Preoperative cytologic interpretation of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a 1-year multi-institutional experience

Ricardo R. Lastra, George Birdsong, David H. Hwang, Merce Jorda, Darcy A. Kerr, Cindy McGrath, Shelley Odronic, Rema Rao, Paul A. VanderLaan, Joe W. Walker, Tatjana Antic

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Introduction: Encapsulated follicular variant of papillary thyroid carcinoma (PTC) has an indolent behavior; hence, a change in terminology to “noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)” has been proposed. Data are scant on the fine-needle aspiration (FNA) diagnosis of nodules proven to be NIFTP upon resection. The aim was to evaluate the FNA diagnosis of nodules diagnosed as NIFTP upon resection. Materials and methods: The archives of 8 participating institutions were searched for thyroid resection specimens obtained in a 1-year period, and pertinent demographic and pathology data were recorded. Results: 2226 thyroid surgeries were performed over the indicated time period. NIFTP was diagnosed in 6.3% of cases; 118 patients (119 nodules) with NIFTP and available preoperative thyroid FNA were included. Preoperative cytologic diagnosis were: non-diagnostic: 0.8%; benign: 5.9%; atypia of undetermined significance/follicular lesion of undetermined significance: 42.9%; follicular neoplasm/suspicious for a follicular neoplasm: 31.0%; suspicious for malignancy: 15.9%; malignant: 3.4%. Molecular data was available for 49 cases, either by Afirma or ThyGenX/ThyroSeq. Of the Afirma cases, 11% were classified as “benign” 2% as “indeterminate” and 87% as “suspicious”; of the ThyGenX/ThyroSeq cases, 50% had NRAS mutations, 20% demonstrated KRAS mutations, 20% showed HRAS mutations, and 10% showed a BRAF mutation (K601E). Conclusions: NIFTP are tumors demonstrating nuclear features similar to those seen in PTC. Our series shows that a preoperative diagnosis of “suspicious for malignancy” or “malignant” is uncommon in NIFTP, suggesting that there are sufficient cytomorphologic differences between PTC and NIFTP to allow for the suspicion of NIFTP on FNA specimens.

Original languageEnglish (US)
Pages (from-to)79-85
Number of pages7
JournalJournal of the American Society of Cytopathology
Volume7
Issue number2
DOIs
StatePublished - Mar 2018

Keywords

  • FVPTC
  • Fine-needle aspiration
  • NIFTP
  • Papillary thyroid carcinoma
  • Thyroid

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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