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Head Neck. 2018 Sep;40(9):1881-1888. doi: 10.1002/hed.25141. Epub 2018 Jun 26.

AHNS Series: Do you know your guidelines? AHNS Endocrine Section Consensus Statement: State-of-the-art thyroid surgical recommendations in the era of noninvasive follicular thyroid neoplasm with papillary-like nuclear features.

Author information

1
Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
2
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
3
Department of Otolaryngology - Head and Neck Surgery, Augusta University, Augusta, Georgia.
4
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
5
Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
6
Department of Surgery, University of California San Francisco, San Francisco, California.
7
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
8
Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York.
9
Department of Head and Neck - Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida.
10
Department of Endocrinology, Mayo Clinic Jacksonville, Jacksonville, Florida.
11
Department of Endocrinology, Memorial Regional Hospital, Hollywood, Florida.
12
Department of Endocrine Neoplasia, MD Anderson Cancer Center; Houston, Texas.
13
Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
14
Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
15
Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.
16
Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania.
17
Department of Otolaryngology, Oregon Health Science University, Portland, Oregon.
18
Department of Otolaryngology, Stanford University, Stanford, California.
19
Department of Otolaryngology and Audiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Abstract

The newly introduced pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) will result in less bilateral thyroid surgery as well as deescalation in T4 suppressive and radioactive iodine treatment. Although, NIFTP is a nonmalignant lesion that has nuclear features of some papillary malignancies, the challenge for the surgeon is to identify a lesion as possibly NIFTP before the pathologic diagnosis. NIFTP, due to its reduction of overall rates of malignancy, will result in the initial surgical pendulum swinging toward lobectomy instead of initial total thyroidectomy. This American Head and Neck Society endocrine section consensus statement is intended to inform preoperative evaluation to attempt to identify those patients whose final pathology report may ultimately harbor NIFTP and can be offered a conservative surgical plan to assist in cost-effective, optimal management of patients with NIFTP.

KEYWORDS:

RAS mutations; lobectomy; surveillance; thyroid cancer; ultrasound

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