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Pathol Int. 2019 Feb 27. doi: 10.1111/pin.12779. [Epub ahead of print]

Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary-like nuclear features in Asian practice.

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Department of Pathology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Shandong, China.
Department of Pathology, Qilu Hospital of Shandong University, Shandong, China.
Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Pathology, Kameda Medical Center, Kamogawa, Japan.
Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan.
Department of Occupational and Environmental Health Monitoring and Assessment, Shandong Center for Disease Control and Prevention, Jinan, China.
Department of Pathology, Yonsei University, College of Medicine, Seoul, South Korea.
Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Cancer Signalling & Metabolism, Instituto de Investigação e Inovação em Saúde, Universidade do Porto Rua Alfredo Allen, 208, 4200-135 Porto, Portugal.
Pathology & Cytopathology, Acıbadem University, Kerem Aydinlar Campus Block-B, Kaydışdagi cad. No:32, 34752 Ataşehir/İstanbul-Turkey.
Faculty of Medicine, Department of Pathology, Nara Hospital, Kindai University, Nara, Japan.


To evaluate the current diagnostic criteria in reporting nuclear features of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), nine Asian pathologists with expertise in thyroid reviewed virtual slides of 30 noninvasive follicular patterned thyroid lesions according to the nuclear scoring system originally proposed by an international expert and a more detailed scoring system proposed by the Asian Working Group. The interobserver agreement for nuclear grading score was generally moderate (kappa value = 0.452). The best consistency fell on the chromatin features (kappa value = 0.658-1.000). A fair to moderate interobserver agreement was demonstrated in the evaluation of nuclear elongation, nuclear overlapping, membrane irregularities and distribution of papillary thyroid carcinoma (PTC) type nuclear features. A slight agreement was rendered for the evaluation of the nuclear enlargement. Intraobserver agreement was substantial to perfect when comparing results of both scoring systems. However, both scoring systems were not able to reliably separate NIFTP from an encapsulated follicular variant PTC with minimal lymph node metastasis or BRAFV600E mutation. Although the three-point nuclear scoring system for the diagnosis of NIFTP is widely used in Asian practice, interobserver variation was considerable. Ancillary immunohistochemical or molecular testing might be helpful in differentiating NIFTP from true PTC.


digital pathology; noninvasive follicular thyroid neoplasm with papillary-like nuclear features; nuclear scoring system; observer variation; tumors of uncertain malignant potential


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