NIFTP: A Critical Pathologist View

Leão, Sydney Correia

doi:10.17140/otloj-3-137

Cited by 2 publications

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References 2 publications

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“…The low interobserver reliability in thyroid histopathology could be one factor . Pathologists have also outlined their reservations surrounding the diagnostic criteria, namely, the challenges associated with assessing the entire tumor capsule for large tumors, the histological assessment of the entire tumor to exclude focal necrosis or vascular invasion, and the lack of molecular testing specific for this entity …”

Section: Discussionmentioning

confidence: 99%

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Caulley

Eskander

Yang

et al. 2022

JAMA Otolaryngol Head Neck Surg

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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 MEASURESFrequency 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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Section: Discussionmentioning

confidence: 99%

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Caulley

Eskander

Yang

et al. 2022

JAMA Otolaryngol Head Neck Surg

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Variation in the Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features

Chen

Rob

Mukherjee

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Noninvasive encapsulated follicular variant of papillary thyroid cancer (EFVPTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in January 2017. The impact of this nomenclature change at a population level remains unknown. Objective Examine use of NIFTP across different US regions and populations. Design Descriptive epidemiology study using SEER-22 data (2000-2019). Participants Individuals diagnosed with papillary or follicular thyroid cancer (2000-2019), or NIFTP (2017-2019). Main outcome measures Annual incidence rates of thyroid cancer by subtype and NIFTP. Using 2018-2019 data: 1) rates of NIFTP at the 17 SEER-22 sites, and 2) comparison of demographics for patients diagnosed with NIFTP versus papillary and follicular thyroid cancer. Results NIFTP comprised 2.2% and 2.6% of cases in 2018 and 2019, respectively. Between 2018-2019, large heterogeneity was observed in the regional use of NIFTP diagnosis, with site-specific incidence rates between 0.0-6.2% (median 2.8%, IQR 1.3-3.6%). A diagnosis of NIFTP (vs papillary and follicular thyroid cancer) was significantly associated with older age (P=0.012 and P=0.009), Black race (both P<0.001), and non-Hispanic ethnicity (both P<0.001) for 2018 and 2019, respectively. Conclusions Marked variation exists in the use of the NIFTP diagnosis. The recent 2021 coding change that resulted in NIFTP, a tumor with uncertain malignant potential and for which there is no long-term outcome data available, no longer being a reportable diagnosis to SEER will disproportionately affect vulnerable patient groups such as older patients and Black patients, in addition to patients who reside in regions with higher rates of NIFTP diagnoses.

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NIFTP: A Critical Pathologist View

Cited by 2 publications

References 2 publications

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Variation in the Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features

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