Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are treated as having conventional thyroid cancer

Al Ghuzlan, Abir

Alves, Venancio A.

Asa, Sylvia L.

Baloch, Zubair W.

Barletta, Justine A.

Basolo, Fulvio

El-Naggar, Adel K.

Ghossein, Ronald A.

Giordano, Thomas J.

Gooding, William E.

Hodak, Steven P.

Kakudo, Kennichi

Khanafshar, Elham

LiVolsi, Virginia A.

Lloyd, Ricardo V.

Maytal, Guy

Mete, Ozgur

Nikiforov, Yuri E.

Nikiforova, Marina N.

Nosé, Vania

Papotti, Mauro

Poller, David

Randolph, Gregory W.

Sadow, Peter M.

Seethala, Raja R.

Tallini, Giovanni

Thompson, Lester D. R.

Tischler, Arthur S.

Tuttle, Michael

Wall, Kathryn B.

Wenig, Bruce M.

IMPORTANCE: Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are treated as having conventional thyroid cancer.
OBJECTIVE: To evaluate clinical outcomes, refine diagnostic criteria, and develop a nomenclature that appropriately reflects the biological and clinical characteristics of EFVPTC.
DESIGN, SETTING, AND PARTICIPANTS: International, multidisciplinary, retrospective study of patients with thyroid nodules diagnosed as EFVPTC, including 109 patients with noninvasive EFVPTC observed for 10 to 26 years and 101 patients with invasive EFVPTC observed for 1 to 18 years. Review of digitized histologic slides collected at 13 sites in 5 countries by 24 thyroid pathologists from 7 countries. A series of teleconferences and a face-to-face conference were used to establish consensus diagnostic criteria and develop new nomenclature.
MAIN OUTCOMES AND MEASURES: Frequency of adverse outcomes, including death from disease, distant or locoregional metastases, and structural or biochemical recurrence, in patients with noninvasive and invasive EFVPTC diagnosed on the basis of a set of reproducible histopathologic criteria.
RESULTS: Consensus diagnostic criteria for EFVPTC were developed by 24 thyroid pathologists. All of the 109 patients with noninvasive EFVPTC (67 treated with only lobectomy, none received radioactive iodine ablation) were alive with no evidence of disease at final follow-up (median [range], 13 [10-26] years). An adverse event was seen in 12 of 101 (12%) of the cases of invasive EFVPTC, including 5 patients developing distant metastases, 2 of whom died of disease. Based on the outcome information for noninvasive EFVPTC, the name "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) was adopted. A simplified diagnostic nuclear scoring scheme was developed and validated, yielding a sensitivity of 98.6% (95% CI, 96.3%-99.4%), specificity of 90.1% (95% CI, 86.0%-93.1%), and overall classification accuracy of 94.3% (95% CI, 92.1%-96.0%) for NIFTP.
CONCLUSIONS AND RELEVANCE: Thyroid tumors currently diagnosed as noninvasive EFVPTC have a very low risk of adverse outcome and should be termed NIFTP. This reclassification will affect a large population of patients worldwide and result in a significant reduction in psychological and clinical consequences associated with the diagnosis of cancer

Nikiforov, Yuri E

Seethala, Raja R

Baloch, Zubair W

Thompson, Lester DR

Barletta, Justine A

Wenig, Bruce M

Giordano, Thomas J

Alves, Venancio A

L., Sylvia

El-Naggar, Adel K

Gooding, William E

Hodak, Steven P

Lloyd, Ricardo V

Nikiforova, Marina N

Poller, David N

Sadow, Peter M

Tischler, Arthur S

Tuttle, R Michael

Wall, Kathryn B

LiVolsi, Virginia A

Randolph, Gregory W

Ghossein, Ronald A

eScholarship - University of California

English

Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors

Thompson, Lester D. R

Asa, Sylvia L

El Naggar, Adel K

Nosé, Vania

Tuttle, R. Michael

Livolsi, Virginia A

BASOLO, FULVIO

Archivio della Ricerca - Università di Pisa

Yuri E. Nikiforov

Raja R. Seethala

Giovanni Tallini

Zubair W. Baloch

Fulvio Basolo

Lester D. R. Thompson

Justine A. Barletta

Bruce M. Wenig

Abir Al Ghuzlan

Kennichi Kakudo

Thomas J. Giordano

Venancio A. Alves

Elham Khanafshar

Sylvia L. Asa

Adel K. El-Naggar

William E. Gooding

Steven P. Hodak

Ricardo V. Lloyd

Guy Maytal

Ozgur Mete

Marina N. Nikiforova

Vania Nosé

Mauro Papotti

David N. Poller

Peter M. Sadow

Arthur S. Tischler

R. Michael Tuttle

Kathryn B. Wall

Virginia A. LiVolsi

Gregory W. Randolph

Ronald A. Ghossein

Crossref

JAMA Oncology

Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma

Portsmouth University Research Portal (Pure)

Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma:a paradigm shift to reduce overtreatment of indolent tumors

Importance: Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are treated as having conventional thyroid cancer. 
Objective: To evaluate clinical outcomes, refine diagnostic criteria, and develop a nomenclature that appropriately reflects the biological and clinical characteristics of EFVPTC. 
Design, Setting, and Participants: International, multidisciplinary, retrospective study of patients with thyroid nodules diagnosed as EFVPTC, including 109 patients with noninvasive EFVPTC observed for 10 to 26 years and 101 patients with invasive EFVPTC observed for 1 to 18 years. Review of digitized histologic slides collected at 13 sites in 5 countries by 24 thyroid pathologists from 7 countries. A series of teleconferences and a face-to-face conference were used to establish consensus diagnostic criteria and develop new nomenclature. 

Main Outcomes and Measures: Frequency of adverse outcomes, including death from disease, distant or locoregional metastases, and structural or biochemical recurrence, in patients with noninvasive and invasive EFVPTC diagnosed on the basis of a set of reproducible histopathologic criteria. 
Results: Consensus diagnostic criteria for EFVPTC were developed by 24 thyroid pathologists. All of the 109 patients with noninvasive EFVPTC (67 treated with only lobectomy, none received radioactive iodine ablation) were alive with no evidence of disease at final follow-up (median [range], 13 [10-26] years). An adverse event was seen in 12 of 101 (12%) of the cases of invasive EFVPTC, including 5 patients developing distant metastases, 2 of whom died of disease. Based on the outcome information for noninvasive EFVPTC, the name "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) was adopted. A simplified diagnostic nuclear scoring scheme was developed and validated, yielding a sensitivity of 98.6% (95% CI, 96.3%-99.4%), specificity of  90.1% (95% CI, 86.0%-93.1%), and overall classification accuracy of 94.3% (95% CI, 92.1%-96.0%) for NIFTP. 
Conclusions and Relevance: Thyroid tumors currently diagnosed as noninvasive EFVPTC have a very low risk of adverse outcome and should be termed NIFTP. This reclassification will affect a large population of patients worldwide and result  in a significant reduction in psychological and clinical consequences associated  with the diagnosis of cancer

TALLINI, GIOVANNI

Archivio istituzionale della ricerca - Alma Mater Studiorum Università di Bologna

Papotti, Mauro Giulio

Institutional Research Information System University of Turin

https://arpi.unipi.it/bitstream/11568/795360/2/Arpi%20795360.pdf

Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma:a paradigm shift to reduce overtreatment of indolent tumors

Abstract

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eScholarship - University of California

Archivio della Ricerca - Università di Pisa

Crossref

Portsmouth University Research Portal (Pure)

Archivio della Ricerca - Università di Pisa

Archivio istituzionale della ricerca - Alma Mater Studiorum Università di Bologna

Institutional Research Information System University of Turin