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

2021 ◽  
Author(s):  
Lisa Caulley ◽  
Antoine Eskander ◽  
Weining Yang ◽  
Edel Auh ◽  
Lydia Cairncross ◽  
...  
Keyword(s):  
Thyroid Neoplasms ◽  
Thyroid Neoplasm ◽  
Papillary Thyroid ◽  
Nuclear Features

HBME1 and CK19 in Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) vs Other Follicular Patterned Thyroid Lesions.

2021 ◽  
Author(s):  
Qandeel Sadiq ◽  
Radhika Sekhri ◽  
Daniel Dibaba ◽  
Qi Zhao ◽  
Shweta Agarwal
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Follicular Adenoma ◽  
Thyroid Neoplasms ◽  
University Hospital ◽  
Thyroid Neoplasm ◽  
Papillary Thyroid ◽  
Non Invasive ◽  
Significant Difference ◽  
Nuclear Features

Abstract Background: Thyroid neoplasms with follicular architecture can have overlapping morphologic features and pose diagnostic confusion amongst pathologists. Various immunohistochemical stains have been investigated as potential diagnostic markers for PTC; amongst which HBME1 and CK19 have gained popularity. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) poses similar diagnostic challenges with interobserver variability and is often misdiagnosed as adenomatoid nodule or follicular adenoma. This study aims to evaluate expression of HBME1 and CK19 in NIFTPs in comparison to other well differentiated thyroid neoplasms and benign mimickers. Method: 73 thyroid cases diagnosed over a period of 3 years at Methodist University Hospital, Memphis, TN were included in this study: 9 NIFTP, 18 papillary thyroid carcinoma (PTC), 11 follicular variant of papillary thyroid carcinoma, invasive (I-FVPTC), 24 follicular adenomas (FA), and 11 multinodular goiters/ adenomatoid nodules (MNG). A tissue microarray (TMA) was constructed and HBME1 and CK19 IHC was performed.Results: HBME1 was expressed in 77.8% NIFTPs, 88.9% PTC, 81.8% I-FVPTC, 16.7 % FA, and 18.2% MNGs. CK19 expression was seen in 66.7% NIFTPs, 83.3% PTC, 81.8% I-FVPTC, 33.3% FA and 45.4% MNGs. Difference in expression of HBME1 and CK19 was statistically significant for NIFTP vs FA (qualitative; p<0.05) and NIFTP vs MNG (p<0.05). No statistically significant difference was found for HBME1 in NIFTP vs PTC (conventional and FVPTC), p>/= 0.2. Sensitivity of HBME1 and CK19 for NIFTP were 78% and 67%, ~88% each for PTC, and 89% and 100% for FVPTC respectively, while specificity of HBME1 and CK19 for NIFTP were 53% each, ~62% each for PTC and ~55% each for FVPTC. Conclusion: Our study indicated that HBME1 and CK19 are valuable markers in differentiating NIFTPs from morphologic mimics like follicular adenoma and adenomatoid nodules/ multinodular goiter. While HBME1 and CK19 are both sensitive in diagnosing lesions with PTC like nuclear features, CK19 stains a higher number of benign lesions in comparison to HBME1. No increase in sensitivity or specificity in diagnosis of NIFTP, PTC or FVPTC was noted on combining the two antibodies.

Utility of Tumor Capsule Thickness as a Predictor of Invasion in Encapsulated Follicular Variant of Papillary Thyroid Carcinoma and a Diagnostic Tool for Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features

2019 ◽  
Vol 28 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Brenda French ◽  
Georgette Hattier ◽  
Stacey K. Mardekian
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Predictive Marker ◽  
Thyroid Neoplasms ◽  
Thyroid Neoplasm ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
Tumor Capsule ◽  
Capsule Thickness ◽  
Nuclear Features

Context. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an extremely indolent subset of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). These lesions share certain features including a delimiting fibrous capsule, and they are distinguished by detailed histological criteria. Objective. We sought to identify whether tumor capsule thickness differs significantly between NIFTP and noninvasive EFVPTC lesions. We also compared tumor capsule thickness between noninvasive and invasive EFVPTC in order to evaluate its utility as a predictive marker of invasion. Design. Encapsulated follicular thyroid neoplasms with papillary-like nuclear features diagnosed over a 3-year period at a single institution were subcategorized into NIFTP, noninvasive EFVPTC, and invasive EFVPTC based on current diagnostic criteria. Maximum tumor capsule thickness for each lesion was measured. Results. A total of 92 lesions (39 NIFTP, 15 noninvasive EFVPTC, and 38 invasive EFVPTC) were evaluated. Tumor capsule thickness was significantly thinner in NIFTP ( P = .022) and significantly thicker in invasive EFVPTC ( P = .0006) when compared with noninvasive EFVPTC. Conclusions. Tumor capsule thickness may be an additional useful marker when distinguishing between NIFTP and noninvasive EFVPTC. A capsule thickness of greater than 0.2 mm should raise suspicion for EFVPTC and thus prompt more thorough review of the submitted tissue for NIFTP exclusionary criteria. Additionally, if capsular and/or vascular invasion are not present on initial slides of an entirely evaluated capsule of EFVPTC that exceeds 0.5 mm in thickness, the pathologist should order additional tissue levels to ensure that a small focus of invasion is not missed.

scholarly journals HBME1 and CK19 expression in non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) vs other follicular patterned thyroid lesions

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Qandeel Sadiq ◽  
Radhika Sekhri ◽  
Daniel T. Dibaba ◽  
Qi Zhao ◽  
Shweta Agarwal
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Follicular Adenoma ◽  
Thyroid Neoplasms ◽  
University Hospital ◽  
Thyroid Neoplasm ◽  
Papillary Thyroid ◽  
Non Invasive ◽  
Significant Difference ◽  
Nuclear Features

Abstract Background Thyroid neoplasms with follicular architecture can have overlapping morphologic features and pose diagnostic confusion among pathologists. Various immunohistochemical stains have been investigated as potential diagnostic markers for PTC, among which HBME1 and CK19 have gained popularity. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) poses similar diagnostic challenges with interobserver variability and is often misdiagnosed as adenomatoid nodule or follicular adenoma. This study aims to evaluate expression of HBME1 and CK19 in NIFTPs in comparison to other well-differentiated thyroid neoplasms and benign mimickers. Method Seventy-three thyroid cases diagnosed over a period of 3 years at Methodist University Hospital, Memphis, TN, USA, were included in this study: 9 NIFTP; 18 papillary thyroid carcinoma (PTC); 11 follicular variant of papillary thyroid carcinoma, invasive (I-FVPTC); 24 follicular adenomas (FA); and 11 multinodular goiters/adenomatoid nodules (MNG). A tissue microarray (TMA) was constructed and HBME1 and CK19 immunohistochemistry was performed. Results 77.8% of NIFTPs, 88.9% of PTCs, 81.8% of I-FVPTCs, 16.7% of FAs, and 18.2% of MNGs showed HBME-1 expression. 66.7% of NIFTPs, 83.3% of PTCs, 81.8% of I-FVPTCs, 33.3% of FAs, and 45.4% of MNGs expressed CK19. Difference in expression of HBME1 and CK19 was statistically significant for NIFTP vs FA (qualitative; p < 0.05) and NIFTP vs MNG (p < 0.05). No statistically significant difference was found for HBME1 in NIFTP vs PTC (conventional and FVPTC), p ≥ 0.2. Sensitivity of HBME1 and CK19 for NIFTP were 78% and 67%, ~ 88% each for PTC, and 89% and 100% for FVPTC, respectively, while specificity of HBME1 and CK19 for NIFTP were 53% each, ~ 62% each for PTC, and ~55% each for FVPTC. Conclusion Our study indicated that HBME1 and CK19 are valuable markers in differentiating NIFTPs from morphologic mimics like follicular adenoma and adenomatoid nodules/multinodular goiter. While HBME1 and CK19 are both sensitive in diagnosing lesions with PTC-like nuclear features, CK19 stains a higher number of benign lesions in comparison to HBME1. No increase in sensitivity or specificity in diagnosis of NIFTP, PTC, or FVPTC was noted on combining the two antibodies.

scholarly journals Study of variants of papillary carcinoma of Thyroid with a special emphasis on NIFTP (Non-invasive Follicular Thyroid Neoplasm with Papillary like nuclear features)

2021 ◽  
Vol 6 (3) ◽  
pp. 207-210
Author(s):  
G V R N Krishna kanth ◽  
N Nirmala Jyoti
Keyword(s):  
Papillary Carcinoma ◽  
Thyroid Neoplasms ◽  
Good Prognosis ◽  
Thyroid Neoplasm ◽  
Papillary Thyroid ◽  
Non Invasive ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study ◽  
Nuclear Features

Rapid advances have taken place in the classification of papillary thyroid neoplasms with reclassification and addition of new variants. One such change is the addition of a new entity called NIFTP (Non-invasive Follicular Thyroid Neoplasm with Papillary like nuclear features). So called recognising its non-malignant potential. The present study is a retrospective observational cohort study on thyroidectomy specimens collected between Jan 2018 to June 2021 focussing on variants of papillary carcinoma with special emphasis on recognising NIFTP – which has got good prognosis and is considered non-malignant. Out of the 40 cases of papillary neoplasms 36 were PTC and 4 were NIFTP. Among the PTC cases 27 were classic PTC, 4 were FVPTC (Follicular Variant of Papillary Thyroid Carcinoma) 3 were papillary microcarcinoma, 1 was Warthin like Variant of PTC and 1 was Encapsulated PTC. The Study concludes that special vigilance is required in strictly adhering to the criteria proposed by new 2017 WHO classification of Papillary tumours. Recognising NIFTP as it is a non-malignant entity should be given due importance.

scholarly journals Effect of Implementing the New Diagnostic Criteria for Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features in King Abdulaziz University Hospital

2016 ◽  
Vol 23 (3) ◽  
pp. 31-37
Author(s):  
Fatimah A. Alturkistani ◽  
Murad A. Alturkustani
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Diagnostic Criteria ◽  
University Hospital ◽  
Thyroid Neoplasm ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
King Abdulaziz University ◽  
Nuclear Features

Pathological diagnosis of follicular variant of papillary thyroid carcinoma has high inter and intra-observer variability among expert pathologists, aff ecting prognosis and management of the disease. A recent study applying strict diagnostic criteria and long-term follow up confi rmed the indolent behavior of a subtype of these tumors. They recommended a nomenclature change to noninvasive follicular thyroid neoplasm with papillary-like nuclear features, refl ecting the low risk of adverse outcomes. We searched the pathology archives of King Abdulaziz University Hospital from 2002-2016 for all cases diagnosed with “follicular variant of papillary thyroid carcinoma”. Clinical data, and imaging fi ndings were retrospectively reviewed. Available pathologyslides were reviewed using the proposed inclusion and exclusion diagnostic criteria. We confi rmed the diagnostic reproducibility of the suggested criteria. Ten out of 37 cases met the diagnostic criteria. Eightadditional patients could have had their diagnosis modifi ed if sufficient tissue samples were available. Follow up data confi rmed the indolent behavior in these cases with no recurrence or adverse outcome. We concluded that application of the new diagnostic criteria for this subtype is reasonable and has major ramifi cations for the diagnosis and management as this will spare unnecessary thyroidectomies, radioactive iodine therapy, and their complications.

Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features in Children: An Institutional Experience and Literature Review

2019 ◽  
Vol 23 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Huiying Wang ◽  
Hernan Correa ◽  
Melinda Sanders ◽  
Wallace W Neblett ◽  
Jiancong Liang
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Thyroid Neoplasm ◽  
Molecular Signature ◽  
Papillary Thyroid ◽  
Total N ◽  
Recent Recommendation ◽  
Institutional Experience ◽  
Nuclear Features

Background Papillary thyroid carcinoma (PTC) in children has a distinctive set of clinicopathologic features and molecular signature compared to their adult counterparts. The recent recommendation to reclassify encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) without invasion as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is based on evidence derived almost exclusively from studies in adults. Clinicopathologic studies restricted to pediatric NIFTP are limited. Methods We retrospectively analyzed all pediatric PTC and NIFTP diagnosed and treated in our institution from 1999 to 2016 (n = 31). Results Using recently published consensus diagnostic criteria, we identified 3 NIFTP and 2 infiltrative follicular variants of papillary thyroid carcinoma (FVPTC) among 31 cases. Two of the NIFTP cases were initially diagnosed as EFVPTC. All 3 patients with NIFTP had unifocal tumors of lower American Joint Committee on Cancer (AJCC) classification (T2 or lower) and were free of lymph node or distant metastasis. Total (n = 1) or completion (n = 2) thyroidectomy was performed in all cases, and only 1 NIFTP patient received subsequent radioablative therapy. No residual or recurrent disease has been observed during follow-up (15–138 months) in patients with NIFTP. Conclusions Our experience with NIFTP in children is similar to outcomes reported in adult studies, suggesting that pediatric NIFTP behave indolently as evidenced by the absence of local recurrence in our cohort.

Sign in / Sign up

Export Citation Format

Share Document