benyan Zhang
- Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | | | - Wei Zhou
- Departments of Ultrasound
- Department of Ultrasound, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
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12
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Muacevic A, Adler JR, Sebeih H, Alessa MA, Alkaf HH, Bahaj A, Abdelmonim SK. Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features: What a Surgeon Should Know. Cureus 2023; 15:e33649. [PMID: 36788866 PMCID: PMC9912993 DOI: 10.7759/cureus.33649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
The inclusion of the less aggressive follicular form of papillary thyroid cancer (PTC) is associated with an increase in the incidence of the condition, with the follicular variant of PTC being the most common of all variants. The majority of individuals with the encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) are treated as though they have classic thyroid cancer, despite the availability of mounting evidence to contradict the aforementioned. According to numerous research, a certain type of noninvasive-EFVPTC (NI-EFVPTC) demonstrated poor histopathologic diagnostic reproducibility and has received aggressive treatment similar to that of a classical thyroid neoplasm. Therefore, to replace the term NI-EFVPC, a new nomenclature for these tumors, called "noninvasive follicular thyroid neoplasm with papillary-like nuclear characteristics" (NIFTP), was introduced in the year 2016. The present paper explores this recently introduced terminology, clinical, histologic, and molecular features, and diagnostic criteria.
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Abdelwahab K, Abdallah A, Metwally IH, Awny S, Hamdy O, Ali KM, Zuhdy M. Effect of non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) terminology on surgical management concepts. REVISTA ESPAÑOLA DE PATOLOGÍA 2022; 56:82-87. [PMID: 37061246 DOI: 10.1016/j.patol.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite the strict diagnostic criteria recently proposed for non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP), its incidence is still unknown. Employing a retrospective analysis of the follicular variant of papillary thyroid carcinoma (FVPTC), we investigated the diagnosis, prevalence and postoperative course of NIFTP. METHODS We examined retrospectively the records of 112 patients who had undergone thyroid surgery and had a postoperative diagnosis of FVPTC at our hospital from 2010 to 2021. All clinical, radiologic, and pathologic features were evaluated. RESULTS Only 34 (27.9%) patients met the strict pathologic criteria for NIFTP; 11 cases having been diagnosed as NIFTP initially and 23 after re-evaluation of histopathologic slides. None of the 11 NIFTP patients underwent a 2-stage operation, in contrast to 10 (29.4%) patients initially diagnosed as FVPTC who had a completion thyroidectomy after the initial hemithyroidectomy. The median follow-up was 14.5 (ranging from 0 to 78) months. None of the cases developed a recurrence. CONCLUSION To avoid unnecessary treatment or the follow-up advised for papillary thyroid carcinoma, clinicians and pathologists should be familiar with the terminology and the corresponding diagnostic criteria for NIFTP and their impact on management.
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Affiliation(s)
- Khaled Abdelwahab
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Ahmed Abdallah
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Shadi Awny
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Khadiga M Ali
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Mohammad Zuhdy
- Surgical Oncology Department, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
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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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Reclassification as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): A retrospective review in a single institution and outcome study. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Since non-invasive follicular thyroid neoplasm (NIFTP) was first defined in 2016, past overtreatment status, impact for the risk of malignancy, and incidence of NIFTP have been the subject of study. Retrospective cohort studies have been published and present widely varying results in different geographic regions. This study aimed to reclassify follicular variants of papillary thyroid carcinoma (FVPTC) cases diagnosed in a single center using the defined stringent NIFTP criteria and to determine incidence, clinicopathological features, and survival of NIFTP cases.
Methods: This retrospective cohort study was conducted in a single center and consisted of patients with diagnosed follicular variant papillary thyroid carcinoma in thyroidectomy/thyroid lobectomy specimens between 2014 and 2021. Reports of FVPTC cases between 2014 and 2018 were evaluated by two experienced pathologists to identify candidates for NIFTP. Archived glass slides of the potential NIFTP cases were retrieved and reviewed independently by two pathologists.
Results: Between 2014 and 2021, 84 patients who underwent surgery were diagnosed with FVPTC. Reports of 49 patients diagnosed before 2018 were re-evaluated by two pathologists, and 20 cases were identified as candidates for NIFTP. After blind evaluation of pathology slides, five cases (10%) were diagnosed as NIFTP according to the criteria established before 2016, and two cases between 2016 and August 2018 were still diagnosed as NIFTP. Fourteen patients were diagnosed with NIFTP between 2014 and 2021. The median follow-up of the NIFTP patients was 4.3 years, and no recurrence and/or metastasis was reported.
Conclusion: NIFTP represents 7.6% of the papillary thyroid carcinoma (PTC) cases in our cohort, which is higher than the incidence rate in our country. The follow-up results of our cases were uneventful considering the indolent nature of NIFTP, but we had high thyroidectomy rates. Due to the concomitant PTC, multifocality, and uncertainties in the follow-up routine, we think it would be appropriate for these patients to remain in active follow-up.
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Sabán M, Tolaba N, Orlandi AM, Deutsch S, Pitoia F, Lowenstein A, Calabrese MC, Cavallo A, Iotti A, Monteros Alvi M, Nallar M, Jaén A, Figurelli S, Carrizo F, Colobraro A, García Tascón G, Saccoliti M, Paes de Lima A, Lencioni M, Califano I, Cabezón C. Non-invasive follicular neoplasm with papillary-like nuclear features: a challenging and infrequent entity in Argentina. Endocrine 2022; 77:493-499. [PMID: 35799079 DOI: 10.1007/s12020-022-03115-7] [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: 02/07/2022] [Accepted: 06/12/2022] [Indexed: 04/17/2023]
Abstract
PURPOSE Non-invasive encapsulated follicular variant of papillary thyroid cancer was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). These neoplasms have an extremely low malignant potential. The aim of this study was (1) to assess the prevalence of NIFTP in patients with papillary thyroid carcinoma, (2) to evaluate their outcomes, and (3) to determine their molecular profile. METHODS Multicenter, descriptive, retrospective study. Patients with papillary thyroid cancer diagnosed from January 2006 to December 2016 from 11 referral centers were included. Diagnosis of NIFTP was based on criteria described by Nikiforov et al. in 2018. At least two pathologists agreed on the diagnosis. Two thousand six hundred and seventy-seven papillary thyroid cancer patients were included; 456 (17%) of them were follicular variant papillary thyroid cancer, and 30 (1.12%) fulfilled diagnostic criteria for NIFTP. RESULTS Each of the 30 included patients underwent a total thyroidectomy, and 50% were treated with radioiodine (median dose 100 mCi). After a median follow-up of 37 months, 84% of patients had an excellent response, 3% had an indeterminate response and data was missing in the remaining 13%. No metastatic lymph nodes, distant metastases or recurrences were found. RAS mutations were detected in 4 patients (13%). CONCLUSION The prevalence of NIFTP in our series is amongst the lowest reported. Excellent outcomes of patients underscore their low malignant potential. Molecular findings differ from other series, probably related to environmental or ethnic features of our population and the meticulous criteria for diagnosing NIFTP.
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Affiliation(s)
| | | | | | | | - Fabián Pitoia
- Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | | | | | | | | | | | | | - Ana Jaén
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Inés Califano
- Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Carmen Cabezón
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Zhu X, Chen C, Guo Q, Ma J, Sun F, Lu H. Deep Learning-Based Recognition of Different Thyroid Cancer Categories Using Whole Frozen-Slide Images. Front Bioeng Biotechnol 2022; 10:857377. [PMID: 35875502 PMCID: PMC9298848 DOI: 10.3389/fbioe.2022.857377] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: The pathological rare category of thyroid is a type of lesion with a low incidence rate and is easily misdiagnosed in clinical practice, which directly affects a patient’s treatment decision. However, it has not been adequately investigated to recognize the rare, benign, and malignant categories of thyroid using the deep learning method and recommend the rare to pathologists. Methods: We present an empirical decision tree based on the binary classification results of the patch-based UNet model to predict rare categories and recommend annotated lesion areas to be rereviewed by pathologists. Results: Applying this framework to 1,374 whole-slide images (WSIs) of frozen sections from thyroid lesions, we obtained an area under a curve of 0.946 and 0.986 for the test datasets with and without WSIs, respectively, of rare types. However, the recognition error rate for the rare categories was significantly higher than that for the benign and malignant categories (p < 0.00001). For rare WSIs, the addition of the empirical decision tree obtained a recall rate and precision of 0.882 and 0.498, respectively; the rare types (only 33.4% of all WSIs) were further recommended to be rereviewed by pathologists. Additionally, we demonstrated that the performance of our framework was comparable to that of pathologists in clinical practice for the predicted benign and malignant sections. Conclusion: Our study provides a baseline for the recommendation of the uncertain predicted rare category to pathologists, offering potential feasibility for the improvement of pathologists’ work efficiency.
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Affiliation(s)
- Xinyi Zhu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cancan Chen
- Digital Health China Technologies Corporation Limited, Beijing, China
| | - Qiang Guo
- Department of Big Data, National Cancer Center/National Clinical Research Center for Cancer / Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhui Ma
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer / Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fenglong Sun
- Digital Health China Technologies Corporation Limited, Beijing, China
| | - Haizhen Lu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hidangmayum A, Mathias M, Kishan Prasad H.L., Sajitha K., Divya Joshi. Synchronous follicular carcinoma and non-invasive follicular thyroid neoplasm with papillary like nuclear features in thyroid-A case report. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i1.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Follicular carcinoma of the thyroid accounts for 5-15% of all the primary cancers of thyroid. Follicular carcinoma clinically manifests as a painless neck mass and rarely presents with metastatic bony lesion, the most common site being the spine. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) constitute 10-20% of all thyroid cancers. The histopathological diagnosis of thyroid follicular carcinoma mandates demonstration of either capsular/vascular invasion. Differentiating between follicular carcinoma and NIFTP is challenging based on histology. Hence extensive sampling of the pathological specimen is required to differentiate the same. Herein we report a case of an elderly woman presented with a pathological fracture of the femur due to metastasis from follicular carcinoma of the thyroid with an incidental NIFTP of the left lobe of the thyroid.
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Al Hassan MS, El Ansari W, El Baba H, Petkar M, Abdelaal A. What you see might not be what you get: Analysis of 15 prospective cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Int J Surg Case Rep 2022; 91:106751. [PMID: 35134690 PMCID: PMC8858746 DOI: 10.1016/j.ijscr.2021.106751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Noninvasive follicular thyroid neoplasm with papillary-like nuclear (NIFTP) is a new entity. No previous study reported prospective cases, outlining using many quantitative and qualitative variables. Methods Retrospective analysis of all (15) prospective NIFTP cases diagnosed between 2017 and 2021 at our institution. Statistical quantitative analysis outlined demographic, history, ultrasound, histopathology and treatment characteristics. Qualitative analysis examined the cases, with details provided on three cases to highlight the different possible presentations and configurations. Results Mean age was 41.5 ± 9.91 years, 73.3% were females, and mean BMI was 29.49 ± 5.74 kg/m2. About 87% patients were symptomatic; 86.6% had neck swelling. Ultrasound (US) showed multiple nodules in 71.4% of cases. Fine-needle aspiration cytology (FNAC) showed that follicular lesion of undetermined significance (42.8%) was most common, followed by benign nodule (21.3%). Using the Bethesda System for Reporting Thyroid Cytopathology, 7 cases were category III, 3 category IV, 3 category II, and 1 category I. 60% of patients underwent total thyroidectomy. All cases were diagnosed postoperatively, 2 patients had additional papillary microcarcinoma. In 3 cases, the NIFTP site in the histopathology of resected specimen was different than the US-recommended site of the FNAC. Conclusion We found discrepancies in the site and diagnosis of the preoperative US recommendation for the FNAC vs the postoperative histopathology of the specimen. These suggest that NIFTP might be incidentally and postoperatively diagnosed, irrespective of US or FNAC findings, hence its ‘true’ incidence might remain underestimated. As NIFTP cases higher BMI, Future research could predict preoperative diagnosis of NIFTP and explore associations with BMI. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is follicular type of papillary carcinoma NIFTP is postoperative diagnosis. Correlation of clinical, imaging, cytological and post-operative histopathology is needed Site and diagnosis of suspected NIFTP on US-guided FNAC and histopathology after resection requires more research Preoperative diagnosis of NIFTP requires more studies. Until guidelines are available, regular follow up should be done
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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: 8] [Impact Index Per Article: 4.0] [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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Radiofrequency ablation and thyroid cancer: review of the current literature. Am J Otolaryngol 2022; 43:103204. [PMID: 34537511 DOI: 10.1016/j.amjoto.2021.103204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyroid nodules are commonly being diagnosed in general population and have a potential for malignant transformation. Historically, surgery has been considered as the first line treatment for these tumors. However, with passage of time newer minimally invasive techniques such as RFA (radiofrequency ablation) has been adapted. Though, RFA for thyroid tumors has been performed more commonly in Asian and European countries, it is a fairly new technique in North America. The aim of the review is to assess the current data and conclude that whether RFA is likely a valuable option when compared to surgery for treatment of thyroid tumors. MATERIALS AND METHODS A Comprehensive PubMed/MEDLINE, Embase and Web of Science search was performed. To expand our search, references of the retrieved articles were also screened for additional data. After selecting the studies that fulfilled the initial screening, authors independently reviewed the selected studies and screened the full texts to identify those that met the inclusion criteria. RESULTS The comprehensive literature search from PubMed/MEDLINE, Web of Science, and EMBASE databases revealed 1094 studies (Embase 870, PubMed 200, and Web of Science 24). References were imported for screening. Amongst 1094 studies, 138 duplicates removed, and 956 studies were screened against title and abstract. After these 777 studies were excluded the remaining 179 studies were assessed for full-text eligibility. Amongst them 127 studies excluded due to wrong design or setting. Finally, 18 studies were included in the review. CONCLUSION RFA appears to be a safe alternative to surgery in selected cases. However, it is not widely used and there are few randomized controlled trials. Furthermore, it is associated with a low risk profile and has shown promising results in patients who are difficult surgery candidates. Currently large-scale prospective studies are needed in North America to establish the efficacy of RFA and its use as an alternative to surgery for thyroid tumors.
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Al-Maghrabi H, Tashkandi M, Khayyat W, Alghamdi A, Alsalmi M, Alzahrani A, Al-Hakami H, Alqarni M. Non-invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) lowers the risk of malignancy in the bethesda system for reporting thyroid cytopathology diagnostic categories. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:105-110. [PMID: 35602399 PMCID: PMC9121695 DOI: 10.4103/sjmms.sjmms_202_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/25/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The introduction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been shown to decrease the risk of malignancy (ROM) in The Bethesda System for Reporting Thyroid Cytopathology. This knowledge may alter the management of patients with thyroid nodules. Objectives: To correlate cytological diagnosis with histological diagnosis for establishing the ROM of all Bethesda system categories after the introduction of NIFTP. Methods: This was a retrospective cohort study. All consecutive fine-needle aspiration cytology (FNAC) specimens collected from January 1, 2013, to December 31, 2017, at King Abdullah Medical City, Jeddah, Saudi Arabia, were assessed, and patients who underwent surgical excision of thyroid nodules were further analyzed. The ROM and overall ROM for each Bethesda category were calculated with and without considering NIFTP as a malignant tumor. Results: Overall, 1066 FNAC specimens were collected, of which 281 had a surgical correlation. Our cases included 18 (6.4%) non-diagnostic (ND), 109 (38.8%) benign, 28 (9.9%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 39 (13.8%) follicular neoplasm or suspicion for follicular neoplasm (FN/SFN), 20 (7.1%) suspicion for malignancy (SM), and 67 (23.8%) malignant (POM) cases. After considering NIFTP diagnosis on resection specimens, the ROM decreased as follows: ND, 38.8% to 27.7% (P = 0.2388); benign, 21.1% to 11.9% (P = 0.0343); AUS/FLUS, 50% to 39.2% (P = 0.2089); FN/SFN, 53.8% to 33.3% (P = 0.0336); SM, 85% to 75% (P = 0.2147); POM, 95.5% to 88% (P = 0.0582). Conclusion: The introduction of NIFTP would significantly decrease the ROM of thyroid FNAC in both benign and FN/SFN categories of the Bethesda system.
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Caulley L, Eskander A, Yang W, Auh E, Cairncross L, Cho NL, Golbon B, Iyer S, Liu JC, Lee PJ, Lindeman B, Meltzer C, Molin N, Moore A, Noel J, Nozolino H, Pasternak J, Price B, Ramsay T, Rolighed L, Sajisevi M, Sharma A, Sinclair C, Sorensen M, Tae K, Tang AL, Tsao G, Williams M, Wrenn S, Xing MH, Zafereo M, Stack BC, Randolph G, Davies L. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg 2021; 148:99-106. [PMID: 34817546 DOI: 10.1001/jamaoto.2021.3277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment. Objective To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size. Design, Setting, and Participants This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. Main Outcomes and Measures Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. Results Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]). Conclusions and Relevance Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lydia Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Jeffrey C Liu
- Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Paul J Lee
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenessa Lindeman
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | | | - Nicole Molin
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alessandra Moore
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Halie Nozolino
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendon Price
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mirabelle Sajisevi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Meredith Sorensen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Santa Rosa, California
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean Wrenn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer Foundation, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Greg Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Louise Davies
- VA Outcomes Group, White River Junction, Vermont.,Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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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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Fakhar Y, Khooei A, Aghaee A, Mohammadzadeh Kosari H, Wartofsky L, Zakavi SR. Bone metastasis from noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); a case report. BMC Endocr Disord 2021; 21:221. [PMID: 34736430 PMCID: PMC8567706 DOI: 10.1186/s12902-021-00883-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 10/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The term non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was recently proposed as a non-malignant thyroid lesion with indolent behavior that does not require post-operative radio-iodine treatment. We are reporting a case of NIFTP with bone metastasis that is the second case reported so far. CASE PRESENTATION We describe a 38-year-old woman who presented with an indeterminate thyroid nodule and underwent total thyroidectomy with the finding of NIFTP on careful pathologic examination. However, her initial follow-up evaluation revealed a serum thyroglobulin level of > 300 ng/ml and a diagnostic whole body 131I scan demonstrated a focus of increased uptake in the left hemipelvis, confirmed on CT scan to be a lytic lesion in the left iliac bone. She was treated with 7.4GBq (200 mCi) of 131I and her follow-up 1 year later revealed an undetectable serum thyroglobulin and a negative whole body 131I scan with no visible uptake in the iliac bone indicating an excellent response. CONCLUSION This case presentation reminds us to be alert to the rare occurrence of distant metastasis in NIFTP and the need for a case by case analysis and continuing post-operative follow-up for detection of residual or recurrent disease.
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Affiliation(s)
- Yasaman Fakhar
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Khooei
- Pathology Department, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atena Aghaee
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Leonard Wartofsky
- Thyroid Cancer Research Unit, MedStar Health Research Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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26
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An integrated AI model to improve diagnostic accuracy of ultrasound and output known risk features in suspicious thyroid nodules. Eur Radiol 2021; 32:2120-2129. [PMID: 34657970 DOI: 10.1007/s00330-021-08298-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES From the viewpoint of ultrasound (US) physicians, an ideal thyroid US computer-assisted diagnostic (CAD) system for thyroid cancer should perform well in suspicious thyroid nodules with atypical risk features and be able to output explainable results. This study aims to develop an explainable US CAD model for suspicious thyroid nodules. METHODS A total of 2992 solid or almost-solid thyroid nodules were analyzed retrospectively. All nodules had pathological results (1070 malignancies and 1992 benignities) confirmed by ultrasound-guided fine-needle aspiration cytology and histopathology after thyroidectomy. A deep learning model (ResNet50) and a multiple risk features learning ensemble model (XGBoost) were used to train the US images of 2794 thyroid nodules. Then, an integrated AI model was generated by combining both models. The diagnostic accuracies of the three AI models (ResNet50, XGBoost, and the integrated model) were predicted in a testing set including 198 thyroid nodules and compared to the diagnostic efficacy of five ultrasonographers. RESULTS The accuracy of the integrated model was 76.77%, while the mean accuracy of the ultrasonographers was 68.38%. Of the risk features, microcalcifications showed the highest contribution to the diagnosis of malignant nodules. CONCLUSIONS The integrated AI model in our study can improve the diagnostic accuracy of suspicious thyroid nodules and output the known risk features simultaneously, thus aiding in training young ultrasonographers by linking the explainable results to their clinical experience and advancing the acceptance of AI diagnosis for thyroid cancer in clinical practice. KEY POINTS • We developed an artificial intelligence (AI) diagnosis model based on both deep learning and multiple risk feature ensemble learning methods. • The AI diagnosis model showed higher diagnostic accuracy for suspicious thyroid nodules than ultrasonographers. • The AI diagnosis model showed partial explainability by outputting the known risk features, thus aiding young ultrasonic doctors in increasing the diagnostic level for thyroid cancer.
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27
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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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Nabhan F, Dedhia PH, Ringel MD. Thyroid cancer, recent advances in diagnosis and therapy. Int J Cancer 2021; 149:984-992. [PMID: 34013533 DOI: 10.1002/ijc.33690] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/23/2022]
Abstract
Over the past several decades, the approach to the diagnosis and management of patients with follicular cell-derived thyroid cancer has evolved based on improved classification of patients better matching clinical outcomes, as well as advances in imaging, laboratory, molecular technologies and knowledge. While thyroid surgery, radioactive iodine therapy and TSH suppression remain the mainstays of treatment, this expansion of knowledge has enabled de-escalation of therapy for individuals diagnosed with low-risk well-differentiated thyroid cancer; better definition of treatment choices for patients with more aggressive disease; and improved ability to optimize treatments for patients with persistent and/or progressive disease. Most recently, the advancement of knowledge regarding the molecular aspects of thyroid cancer has improved thyroid cancer diagnosis and has enabled individualized therapeutic options for selected patients with the most aggressive forms of the disease. Guidelines from multiple societies across the world reflect these changes, which focus on taking a more individualized approach to clinical management. In this review, we discuss the current more personalized approach to patients with follicular cell-derived thyroid cancer and point toward areas of future research still needed in the field.
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Affiliation(s)
- Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Cancer Biology Program, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Priya H Dedhia
- Cancer Biology Program, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA.,Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Cancer Biology Program, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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Thodou E, Canberk S, Schmitt F. Challenges in Cytology Specimens With Hürthle Cells. Front Endocrinol (Lausanne) 2021; 12:701877. [PMID: 34248855 PMCID: PMC8267832 DOI: 10.3389/fendo.2021.701877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/02/2021] [Indexed: 12/28/2022] Open
Abstract
In fine-needle aspirations (FNA) of thyroid, Hürthle cells can be found in a broad spectrum of lesions, ranging from non-neoplastic conditions to aggressive malignant tumors. Recognize them morphologically, frequently represents a challenging for an adequately diagnosis and are associated with a significant interobserver variability. Although the limitations of the morphologic diagnosis still exist, the interpretation of the context where the cells appear and the recent advances in the molecular knowledge of Hürthle cells tumors are contributing for a more precise diagnosis. This review aims to describe the cytology aspects of all Hürthle cells neoplastic and non-neoplastic thyroid lesions, focusing on the differential diagnosis and reporting according to The Bethesda System for Reporting Thyroid Cytology (TBSRTC). New entities according to the latest World Health Organization (WHO) classification are included, as well as an update of the current molecular data.
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Affiliation(s)
- Eleni Thodou
- Department of Pathology, Medical School, University of Thessaly, Larissa, Greece
| | - Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
- Medical Faculty, Porto University, Porto, Portugal
- CINTESIS@RISE, Porto, Portugal
- *Correspondence: Fernando Schmitt,
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Al Hassan MS, El Ansari W, Elshafeey A, Petkar M, Abdelaal A. First bilateral non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) co-occurring with bilateral papillary thyroid microcarcinoma. Case report and literature review. Int J Surg Case Rep 2020; 78:411-416. [PMID: 33341424 PMCID: PMC7814091 DOI: 10.1016/j.ijscr.2020.11.159] [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: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022] Open
Abstract
Non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a benign lesion with no evidence of recurrence or metastasis. NIFTP is managed with partial or total thyroidectomy which is sufficient to achieve total cure. Co- coexistence of NIFTP and papillary microcarcinoma can be managed by resection and radioactive iodine ablation of the thyroid. The current case in probably the first reported bilateral NIFTP with bilateral papillary microcarcinoma.
Introduction Non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a recently characterized lesion with very low malignant potential. This has allowed for less aggressive management of this tumor subtype. Papillary thyroid carcinoma (PTC) has malignant potential and requires different considerations in management. Presentation of case A 33-year-old woman presented to our Thyroid Surgery Clinic with a left neck swelling slowly enlarging over 4 years, and recent right-sided neck pain. Neck ultrasound and fine needle aspiration for cytology found bilateral thyroid nodules, labelled as ‘follicular lesion of undetermined significance’ (FLUS). Final pathology report after total thyroidectomy identified four distinct tumors: bilateral NIFTP lesions and bilateral papillary microcarcinomas. Discussion Management of NIFTP comprises partial or total thyroidectomy without further intervention. Management of PTC is the same but with the possible addition of radioactive ablation due to the increased malignant potential. This is the first report of bilateral NIFTP lesions and bilateral papillary microcarcinomas co-occurring together in the same patient, so management was challenging. The decision was made to give the patient low dose radioactive iodine ablation and continue monitoring. Ultrasound of the neck follow up 6 months later showed no residual thyroid tissue or local recurrence. Conclusion Although rare, NIFTP can co-occur with PTC. Bilateral NIFTP with bilateral PTC is extremely rare. Surgeons and pathologists need to be aware of this rare entity that can co-occur in both thyroid lobes. Total thyroidectomy is the definitive treatment. Post-surgery surveillance is important and follow up needs to be watchful for any recurrence or metastasis.
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Affiliation(s)
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skövde, Skövde, Sweden.
| | | | - Mahir Petkar
- Department of Laboratory Medicine & Pathology, Hamad General Hospital, Doha, Qatar
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Bai Y, Kakudo K, Jung CK. Updates in the Pathologic Classification of Thyroid Neoplasms: A Review of the World Health Organization Classification. Endocrinol Metab (Seoul) 2020; 35:696-715. [PMID: 33261309 PMCID: PMC7803616 DOI: 10.3803/enm.2020.807] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
Advances in medical sciences and evidence-based medicine have led to momentous changes in classification and management of thyroid neoplasms. Much progress has been made toward avoiding overdiagnosis and overtreatment of thyroid cancers. The new 2017 World Health Organization (WHO) classification of thyroid neoplasms updated the diagnostic criteria and molecular and genetic characteristics reflecting the biology and behavior of the tumors, and newly introduced the category of borderline malignancy or uncertain malignant potential. Some neoplasms were subclassified, renamed, or redefined as a specific entity. This review introduces changes in the fourth edition WHO classification of thyroid tumors and updates the contemporary diagnosis and classification of thyroid tumors. We also discuss several challenges with the proposal of new diagnostic entities, since they have unique histopathologic and molecular features and clinical relevance.
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Affiliation(s)
- Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing,
China
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi,
Japan
- Department of Human Pathology, Wakayama Medical University, Graduate School of Medicine, Wakayama,
Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, The Catholic University of Korea, Seoul,
Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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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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Malignancy is in the eye of the beholder: Pathologic diagnosis of challenging follicular neoplasms in the era of noninvasive follicular thyroid neoplasms with papillary-like nuclear features and immunohistochemical and molecular adjuncts. Surgery 2020; 169:22-26. [PMID: 32471652 DOI: 10.1016/j.surg.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/24/2020] [Accepted: 04/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Classification of thyroid follicular neoplasms can be challenging for pathologists. Introduction of noninvasive follicular thyroid neoplasms with papillary-like nuclear features, the utilization of immunohistochemistry, and molecular analysis are all thought to be valuable diagnostic adjuncts. Our aim was to determine whether interobserver variability for follicular neoplasms has improved since the application of these adjuncts. METHODS One representative section from a cohort of follicular neoplasms previously proven difficult for pathologists were examined independently by 7 pathologists and assigned to 1 of 3 diagnostic categories (benign, neoplasms with papillary-like nuclear features, or malignant). This process was carried out separately 3 times: (1) after viewing hematoxylin and eosin stain slides, (2) hematoxylin and eosin stain in conjunction with immunohistochemistry, and (3) hematoxylin and eosin stain/immunohistochemistry in conjunction with molecular analysis. The interobserver variability and overall agreement were then calculated using the free-marginal kappa coefficient. RESULTS Agreement on hematoxylin and eosin stain was 57%, with a kappa coefficient of 0.36 (minimal agreement). The agreement improved slightly with the application of immunohistochemistry (kappa coefficient = 0.49 [weak agreement] and a percentage agreement 67%). The level of agreement decreased slightly after the addition of molecular analysis (kappa coefficient = 0.43 [weak agreement] and percentage agreement 62%). CONCLUSION Despite attempts to standardize the diagnostic criteria for neoplasms with papillary-like nuclear features and the utilization immunohistochemistry and molecular analysis, attaining pathologic consensus for difficult follicular neoplasms of the thyroid remains a challenge.
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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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Macerola E, Proietti A, Basolo F. Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP): a new entity. Gland Surg 2020; 9:S47-S53. [PMID: 32055498 DOI: 10.21037/gs.2019.12.24] [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: 01/28/2023]
Abstract
Since its first official definition in 2016, the new histo-pathological entity of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) has attracted much interest among "thyroidologists" worldwide. This is a subset of encapsulated and noninvasive follicular variant papillary thyroid cancer, whose introduction had the intent of de-escalating treatment given its very low malignant potential, approaching to that of follicular adenomas. Many researchers focused on the possibility of preoperatively identifying NIFTP, and investigated their cyto-morphological and molecular characteristics; other ones explored histological and clinical-pathological NIFTP features. Although the majority of published studies confirmed that NIFTP are indolent lesions, some papers did question their low-risk nature. In this brief review, the main aspects of histology, cytology and molecular pathology of NIFTP are discussed based on the current literature.
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Affiliation(s)
- Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Agnese Proietti
- Section of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Lewiński A, Adamczewski Z, Zygmunt A, Markuszewski L, Karbownik-Lewińska M, Stasiak M. Correlations between Molecular Landscape and Sonographic Image of Different Variants of Papillary Thyroid Carcinoma. J Clin Med 2019; 8:jcm8111916. [PMID: 31717363 PMCID: PMC6912205 DOI: 10.3390/jcm8111916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
Papillary thyroid carcinoma (PTC), the most common thyroid cancer, is predominantly driven by mutations in BRAF (primarily p. V600E) and RAS oncogenes. Ultrasound (US) examination provides significant diagnostic data in the management of thyroid nodules, as many sonographic features of thyroid lesions are correlated with the potential risk of thyroid carcinoma. The aim of the study was to analyze the current literature in regard to the potential associations between genetic landscape and sonographic features of PTC. Based on the current literature, sonographic features of PTCs correlate with their molecular drivers, particularly between tumors harboring BRAFV600E versus activating RAS mutations, although many of these findings appear to be dependent on the tumor variant. Suspicious US findings, such as hypoechogenicity, spiculated/microlobulated margins, non-parallel orientation/taller-than-wide shape, and the presence of microcalcifications, are typical for PTC positive for BRAFV600E mutations. On the contrary, tumors with RAS mutations are most frequently hypo- or isoechoic and ovoid-to-round in shape, with smooth margins and without calcifications. There are also some US features typical for PTCs harboring other mutations, including BRAFK601E, RET/PTC rearrangements, PAX8-PPARγ, CTNNB1, and APC. However, further research is necessary, as some rare PTC variants still cannot be reliably analyzed due to the scarce published data.
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Affiliation(s)
- Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
- Correspondence: or ; Tel.: +48-42-271-1141; Fax: +48-42-271-1140
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Arkadiusz Zygmunt
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338 Lodz, Poland; (Z.A.); (A.Z.)
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Leszek Markuszewski
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
| | - Małgorzata Karbownik-Lewińska
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
- Chair and Department of Oncological Endocrinology, Medical University of Lodz, 90-752 Lodz, Poland
| | - Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital—Research Institute, 93-338 Lodz; Poland; (L.M.); (M.K.-L.); (M.S.)
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Paniza ACDJ, Mendes TB, Viana MDB, Thomaz DMD, Chiappini PBO, Colozza-Gama GA, Lindsey SC, de Carvalho MB, Alves VAF, Curioni O, Bastos AU, Cerutti JM. Revised criteria for diagnosis of NIFTP reveals a better correlation with tumor biological behavior. Endocr Connect 2019; 8:1529-1538. [PMID: 31671409 PMCID: PMC6893310 DOI: 10.1530/ec-19-0459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
The recent reclassification of a follicular variant of papillary thyroid carcinoma (FVPTC), subset as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), aims to avoid overtreatment of patients with an indolent lesion. The diagnosis of NIFTP has recently been revisited using more rigid criteria. This study presents histological and molecular findings and a long clinical follow-up of 94 FVPTC, 40 cases of follicular adenoma (FTA) and 22 cases of follicular carcinoma (FTC) that were classified before the advent of the NIFTP reclassification. All slides were reviewed using these rigid criteria and analysis of numerous sections of paraffin blocks and reclassified as 7 NIFTPs, 2 EFVPTCs, 29 infiltrative FVPTC (IFVPTCs), 57 invasive EFVPTC (I-EFVPTCs), 39 FTAs and 22 FTCs. Remarkably, EFVPTC and NIFTP patients were all free of disease at the end of follow-up and showed no BRAF mutation. Only one NIFTP sample harbored mutations, an NRAS Q61R. PAX8/PPARG fusion was found in I-EFVPTCs and FTC. Although additional studies are needed to identify a specific molecular profile to aid in the diagnosis of lesions with borderline morphological characteristics, we confirmed that the BRAF V600E mutation is an important tool to exclude the diagnosis of NIFTP. We also show that rigorous histopathological criteria should be strongly followed to avoid missing lesions in which more aggressive behavior is present, mainly via the analysis of capsule or vascular invasion and the presence of papillary structures.
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Affiliation(s)
- Ana Carolina de Jesus Paniza
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thais Biude Mendes
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Matheus Duarte Borges Viana
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Débora Mota Dias Thomaz
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Gabriel A Colozza-Gama
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Susan Chow Lindsey
- Division of Endocrinology, Department of Medicine, Laboratory of Molecular and Translational Endocrinology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Otavio Curioni
- Department of Head and Neck Surgery and Otorhinolaryngology, Hospital Heliópolis, São Paulo, Brazil
| | - André Uchimura Bastos
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Janete Maria Cerutti
- Division of Genetics, Department of Morphology and Genetics, Genetic Bases of Thyroid Tumors Laboratory, Universidade Federal de São Paulo, São Paulo, Brazil
- Correspondence should be addressed to J M Cerutti:
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