Endocrine

, Volume 59, Issue 1, pp 143–150 | Cite as

Should subcentimeter non-invasive encapsulated, follicular variant of papillary thyroid carcinoma be included in the noninvasive follicular thyroid neoplasm with papillary-like nuclear features category?

  • Bin Xu
  • Nada Farhat
  • Justine A. Barletta
  • Yin P. Hung
  • Dario de Biase
  • Gian Piero Casadei
  • Ayse Mine Onenerk
  • R. Michael Tuttle
  • Benjamin R. Roman
  • Nora Katabi
  • Vania Nosé
  • Peter Sadow
  • Giovanni Tallini
  • William C. Faquin
  • Ronald Ghossein
Original Article

Abstract

Objective

In 2016, non-invasive, well-circumscribed and encapsulated, follicular variant of papillary thyroid carcinoma (NI-EFV PTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in order to reduce overtreatment of this indolent tumor. However, the study cohort did not include subcentimeter tumors, i.e., papillary thyroid microcarcinoma (mPTC) with NI-EFV morphology, and such lesions are still regarded and staged by most pathologists as microcarcinomas. It is therefore crucial to evaluate the clinical outcome of subcentimeter NI-EFVs.

Methods

A total of 52 patients with unifocal mPTC, NI-EFV from five tertiary hospitals who had at least one year clinical follow-up (FU) without post-operative RAI administration were included in the study. A control group of 57 invasive mPTC follicular variant was also included.

Results

The median tumor size was 0.44 cm (range 0.1–0.9 cm). There were no distant or lymph node metastases at diagnosis in all patients. Twenty-three patients (44%) underwent lobectomy alone, while the remaining received total thyroidectomy. No recurrence was observed in the entire cohort (n = 52) including all 38 patients with at least 2 years of FU (median FU: 6.3 years). Among 25 patients with ≥5 years of FU, none recurred with a median FU of 9.6 years (range 5.2–18.1 years). In contrast, in the control group with invasive mPTC follicular variant, there were 5 (9%) patients with nodal metastasis at presentation and 1 (2%) who displayed nodal recurrence.

Conclusion

Papillary thyroid microcarcinoma, NI-EFV, when stringently selected for, lacks metastasis at presentation and follows an extremely indolent clinical course, even when treated conservatively without RAI therapy. Provided stringent inclusion criteria are met, classification of subcentimeter mPTC, NI-EFV as NIFTP should be considered in order to avoid overtreatment of these biologically indolent lesions.

Keywords

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) Follicular variant Papillary thyroid carcinoma Papillary microcarcinoma 

Notes

Acknowledgements

Research reported in this publication was supported in part by an Italian Government-Ministero della Salute Grant No. RF-2011-02350857 to G.T.

Funding

Research reported in this publication was supported in part by the Cancer Center Support Grant of the National Institutes of Health/National Cancer Institute under award number P30CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Bin Xu
    • 1
  • Nada Farhat
    • 2
  • Justine A. Barletta
    • 3
    • 4
  • Yin P. Hung
    • 3
  • Dario de Biase
    • 5
  • Gian Piero Casadei
    • 6
  • Ayse Mine Onenerk
    • 7
  • R. Michael Tuttle
    • 8
  • Benjamin R. Roman
    • 9
  • Nora Katabi
    • 2
  • Vania Nosé
    • 4
    • 7
  • Peter Sadow
    • 4
    • 7
  • Giovanni Tallini
    • 10
  • William C. Faquin
    • 4
    • 7
  • Ronald Ghossein
    • 2
  1. 1.Sunnybrook Health Sciences CentreTorontoCanada
  2. 2.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of PathologyBrigham and Women’s HospitalBostonUSA
  4. 4.Department of PathologyHarvard Medical SchoolBostonUSA
  5. 5.Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie)University of BolognaBolognaItaly
  6. 6.Anatomic Pathology UnitOspedale MaggioreBolognaItaly
  7. 7.Departments of PathologyMassachusetts General HospitalBostonUSA
  8. 8.Departments of Medicine, and Memorial Sloan Kettering Cancer centerNew YorkUSA
  9. 9.Department of SurgeryMemorial Sloan Kettering Cancer centerNew YorkUSA
  10. 10.Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale)University of Bologna School of MedicineBolognaItaly

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