Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features and Its Impact on the Risk of Malignancy in the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience

Kim, Mi-Lim; Kim, Joung Eun; Chung, Yul Ri; Kwak, Yoonjin; Park, So Yeon

doi:10.4132/jptm.2018.04.03

Cited by 25 publications

(31 citation statements)

References 22 publications

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“…We excluded a further 233 studies and finally selected 38 studies, which included 145,066 thyroid nodules, for meta‐analysis (Fig. ) . Among the included studies, 4 were prospective and 34 were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…TBSRTC 2017 adopted NIFTP terminology and provided 2 ranges of ROM, one considering NIFTP as malignancy and another not . In the present study, we included 4 studies that applied the post‐NIFTP classification . All patients in these studies received recommendations for surgical intervention before the NIFTP terminology was introduced so the RR was not affected by the updated guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

Vuong

Ngo

Bychkov

et al. 2019

Cancer Cytopathology

101

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There is increasing evidence showing that clinicians employ different management strategies in their use of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this meta-analysis, we investigated the differences in diagnosis frequency, resection rate (RR), and risk of malignancy (ROM) between Western (ie, American and European) and Asian cytopathology practices. We searched PubMed . Proportion and 95% CIs were calculated using a random-effect model. We used independent sample t tests to compare frequencies, RR, and ROM between Western and Asian practices. We analyzed a total of 38 studies with 145,066 fine-needle aspirations. Compared with Asian practice, Western series had a significantly lower ROM in most of TBSRTC categories, whereas the RR was not statistically different. Focusing on indeterminate nodules, the RR in Western series was significantly higher (51.3% vs 37.6%; P = .048), whereas the ROM was significantly lower (25.4% vs 41.9%; P = .002) compared with those in Asian series. The addition of Asian cohorts increased ROM for most of diagnostic categories compared with the original TBSRTC. In conclusion, this study demonstrates a difference in Western and Asian thyroid cytology practice, especially regarding the indeterminate categories. Lower RR and higher ROM suggest that Asian clinicians adopt a more conservative approach, whereas immediate diagnostic surgery is favored in Western practice for indeterminate nodules. The addition of Asian series into a meta-analysis of TBSRTC altered ROM for several categories, which should be considered in future revisions of TBSRTC.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

Vuong

Ngo

Bychkov

et al. 2019

Cancer Cytopathology

101

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“…The reclassification of NIFTP as a non-malignant lesion decreases the ROM in most Bethesda categories; the scale of the impact differs significantly among various institutions (9,11,61,62,63,64,65,66,67,68,69,70). According to the latest large meta-analysis conducted by Vuong et al (14 studies, 14,153 resected nodules), the highest absolute decrease in ROM was observed in SM, FN/SFN and AUS/FLUS categories (15.8%, 10.6% and 9.5%, respectively) (71).…”

Section: Niftp In Fine-needle Aspiration Biopsymentioning

confidence: 99%

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Zajkowska

Kopczyński

Góźdż

et al. 2020

Endocrine Connections

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Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a borderline thyroid tumour formerly known as noninvasive encapsulated follicular variant of papillary thyroid carcinoma. The prevalence of NIFTP is estimated at 4.4–9.1% of all papillary thyroid carcinomas worldwide; however, the rate of occurrence of NIFTP is eight times lower in Asian countries than in Western Europe and America. At the molecular level, NIFTP is characterised by the lack of BRAF V600E and BRAF V600E-like mutations or other high-risk mutations (TERT, TP53) and a high rate of RAS mutations, which is similar to other follicular-pattern thyroid tumours. The diagnosis of NIFTP can only be made after histological examination of the entire tumour removed during surgery and is based on strictly defined inclusion and exclusion criteria. Although the diagnosis is postoperative, the combination of certain findings of preoperative tests including ultrasonography, cytology, and molecular testing may raise suspicion of NIFTP. These tumours can be effectively treated by lobectomy, although total thyroidectomy remains an option for some patients. Radioactive iodine and thyroid stimulating hormone suppression therapy are not required. NIFTP has an extremely good prognosis, even when treated conservatively with lobectomy alone. Nevertheless, it cannot be considered as a benign lesion. The risk of adverse outcomes, including lymph node and distant metastases, is low but not negligible.

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“…Clinicians should always be aware of the malignancy rate in various Bethesda categories in their respective hospitals to improve their management decisions. Few studies have shown that NIFTP has affected malignancy risk in each category with the greatest impact being on FN/SFN and nondiagnostic categories . A recent meta‐analysis by Layfield et al has shown that NIFTP remarkably affect risk of malignancy in indeterminate Bethesda categories .…”

Section: Discussionmentioning

confidence: 99%

“…AUS, atypia of undetermined significance; DROM, difference in risk of malignancyFLUS, follicular neoplasm of undetermined significance; FN, follicular neoplasm; NIFTP, noninvasive follicular thyroid neoplasm with papillary-like nuclear features; ROM, risk of malignancy SFN, suspicious of follicular neoplasm. Comparative analysis of ultrasound and cytology findings of NIFTP with other differential diagnosis37,38,42 that NIFTP has affected malignancy risk in each category with the greatest impact being on FN/SFN and nondiagnostic categories 40. A recent meta-analysis by Layfield et al has shown that NIFTP remarkably affect risk of malignancy in indeterminate Bethesda categories.…”

mentioning

confidence: 99%

Noninvasive follicular neoplasm with papillary like nuclear features: A comprehensive analysis with a diagnostic algorithm

Rana

Shreyamsa

Ramakant

et al. 2019

Diagnostic Cytopathology

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Background Noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) lacks the carcinoma label, avoiding aggressive therapy, physiological, social and financial impact of cancer diagnosis. Unfortunately, the preoperative diagnosis is still a challenge. Varied incidence of NIFTP has been document with limited data on preoperative cytological, radiological characteristics and the impact on risk of malignancy in each category of the Bethesda system of reporting thyroid cytopathology. Method Retrospective analysis of 20 NIFTPs with an attempt to provide a preoperative diagnostic algorithm based on the cytological and ultrasound features along with incidence and implication on risk of malignancy in various Bethesda categories with its impact on patient management. Result Incidence of NIFTP in our study was higher in comparison to that documented from other Asian countries. TIRADS 3 was the most common sonographic diagnosis. NIFTP was commonly preceded by indeterminate or benign Bethesda category. Major impact of excluding NIFTP form malignant category was seen on Bethesda categories II and IV with 20% and 27% reduction in risk of malignancy, respectively. Conclusion Retrospective analysis should not be confined only to follicular variant of papillary thyroid carcinoma but cases of follicular adenoma and adenomatous colloid nodule should always be included in review to ascertain the true incidence of NIFTP. NIFTPs are less likely to have malignant preoperative cytology. NIFTP shares major cytological and ultrasound features with follicular adenoma, adenomatous colloid nodule and minimally invasive follicular papillary carcinoma. When analyzed together, taking minor findings in consideration, can favor a diagnosis.

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Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features and Its Impact on the Risk of Malignancy in the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience

Cited by 25 publications

References 22 publications

Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta‐analysis

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity

Noninvasive follicular neoplasm with papillary like nuclear features: A comprehensive analysis with a diagnostic algorithm

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