Abstract
Context
Tumour capsule integrity is becoming a relevant issue to predict the biological behaviour of human tumours, including thyroid cancer.
Aim
To verify if a whole tumour capsule in the classical variant of PTC (CVPTC) could have a predictive role of a good outcome as for follicular variant (FVPTC).
Methods
FVPTC (n=600) and CVPTC (n=554) cases, were analysed. We distinguished encapsulated-FVPTC (E-FVPTC) and encapsulated-CVPTC (E-CVPTC) and, thereafter, invasive (Ei-FVPTC and Ei-CVPTC) and non-invasive (En-FVPTC and En-CVPTC) tumours, according to the invasion or integrity of tumour capsule, respectively. Cases without tumour capsule were indicated as invasive-FVPTC (I-FVPTC) and invasive-CVPTC (I-CVPTC). Sub-group of each variant was evaluated for BRAF mutations.
Results
E-FVPTC was more frequent than E-CVPTC (p<0.0001). No differences were found between En-FVPTC and En-CVPTC or between Ei-FVPTC and Ei-CVPTC. After 18 years of follow-up, a greater number of not-cured cases were observed in Ei-CVPTC with respect to Ei-FVPTC, but not in En-CVPTC to En-FVPTC. Multivariate clustering analysis showed that En-FVPTC, En-CVPTC, and Ei-FVPTC have similar features but different from I-FVPTC and I-CVPTC and, to a lesser extent, from Ei-CVPTC. 177/614 (28.8%) cases were BRAF V600E-mutated and 10/614(1.6%) carried BRAF-rare alterations. Significantly higher rate of En-CVPTC (22/49,44.9%) than En-FVPTC (15/195,7.7%) (p<0.0001) were BRAF V600E-mutated.
Conclusions
En-CVPTC is less prevalent than En-FVPTC. However, they have a good clinical/ pathological behavior comparable to En-FVPTC. This finding confirms the good prognostic role of a whole tumour capsule also in CVPTC. New nomenclature for En-CVPTC, similar to that introduced for En-FVPTC (i.e, NIFTP) could be envisaged.