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The endocrine system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a recently recognized tumour with very low malignant potential which shows papillary nuclear features and a follicular pattern of growth. Previously these tumours would have been referred to as ‘non-invasive encapsulated follicular variant of papillary carcinoma’. NIFTP commonly presents as a painless mass in either lobe of the thyroid gland. Histologically it is marked by clear demarcation from the surrounding tissue or encapsulation, a follicular growth pattern and papillary nuclear features. No invasion is seen despite thorough investigation. NIFTP does not, unlike papillary carcinomas, contain the BRAF V600E mutation but more usually RAS mutations. Importantly, if correctly diagnosed NIFTP has a very low rate of recurrence (<1% at 15 years).
Thyroid nodules and multinodular goiter
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Poorani N. Goundan, Stephanie L. Lee
FNB without molecular testing has a sensitivity of 65 to 98% (mean, 83%), a specificity of 72 to 100% (mean, 92%), and a diagnostic accuracy of 85 to 100% (mean, 95%). The predictive value of a cytological result that is positive or suspicious for malignancy is 75% (range, 50–96%). The false-negative rate may be as low as 1% and as high as 11% (mean, 5%), and false-positive rates range from 0% to 7% (mean, 5%) (84, 85). Recently, an expert panel proposed the reclassification of certain tumors as premalignant lesions, in other words, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) (86). This change, as reflected in the newest version of the Bethesda classification system, would modify the expected risk of malignancy in each cytologic category, particularly for Bethesda III, IV, and V (87–89) (Table 7.4).
Impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on fine-needle aspiration diagnoses of thyroid nodules
Published in Baylor University Medical Center Proceedings, 2021
Li Chen, Lina Liu, Parsa Hodjat, Bing Leng
The term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was first introduced in 2016.1–3 NIFTP is characterized by encapsulation/well demarcation, follicular architecture, and nuclear features of papillary thyroid carcinoma (PTC). Before 2016, NIFTP belonged to the category of noninvasive follicular variant of papillary thyroid carcinoma (NIFVPTC) and was treated with total thyroidectomy. Studies by several groups4,5 reported indolent behavior in cases of NIFVPTC with no contribution to cancer-related deaths. Molecular studies demonstrated that the molecular profile of NIFVPTC was similar to that of follicular adenoma/follicular thyroid carcinoma with a high frequency of RAS mutations and absence of BRAF mutations.6–8 Based on its indolent biological behavior and distinct histology and molecular mutations, an international multidisciplinary working group conceded the terminology as NIFTP and noted that NIFTP can be sufficiently managed with lobectomy or hemithyroidectomy.1 The nomenclature of NIFTP was adopted in our surgical pathology and cytopathology services in 2016. In this retrospective study, we investigated the impact of the NIFTP terminology application on FNA diagnosis of thyroid nodules and clinical management.
Evaluation of the Bethesda System and the ACR TIRADS in an Endemic Goiter Region
Published in Endocrine Research, 2020
Mustafa Karaagac, Talha Sarigoz, Tamer Ertan, Omer Topuz
For clarity of communication, BSRTC was formed and it recommends that each report starts with one of the six diagnostic categories. BSRTC has been adopted at our institution since 2009. In 2017, BSRTC has been revised based on post-2010 data and noninvasive follicular variant of papillary thyroid carcinoma was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).17 Since NIFTP is a surgical disease, the higher risk estimates were taken as a reference for comparison of data. BSRTC recommends repeat aspiration for ND/UNS category and for benign results, clinical and sonographic follow-up. However, in the EGR setting, benign results had a cancer risk of 6.2% which was two times more than the 2017 BSRTC revision reported. So, in EGRs, it may be wise to repeat TFNA in patients with benign category aspirations rather than follow-up. The reasonable ROM for ND/UNS is 5%-10%, whereas the malignancy rate for resected ND/UNS nodules is 9%-32%.17 The calculated ROM for ND/UNS was 14.43% and it is consistent with literature. Malignancy risk for FN/SFN, SM and malignant categories was also in line with the latest report. Recommendations of the 2017 revision for those categories seem appropriate for iodine-deficient populations.
Update on: proteome analysis in thyroid pathology – part II: overview of technical and clinical enhancement of proteomic investigation of the thyroid lesions
Published in Expert Review of Proteomics, 2018
Isabella Piga, Stefano Casano, Andrew Smith, Silvia Tettamanti, Davide Leni, Giulia Capitoli, Angela Ida Pincelli, Marcella Scardilli, Stefania Galimberti, Fulvio Magni, Fabio Pagni
The possible application of molecular techniques for the diagnostic triage of thyroid nodules still persists as an interesting topic in pathology. In a previous review, the contribution of pivotal proteomics experiments in this field was underlined [1]. Moreover, in the last 3 years (2015–2018), this interest has grown even further due to some of the significant technical improvements that have occurred in the fields of proteomics, genetics and immunohistochemistry (IHC). Finally, some changes in the diagnostic categories, such as the introduction of the new Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) terminology has modified the clinical landscape [2]. The current review updates the recent findings obtained by proteomics approaches, focusing on the recent novelties, both in tissue and serological samples, for the management of thyroid cancer.