Did Introducing a New Category of Thyroid Tumors (Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features) Decrease the Risk of Malignancy for the Diagnostic Categories in the Bethesda System for Reporting Thyroid Cytopathology?

Kopczyński, Janusz; Suligowska, Agnieszka; Niemyska, Kornelia; Pałyga, Iwona; Walczyk, Agnieszka; Gąsior-Perczak, Danuta; Kowalik, Artur; Hińcza, Kinga; Mężyk, Ryszard; Góźdż, Stanisław; Kowalska, Aldona

doi:10.1007/s12022-020-09619-0

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Most of the articles (86%) [21, 22, 24, 26, 28-31, 33-35, 37-45, 47, 49-73, 75, 77-79] analysed data from a single institution with only 14% [20,23,32,36,46,48,74,76] being multi-institutional. The articles originated from North America (55%) [26, 28, 30, 31, 34, 39, 40, 42, 44, 47-49, 51-60, 62, 64, 65, 67-70, 72, 74, 75], Asia (26%) [21, 22, 32, 33, 36-38, 43, 46, 50, 61, 63, 66, 73, 77], Europe (14%) [23,29,35,41,45,71,78,79], and South America (2%) [24]. Two articles included data from both North America and Europe (3%) [20,76].…”

Section: Summary Of the Studiesmentioning

confidence: 99%

Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis

et al. 2021

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Background: A low-risk thyroid tumour, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced in 2016. NIFTP criteria require a thorough histological examination to rule out capsular and lymphovascular invasion, which denies the possibility of preoperative cytological diagnosis. Nevertheless, since the adoption of the new entity, the cytology of NIFTP has been a subject of interest. Objectives: The present systematic review and meta-analysis investigate the cytological diagnosis of NIFTP. Method: An online PubMed literature search was conducted between March 1, 2020, and June 30, 2020, for all original articles considering the cytology of histologically proven NIFTP. The studies including data on fine needle aspiration specimens classified by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) categories, risk of malignancy (ROMs) in the TBSRTC categories, and cytomorphological features of NIFTP were included in the meta-analysis. Non-English studies and case reports were excluded. The data were tabulated and statistical analysis was performed with Open Meta-Analyst program. Results: Fifty-eight studies with a total of 2,553 NIFTP cases were included in the study. The pooled prevalence of NIFTP cases was calculated among 25,892 surgically resected cases from 20 studies and the results show that NIFTP consisted 4.4% (95% confidence interval [CI]: 3.5–5.4%) of all cases. Most of the NIFTP cases (79.0%) belonged to the intermediate categories of TBSRTC. The pooled distribution of NIFTP cases in each TBSRTC category was 1.3% (95% CI: 0.8–1.7%) in non-diagnostic (ND), 8.9% (95% CI: 6.9–10.8%) in benign, 29.2% (95% CI: 25.0–33.4%) in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 24.2% (95% CI: 19.6–28.9%) in follicular neoplasm (FN), 19.5% (95% CI: 16.1–22.9%) in suspicious for malignancy (SM), and 6.9% (95% CI: 5.2–8.7%) in malignant. Compared to pre-NIFTP era, the pooled risk differences of ROM were reduced by 2.4% in ND, 2.7% in benign, 8.2% in AUS/FLUS, 8.2% in FN, 7.3% in SM, and 1.1% in the malignant category. The cytomorphological features of NIFTP were similar to follicular variant of papillary thyroid carcinoma (FVPTC) but lesser to papillary thyroid carcinoma (PTC). Conclusions: Based on our results, NIFTP remains a histological diagnosis. Although cytomorphological features cannot be used in differentiating NIFTP from FVPTC, they may guide in separating NIFTP from PTC. Features such as papillae, microfollicles, giant cells, psammoma bodies, and the amount of papillary-like nuclear features should be taken into account when suspicious of NIFTP. NIFTP should not have papillae or psammoma bodies, and giant cells were rarely observed.

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Section: Summary Of the Studiesmentioning

confidence: 99%

Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis

et al. 2021

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“…In terms of the relationship between nuclear features and BRAFV600E mutation, the existence of non‐invasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) should be explored further. NIFTP is a recently independently categorized entity of thyroid neoplasm with nuclear features of papillary carcinoma diagnosed by definite criteria 35 . NIFTP is a well‐encapsulated and non‐invasive tumour behaving like follicular adenoma 35 .…”

Section: Discussionmentioning

confidence: 99%

“…NIFTP is a recently independently categorized entity of thyroid neoplasm with nuclear features of papillary carcinoma diagnosed by definite criteria 35 . NIFTP is a well‐encapsulated and non‐invasive tumour behaving like follicular adenoma 35 . In addition, in contrast to papillary carcinoma, NIFTP frequently shows RAS mutation but does not show BRAFV600E mutation 36 .…”

Section: Discussionmentioning

confidence: 99%

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Computer‐assisted image analysis of cytological specimens clarify the correlation between nuclear size and intranuclear cytoplasmic inclusions regardless of BRAFV600E mutation in papillary thyroid carcinoma

et al. 2021

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Objective The morphological features of nuclei in cytological and histological specimens were compared and examined for the presence of BRAFV600E mutation and the appearance rate of intranuclear cytoplasmic inclusions (NI). Methods BRAFV600E mutation was identified using a mutation‐specific antibody (clone; VE1) in 103 thyroid papillary carcinoma cases at Gunma University Hospital. The nuclear area, perimeter, and roundness of the corresponding cytological specimens and haematoxylin and eosin‐stained specimens were analysed using image analysis software, and the appearance rate of NI was calculated and compared. Results BRAFV600E mutation was detected in 71 (69%) cases. The appearance rate of NI was significantly higher in the BRAFV600E mutation‐positive group in cytological and histological specimens (P = .0070 and .0184, respectively). Significant differences were observed between the BRAFV600E mutation‐negative and ‐positive groups in the average nuclear area and average nuclear perimeter in cytological specimens (P = .0137 and .0152, respectively). In addition, nuclear enlargement was correlated with the appearance rate of NI regardless of the presence of BRAFV600E mutation in cytological specimens. In the BRAFV600E mutation‐negative group, the nuclear area and perimeter were significantly smaller in the lymph node metastasis‐positive cases (P = .0182 and .0260, respectively). Conclusion This study found that the appearance rate of NI was positively correlated with the nuclear area and perimeter and negatively correlated with nuclear roundness in cytological specimens. Furthermore, these results were observed regardless of the existence of BRAFV600E mutation. These results have never been previously reported and clearly demonstrate the usefulness of cytological specimens in computer‐assisted image analysis.

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“…Recently, studies on the impact of NIFTP on thyroid cytology diagnostics showed, after revision of the criteria in 2018 [29], a smaller ROM reduction in the various diagnostic classes of TBSRTC. Kopczynski et al [30] observed a statistically nonsignificant reduction of 0.7% for the FN/SFN category, 4.2% for the SUSP category, 0.5% for the MAL category, and no reduction in ROM for the AUS/FLUS category. In another study, Ventura et al [31] observed a reduction in ROM of 15.2% for AUS/FLUS, 7.6% for FN/SFN, and 14.2% for SFN.…”

Section: Remodeling the Risk Of Malignancymentioning

confidence: 96%

Reporting Thyroid Cytology in a Globalized World

et al. 2021

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The Italian SIAPEC-AIT 2014 classification, the 2017 Bethesda System for Reporting Thyroid Cytology (TBSRTC), the 2016 UK Royal College of Pathologists (RCPath) thyroid reporting system, and the 2019 Japanese reporting system for thyroid aspiration cytology (JRSTAC2019) represent the most widely used reporting systems among clinicians and pathologists for the purpose of cytologically diagnosing, estimating the potential risk of malignancy (ROM), and defining the most appropriate treatment for a patient with a thyroid nodule. Although all the systems use overlapping diagnostic categories and morphologic criteria, they differ on the basis of the criteria for inclusion in the cytologic categories, which may, in turn, affect the ROM of a given category and the clinical management of the patient, particularly with regard to the “indeterminate” categories. The aim of this review is to analyze the main differences that emerge between the systems and to propose possible solutions for a comprehensive reporting system that integrates and harmonizes all the criteria of the Italian classification and the Bethesda system, also taking into account the impact that the new tumor entity NIFTP (non-invasive follicular tumor with papillary-like nuclear features) that has, in many instances, replaced the non-invasive form of the follicular variant of papillary carcinoma, has had on the modification of malignancy risks.

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Did Introducing a New Category of Thyroid Tumors (Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features) Decrease the Risk of Malignancy for the Diagnostic Categories in the Bethesda System for Reporting Thyroid Cytopathology?

Cited by 7 publications

References 24 publications

Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis

Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis

Computer‐assisted image analysis of cytological specimens clarify the correlation between nuclear size and intranuclear cytoplasmic inclusions regardless of BRAFV600E mutation in papillary thyroid carcinoma

Reporting Thyroid Cytology in a Globalized World

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