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JAMA Oncol. 2016 Aug 1;2(8):1023-9. doi: 10.1001/jamaoncol.2016.0386.

Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors.

Author information

1
Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania.
2
Anatomic Pathology, Department of Medicine (DIMES), University of Bologna School of Medicine, Bologna, Italy.
3
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia.
4
Department of Surgical, Medical and Molecular Pathology, University of Pisa, Pisa, Italy.
5
Southern California Permanente Medical Group, Woodland Hills.
6
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
7
Department of Pathology, Mount Sinai Health System, New York, New York.
8
Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
9
Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Japan.
10
Department of Pathology, University of Michigan, Ann Arbor11Comprehensive Cancer Center, University of Michigan, Ann Arbor.
11
Department of Pathology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil13Department of Pathology, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil.
12
Department of Pathology, University of California San Francisco.
13
Department of Pathology, University Health Network, Toronto, Ontario, Canada.
14
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston.
15
Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
16
Division of Endocrinology and Metabolism, New York University School of Medicine, New York.
17
University of Wisconsin School of Medicine and Public Health, Madison.
18
Department of Psychiatry, Massachusetts General Hospital, Boston.
19
Department of Pathology, Massachusetts General Hospital, Boston22Department of Pathology Harvard Medical School, Boston, Massachusetts.
20
Department of Oncology, University of Turin, Torino, Italy.
21
University of Portsmouth, Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom.
22
Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts.
23
Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York.
24
Thyroid Cancer Survivors Association Inc, Raleigh, North Carolina.
25
General and Thyroid and Parathyroid Endocrine Surgery Division, Massachusetts Eye and Ear Infirmary, Boston.
26
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.

Abstract

IMPORTANCE:

Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are treated as having conventional thyroid cancer.

OBJECTIVE:

To evaluate clinical outcomes, refine diagnostic criteria, and develop a nomenclature that appropriately reflects the biological and clinical characteristics of EFVPTC.

DESIGN, SETTING, AND PARTICIPANTS:

International, multidisciplinary, retrospective study of patients with thyroid nodules diagnosed as EFVPTC, including 109 patients with noninvasive EFVPTC observed for 10 to 26 years and 101 patients with invasive EFVPTC observed for 1 to 18 years. Review of digitized histologic slides collected at 13 sites in 5 countries by 24 thyroid pathologists from 7 countries. A series of teleconferences and a face-to-face conference were used to establish consensus diagnostic criteria and develop new nomenclature.

MAIN OUTCOMES AND MEASURES:

Frequency of adverse outcomes, including death from disease, distant or locoregional metastases, and structural or biochemical recurrence, in patients with noninvasive and invasive EFVPTC diagnosed on the basis of a set of reproducible histopathologic criteria.

RESULTS:

Consensus diagnostic criteria for EFVPTC were developed by 24 thyroid pathologists. All of the 109 patients with noninvasive EFVPTC (67 treated with only lobectomy, none received radioactive iodine ablation) were alive with no evidence of disease at final follow-up (median [range], 13 [10-26] years). An adverse event was seen in 12 of 101 (12%) of the cases of invasive EFVPTC, including 5 patients developing distant metastases, 2 of whom died of disease. Based on the outcome information for noninvasive EFVPTC, the name "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) was adopted. A simplified diagnostic nuclear scoring scheme was developed and validated, yielding a sensitivity of 98.6% (95% CI, 96.3%-99.4%), specificity of 90.1% (95% CI, 86.0%-93.1%), and overall classification accuracy of 94.3% (95% CI, 92.1%-96.0%) for NIFTP.

CONCLUSIONS AND RELEVANCE:

Thyroid tumors currently diagnosed as noninvasive EFVPTC have a very low risk of adverse outcome and should be termed NIFTP. This reclassification will affect a large population of patients worldwide and result in a significant reduction in psychological and clinical consequences associated with the diagnosis of cancer.

PMID:
27078145
PMCID:
PMC5539411
DOI:
10.1001/jamaoncol.2016.0386
[Indexed for MEDLINE]
Free PMC Article
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