Coming to terms with <scp>NIFTP</scp>: A provisional approach for cytologists

Krane, Jeffrey F.; Alexander, Erik K.; Cibas, Edmund S.; Barletta, Justine A.

doi:10.1002/cncy.21769

Cited by 69 publications

(66 citation statements)

References 22 publications

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“…Pseudoinclusion is a relatively specific characteristic of PTC type nuclear features but can also be observed in a hyalinizing trabecular tumor, medullary thyroid carcinoma and even benign thyroid lesions . As definite nuclear pseudoinclusions are rarely found in NIFTPs, stricter criteria were recommended for the diagnosis of definitive malignancy in cytologic specimens . A fair agreement for this relatively easily recognized microscopic feature found in our study was likely caused by the various depth of browsing through the whole virtual slide on the high magnification by different reviewers.…”

Section: Discussionsupporting

confidence: 64%

Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features in Asian practice

Liu

Bychkov

Jung

et al. 2019

Pathology International

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To evaluate the current diagnostic criteria in reporting nuclear features of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP), nine Asian pathologists with expertise in thyroid reviewed virtual slides of 30 noninvasive follicular patterned thyroid lesions according to the nuclear scoring system originally proposed by an international expert and a more detailed scoring system proposed by the Asian Working Group. The interobserver agreement for nuclear grading score was generally moderate (kappa value = 0.452). The best consistency fell on the chromatin features (kappa value = 0.658–1.000). A fair to moderate interobserver agreement was demonstrated in the evaluation of nuclear elongation, nuclear overlapping, membrane irregularities and distribution of papillary thyroid carcinoma (PTC) type nuclear features. A slight agreement was rendered for the evaluation of the nuclear enlargement. Intraobserver agreement was substantial to perfect when comparing results of both scoring systems. However, both scoring systems were not able to reliably separate NIFTP from an encapsulated follicular variant PTC with minimal lymph node metastasis or BRAFV600E mutation. Although the three‐point nuclear scoring system for the diagnosis of NIFTP is widely used in Asian practice, interobserver variation was considerable. Ancillary immunohistochemical or molecular testing might be helpful in differentiating NIFTP from true PTC.

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Section: Discussionsupporting

confidence: 64%

Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features in Asian practice

Liu

Bychkov

Jung

et al. 2019

Pathology International

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“…One approach to resolving this would include the potential to downgrade an FNAB of a presumed FVPTC from the malignant category to either the SM or FN/SFN category. Some groups have suggested the use of more stringent criteria for the inclusion of follicular‐patterned lesions with PTC‐like nuclear features within the SM and malignant categories of TBSRTC . The findings from our FNAB cohort of NIFTP and IFVPTC cases suggest that such an approach would likely result in reclassification of both NIFTP and IFVPTC cases because of their overlapping features.…”

Section: Discussionmentioning

confidence: 86%

Cytological, molecular, and clinical features of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features versus invasive forms of follicular variant of papillary thyroid carcinoma

Zhao

Dias‐Santagata

Sadow

et al. 2017

Cancer Cytopathology

102

109

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BACKGROUND:The noninvasive follicular variant of papillary thyroid carcinoma (PTC) has an indolent clinical behavior in comparison with other PTCs, including the invasive follicular variant of papillary thyroid carcinoma (IFVPTC). Recently, the term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced to emphasize the low biological potential of these tumors. This study compares clinical, cytological, and molecular features of NIFTP and IFVPTC. METHODS: The study consisted of 97 thyroid fine-needle aspiration biopsy (FNAB) cases with corresponding surgical pathology from the pathology archives of the Massachusetts General Hospital. The collected patient data included the following: age, sex, type of surgery, tumor size, and prior cytological diagnosis with The Bethesda System for Reporting Thyroid Cytopathology. A molecular analysis using anchored multiplex polymerase chain reaction was performed for all cases. Each case was reviewed and subclassified histologically as NIFTP or IFVPTC. Cytology slides were scored semiquantitatively for nuclear atypia. The statistical analysis was performed with the nonparametric Mann-Whitney test. RESULTS: The 97-case cohort consisted of 50 NIFTP cases and 47 IFVPTC cases, including 18 encapsulated IFVPTC cases and 29 nonencapsulated IFVPTC cases. Differences in the type of surgery (P 5.0399), molecular features (P 5.0141), cytological classification (P 5.0266), and nuclear scores (P 5.0141) between NIFTP and IFVPTC were observed.There was overlap in the cytological classification of NIFTP and IFVPTC; however, NIFTP was more often classified as atypia of undetermined significance/follicular lesion of undetermined significance or follicular neoplasm/suspicious for follicular neoplasm in comparison with both subsets of IFVPTC. NIFTP was primarily associated with mutations in RAS, whereas an equal number of IFVPTC cases were associated with BRAFV600E or with RAS mutations. CONCLUSIONS:Despite differences in the cytological classification and molecular profiles between NIFTP and IFVPTC, the degree of overlap makes it unlikely that most cases of NIFTP and IFVPTC can be accurately distinguished with FNAB. Cancer Cytopathol 2017;125:323-31.

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“…However, the use of criteria (eg, the number of criteria required) may vary from individual to individual. Because false‐positive diagnoses are to be avoided, individual cytopathologists and institutions already may have started to adjust their practice patterns regarding the PFM/PTC diagnosis . Multidisciplinary discussions among physicians and diagnosticians are important to develop a common understanding of this challenging area.…”

Section: Discussionmentioning

confidence: 99%

The influence of the noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) resection diagnosis on the false‐positive thyroid cytology rate relates to quality assurance thresholds and the application of NIFTP criteria

Ohori

Wolfe

Carty

et al. 2017

Cancer Cytopathology

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Coming to terms with NIFTP: A provisional approach for cytologists

Cited by 69 publications

References 22 publications

Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features in Asian practice

Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features in Asian practice

Cytological, molecular, and clinical features of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features versus invasive forms of follicular variant of papillary thyroid carcinoma

The influence of the noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) resection diagnosis on the false‐positive thyroid cytology rate relates to quality assurance thresholds and the application of NIFTP criteria

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