Thyroid Pathology

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Histopathology of Encapsulated Follicular-Patterned Thyroid : AJSP: Reviews & Reports

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Cancer 86 1 — PubMed Google Scholar. To confirm the representativity of the series, the incidence of the different diagnostic class was compared to a standard, expected, distribution taken from the study of Bizzarro et al. Statistical analyses were performed using the open-source R software v.

A linear regression approach was used to evaluate the impact of diameters on an explanatory variable. To compare the evaluated NS on cytological and histological samples, and to compare the diagnostic classes and distribution of our data with an italian cohort population and a target distribution of an international review, the exact Fisher test was used.

For each test, the level of significance was set equal to 0. Appropriate informed consent was obtained from all subjects of the study. Of the remaining 77 cases:. Overall, 46 out of 77 cases The average age at diagnosis was 55 years range 21—81 years. The FNA diagnostic class was available in 55 out of 68 cases The average age of the patients included in our series was approximately 10 years greater than that of the Nikiforov series, whilst it is slightly lower than the average age of the general population with a thyroid nodule.

The mean time of follow-up was 42 months median 48 months, range 1—96 months. In this period no patient encountered recurrence. In 10 out of 68 cases At the histological re-examination, in 10 out of 68 cases The distribution of our 43 cases reflected the pivotal studies of Bizzarro et al. B , C Different cells populations Noninvasive follicular thyroid neoplasm with papillary-like nuclear features NIFTP showing the sprinkling; on the left, papillary thyroid carcinoma-like PTC-like features and, on the right, follicles with dark, hyperplastic-like nuclei.

By comparing the number of cases with a different NS, evaluated on cytological smears and histological sections, a statistically significant difference was found when the exact Fisher test was performed p-value 0. In , an international group of pathologists proposed that the term non-invasive EFVPTC should be replaced with NIFTP, outlining the morphological inclusion criteria necessary to make this diagnosis 2.

The new terminology has been accepted and introduced in the WHO Classification of tumours of the endocrine organs 1. A team of thyroid-committed pathologists performed the morphological revision of the histological series to obtain a final homogeneous group of 68 cases. In a previous study by Pagni et al.

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Effectively, these characteristics are related with an earlier age of diagnosis; moreover, the reference study on NIFTP started from second-level international institutions that selectively enroll neoplastic patients for the surgical treatment with higher aggressiveness or higher tumour-stage. On the other hand, our working group planned a monocentric study from a first-level general hospital that is primarily focused on benign thyroid pathology in patients with a more advanced age. The treatment of incidental thyroid tumours is still debated: some authors suggest a conservative surgical approach while Maturo et al.

Micro-NIFTPs may occur as incidental findings in thyroidectomies performed for struma or other pathological conditions.


Xu et al. Comparing cases that had preoperative FNA performed on target lesions Vs incidental NIFTPs, diameters of these two subgroups showed a statistically significant difference p-value 0. In a previous study of our group that investigated the problem of incidental diagnoses in a PTCs series, the frequency of incidentalomas accounted for Accidental diagnoses were more associated with size and a multinodular clinical presentation; both small difficult to detect and large so-called prevailing nodules were possible pitfalls These modifications could be correlated with a genetic multifocality that is developing from a hyperplastic nodule or from a FA Compared to the multifocality parameter, Thompson et al.

Schmitt recently underlined that multifocality and bilaterality are part of the spectrum of NIFTP, so active surveillance of the contralateral lobe should be considered when a conservative surgical approach is chosen 8. Data regarding the clonal relationship between different synchronous intrathyroid NIFTP foci is poor and this aspect could be studied in future genetic projects.

This would facilitate appropriate programming of surgical therapy. In fact, the comparison of our case study with that of another Italian centre that took into account a similar number of cases 43 versus 37 , and with the review of Bongiovanni et al. The introduction of a semi-quantitative parameter, such as the NS may only allow to propose a suspicious of NIFTP on cytological preparations. In our series the number of cases with NS 2—3 were lower on cytological smears, since, in histology, a NS 1 is excluded by definition p-value 0.

Brandler et al. However, the diagnosis of NIFTP can currently only occur on histological sections because of the need for a scrupulous evaluation of the tumour capsule to rule out its invasion The NIFTP era is changing the approach to thyroid histopathology; physicians should envision a NIFTP diagnosis not only for solitary nodules, having important consequences both in the ecographic triage and in the pathological examination.

Multifocality and bilaterality are part of the spectrum of NIFTPs, that can arise in a multinodular background with variable sizes from microscopic lesions to very large ones. In this sense, a close monitoring of the contralateral lobe is justified in patients that are not submitted to total thyroidectomy. Moreover, the heterogeneity of PTC-like nuclear features is a significant factor that may affect histopathology. The possible coexistence of two lesions and the so-called sprinkling phenomenon should be considered carefully.

Finally, although a NIFTP diagnosis may be incidental especially in a multinodular goiter presentation, where FNA is performed on a different target , cytopathological criteria such as the NS evaluation may help the pathologists in including NIFTP in the differential diagnosis of indeterminate cases in the preoperative setting and to more appropriately select the correct treatment. Lloyd, R. International Agency for Research on Cancer. Nikiforov, Y. JAMA Oncol 2 , — Tallini, G. J Clin Endocrinol Metab. Hung, Y. Histopathology 72 , 53—69 Seethala, R.

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a review for pathologists. Mod Pathol 31 , 39—55 Thompson, L. Ninety-four cases of encapsulated follicular variant of papillary thyroid carcinoma: A name change to Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features would help prevent overtreatment. Mod Pathol 29 , — Amendoeira, I. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features NIFTP : impact on the reclassification of thyroid nodules.

Endocr Relat Cancer 25 , R—R Canberk S. The other side of the coin: understanding noninvasive follicular tumor with papillary-like nuclear features in Unifocal and multifocal settings. LiVolsi, V. Journal of Basic and Clinical Medicine 6 , 8—13 Vanzati, A. Arch Pathol Lab Med , — Jug, R. Patholog Res Int , Brandler, T. Can noninvasive follicular thyroid neoplasm with papillary-like nuclear features be distinguished from classic papillary thyroid carcinoma and follicular adenomas by fine-needle aspiration?

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Cancer Cytopathol , — Faquin, W. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology. Strickland, K. Thyroid 25 , — Zhou, H. Cancer Cytopathol , 20—26 Bongiovanni, M. Nardi, F. Italian consensus for the classification and reporting of thyroid cytology. J Endocrinol Invest 37 , — Comparison of 5-tiered and 6-tiered diagnostic systems for the reporting of thyroid cytopathology: a multi-institutional study.

Cancer Cytopathol 2 , —25 Ali, S. Second edition. Springer Gharib, H. American association of clinical endocrinologists, american college of endocrinology, and associazione medici endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules— update. Endocr Pract 22 , — Bizzarro, T. Young investigator challenge: The morphologic analysis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on liquid-based cytology: Some insights into their identification.

Thyroid Cancer Pathology

Rossi, E. Endocr Pathol 30 2 , — Burman, K. Thyroid Nodules.