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Non-invasive follicular thyroid neoplasm with papillary-like nuclearfeatures (NIFTP): a review and update

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Abstract

Background

The nomenclature “Non-invasive Follicular Neoplasm with Papillary-like Nuclear Features (NIFTP)” was introduced in 2016. While NIFTP differs from classic papillary thyroid carcinoma (PTC) in imaging, cytomorphology, histology, molecular profile, treatment, follow up, outcome, and behavior, it largely overlaps with follicular variant of PTC at imaging and cytomorphology. Herein, we review the literature for better understanding NIFTP, and its impact on patient care.

Methods

The English literature was thoroughly evaluated with the key word of “Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP)”.

Observations

NIFTP presents as a thyroid nodule. On imaging, it is a round-to-oval, well circumscribed mass with solid internal content. Aspirated material shows a microfollicular pattern with focal nuclear features of PTC mostly reported in categories 3–5 of the Bethesda System for Reporting Thyroid Cytology (TBRSTC). NIFTP has decreased risk of malignancy in TBRSTC categories 3–6. Histologic examination of NIFTP reveals an encapsulated neoplasm with follicular pattern and nuclear features of PTC with no capsular or vascular invasion. No papillary structure, atypia, or mitosis is present. In contrast to PTC, only 4% of NIFTP cases harbor a BRAF mutation. Because NIFTP carries an excellent prognosis and indolent behavior, the tumor behavior was changed from malignant to a neoplasm with tumor with extremely indolent behavior. The recommended treatment is lobectomy with no further ablation therapy. Until better understanding of NIFTP, patient’s follow up should be occasionally performed by neck ultrasonography and serum thyroglobulin measurement.

Conclusion

NIFTP carries an excellent prognosis. It is critical for both clinicians and patients to be aware of extremely indolent behavior of NIFTP in order to prevent unnecessary, aggressive treatment.

Highlights

  • Non-invasive follicular thyroid neoplasm with papillary like nuclear features (NIFTP) refers to a subset of encapsulated thyroid neoplasms that was recently reclassified from malignant to tumor with extremely indolent behavior.

  • The tumor behavior and molecular profile differ from papillary thyroid carcinoma and it is treated with lobectomy with a favorable outcome.

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References

  1. Y.E.S.R. Nikiforov, G. Tallini, Z.W. Baloch, F. Basolo et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol. 2, 1023–1029 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  2. G. Tallini, R.M. Tuttle, R.A. Ghossein, The history of the follicular variant of papillary thyroid carcinoma. J. Clin. Endocrinol. Metab. 102, 15–22 (2017)

    PubMed  Google Scholar 

  3. L.D. Thompson, 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, 698–707 (2016)

    Article  CAS  PubMed  Google Scholar 

  4. M.M.M. Jaconi, A.I. Pincelli, V. Giardini, M. Scardilli, A. Smith, G. Fellegara, F. Pagni, The impact of the non-invasive follicular thyroid neoplasm with papillary-like nuclear feature terminology in the routine diagnosis of thyroid tumours. Cytopathology 28, 495–502 (2017)

    Article  CAS  PubMed  Google Scholar 

  5. Z.W.S.R. Baloch, W.C. Faquin, M.G. Papotti, F. Basolo et al. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): A changing paradigm in thyroid surgical pathology and implications for thyroid cytopathology. Cancer Cytopathol. 124, 616–620 (2016)

    Article  PubMed  Google Scholar 

  6. I.M.T. Amendoeira, M. Sobrinho-Simoes, Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): impact on the reclassification of thyroid nodules. Endocr. Relat. Cancer 25, R247–R258 (2018)

    Article  CAS  PubMed  Google Scholar 

  7. D.E.J.X. Range, An update on noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Curr. Opin. Oncol. 30, 1–7 (2018)

    Article  PubMed  Google Scholar 

  8. J. Liu, B. Singh, G. Tallini et al. Follicular variant of papillary thyroid carcinoma: a clinicopathologic study of a problematic entity. Cancer 107, 1255–1264 (2006)

    Article  PubMed  Google Scholar 

  9. R.J.X. Jug Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: an evidence-based nomenclature change. Pathol. Res. Int. 2017, 1057252 (2017)

    Article  Google Scholar 

  10. R.V.A.S. Lloyd, V.A. LiVolsi, P.M. Sadow, A.S. Tischler, R.A. Ghossein, R.M. Tuttle, Y.E. Nikiforov, The evolving diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Hum. Pathol. 74, 1–4 (2018)

    Article  PubMed  Google Scholar 

  11. R.V.O.R. Lloyd, G. Kloppel, J. Rosai. WHO Classification of Tumors of Endocrine Organs. 4th edn. (International Agency for Research on Cancer, Lyon, 2017). p. 66–80

  12. M.R.S.J. Kwon, S.Y. Hahn, Y.L. Oh, J.Y. Kwak, E. Lee, Y. Lim, Histogram analysis of greyscale sonograms to differentiate between the subtypes of follicular variant of papillary thyroid cancer. Clin. Radiol. 73(591), e591–591 e597 (2018)

    Google Scholar 

  13. G.C.H.F. Yang, KO, Pathologic basis of the sonographic differences between thyroid cancer and noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Ultrasonography 37, 157–163 (2018)

    Article  CAS  PubMed  Google Scholar 

  14. S.Y.S.J. Hahn, Y.L. Oh, T.H. Kim, Y. Lim, J.S. Choi, Role of ultrasound in predicting tumor invasiveness in follicular variant of papillary thyroid carcinoma. Thyroid 27, 1177–1184 (2017)

    Article  PubMed  Google Scholar 

  15. S.A.S. Mahajan, N. Kocheri, D. Jain, S.R. Mathur, V.K. Iyer, Cytopathology of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: a comparative study with similar patterned papillary thyroid carcinoma variants. Cytopathology 29, 233–240 (2018)

    Article  CAS  PubMed  Google Scholar 

  16. J.B.C.M. Chandler, M.L. Prasad, G.G. Callender, C. Quinn, D. Chhieng, A.J. Adeniran, Identification of distinct cytomorphologic features in the diagnosis of NIFTP at the time of preoperative FNA: implications for patient management. Cancer Cytopathol. 125, 865–875 (2017)

    Article  PubMed  Google Scholar 

  17. F.M.F. Maletta, L. Torregrossa, E. Duregon, G.P. Casadei et al. Cytological features of “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” and their correlation with tumor histology. Hum. Pathol. 54, 134–142 (2016)

    Article  CAS  PubMed  Google Scholar 

  18. G.C.H.F.K. Yang, T. Scognamiglio, Sonographic and cytologic differences of NIFTP from infiltrative or invasive encapsulated follicular variant of papillary thyroid carcinoma: a Review of 179 Cases. Diagn. Cytopathol. 45, 533–541 (2017)

    Article  PubMed  Google Scholar 

  19. T.C.Z.F. Brandler, C.Z. Liu, M. Cho, R.P. Lau, A. Simsir, K.N. Patel, W. Sun, Can noninvasive follicular thyroid neoplasm with papillary-like nuclear features be distinguished from classic papillary thyroid carcinoma and follicular adenomas by fine-needle aspiration? Cancer Cytopathol. 125, 378–388 (2017)

    Article  CAS  PubMed  Google Scholar 

  20. J.F.A.E. Krane, E.S. Cibas, J.A. Barletta, Coming to terms with NIFTP: a provisional approach for cytologists. Cancer Cytopathol. 124, 767–772 (2016)

    Article  PubMed  Google Scholar 

  21. B.E.C.S. Howitt, M. Eszlinger, R. Paschke, M.G. Drage, J.F. Krane, J.A. Barletta, Fine-needle aspiration diagnoses of noninvasive follicular variant of papillary thyroid carcinoma. Am. J. Clin. Pathol. 144, 850–857 (2015)

    Article  CAS  PubMed  Google Scholar 

  22. T.M.M. Bizzarro, S. Capodimonti, P. Straccia, C.P. Lombardi, A. Pontecorvi, L.M. Larocca, E.D. Rossi, 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. Cancer Cytopathol. 124, 699–710 (2016)

    Article  CAS  PubMed  Google Scholar 

  23. H.B.Z. Zhou, R. Nayar, T. Bizzarro, G. Fadda et al. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): Implications for the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Cancer Cytopathol. 126, 20–26 (2018)

    Article  CAS  PubMed  Google Scholar 

  24. W.C.W.L. Faquin, A.H. Afrogheh, S.Z. Ali, J.A. Bishop et al. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology. Cancer Cytopathol. 124, 181–187 (2016)

    Article  PubMed  Google Scholar 

  25. R.P.P.J. Lau, T.C. Brandler, C.Z. Liu, A. Simsir, F. Zhou, Impact of the Reclassification of “Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma” to “Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features” on the Bethesda System for Reporting Thyroid Cytopathology: A Large Academic Institution’s Experience. Am. J. Clin. Pathol. 149, 50–54 (2017)

    Article  PubMed  Google Scholar 

  26. A.K.S. Bychkov, S. Agarwal, D. Jain, C.K. Jung et al. Impact of non-invasive follicular thyroid neoplasm with papillary-like nuclear features on the Bethesda system for reporting thyroid cytopathology: a multi-institutional study in five Asian countries. Pathology 50, 411–417 (2018)

    Article  PubMed  Google Scholar 

  27. W.S.A. Li, M. Lew, J. Pang, X. Jing, Implementing noninvasive follicular thyroid neoplasm with papillary-like nuclear features may potentially impact the risk of malignancy for thyroid nodules categorized as AUS/FLUS and FN/SFN. Diagn. Cytopathol. 46, 148–153 (2018)

    Article  PubMed  Google Scholar 

  28. J.F.W.W. Hang, A.G. Zhou, D.S. Cooper, S.Z. Ali, The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on the rate of malignancy for atypia of undetermined significance subcategories. Cancer Cytopathol. 126, 309–316 (2018)

    Article  PubMed  Google Scholar 

  29. E.S. Cibas, S.Z. Ali, The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 27, 1341–1346 (2017)

    Article  PubMed  Google Scholar 

  30. K.P.S.A. du Jour, A.Y. Chen, C.C. Griffith, Application of Strict Criteria for Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features and Encapsulated Follicular Variant Papillary Thyroid Carcinoma: a Retrospective Study of 50 Tumors Previously Diagnosed as Follicular Variant PTC. Endocr. Pathol. 29, 35–42 (2018)

    Article  PubMed  Google Scholar 

  31. Y.P.B.J. Hung, A user’s guide to non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Histopathology 72, 53–69 (2018)

    Article  PubMed  Google Scholar 

  32. K.E.-N.A. Kakudo, S.P. Hodak, E. Khanafshar, Y.E. Nikiforov, V. Nose, L.D.R. Thompson, Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in thyroid tumor classification. Pathol. Int. 68, 327–333 (2018).

    Article  PubMed  Google Scholar 

  33. L.D.R.P.D. Thompson, K. Kakudo, R. Burchette, Y.E. Nikiforov, R.R. Seethala, An International Interobserver Variability Reporting of the Nuclear Scoring Criteria to Diagnose Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: a Validation Study. Endocr. Pathol. 29, 242–249 (2018).

    Article  PubMed  Google Scholar 

  34. D.N.N.Y. Poller, Non-invasive follicular thyroid neoplasm with papillary-like nuclei: reducing overtreatment by reclassifying an indolent variant of papillary thyroid cancer. J. Clin. Pathol. 69, 947–948 (2016).

    Article  Google Scholar 

  35. R.R.B.Z. Seethala, J.A. Barletta, E. Khanafshar, O. Mete et al. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a review for pathologists. Mod. Pathol. 31, 39–55 (2018)

    Article  CAS  PubMed  Google Scholar 

  36. G.P.M. Arnoux, “Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features” With Focal Spindle Cell Metaplasia. Int. J. Surg. Pathol. 26, 261–265 (2018)

    Article  PubMed  Google Scholar 

  37. M.R.A.A. Haroon Al Rasheed, G. Tarjan, Encapsulated follicular variant of papillary thyroid carcinoma/noninvasive follicular thyroid neoplasm with papillary-like nuclear features with Spindle Cell Metaplasia: case report and review of literature. Pathol. Res. Pract. 213, 416–421 (2017)

    Article  PubMed  Google Scholar 

  38. K.C.H.B. Strickland, J.A. Barletta, E.S. Cibas, J.F. Krane, Suggesting the cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): a retrospective analysis of atypical and suspicious nodules. Cancer Cytopathol. 126, 86–93 (2018)

    Article  CAS  PubMed  Google Scholar 

  39. Z.W.H.R. Baloch, E.M. Brett, G. Randolph, J.R. Garber, A.E.S.S. Committee, C. Thyroid Scientific, American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Commentary: Managing Thyroid Tumors Diagnosed as Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Endocr. Pract. 23, 1150–1155 (2017)

    Article  PubMed  Google Scholar 

  40. B.T.G. Xu, T. Scognamiglio, B.R. Roman, R.M. Tuttle, R.A. Ghossein, Outcome of large noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Thyroid 27, 512–517 (2017)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. M. Rivera, J. Ricarte-Filho, J. Knauf et al. Molecular genotyping of papillary thyroid carcinoma follicular variant according to its histological subtypes (encapsulated vs infiltrative) reveals distinct BRAF and RAS mutation patterns. Mod. Pathol. 23, 1191–1200 (2010)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. B.E. Howitt, Y. Jia, L.M. Sholl, J.A. Barletta, Molecular alterations in partially-encapsulated or well-circumscribed follicular variant of papillary thyroid carcinoma. Thyroid 23, 1256–1262 (2013)

    Article  CAS  PubMed  Google Scholar 

  43. L. Zhao, D. Dias-Santagata, P.M. Sadow, W.C. Faquin, Cytological, molecular, and clinical features of noninvasive follicular thyroid neoplasm with papillary-like nuclear features versus invasive forms of follicular variant of papillary thyroid carcinoma. Cancer Cytopathol. 125, 323–331 (2017)

    Article  CAS  PubMed  Google Scholar 

  44. V.A. Paulson, P. Shivdasani, T.E. Angell et al. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Accounts for More Than Half of “Carcinomas” Harboring RAS Mutations. Thyroid 27, 506–511 (2017)

    Article  CAS  PubMed  Google Scholar 

  45. D.C.N. Ng, Z.V. Ma, A. van Zante, B. Ljung, E. Khanafshar, Cytomorphologic features of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): a comparison with infiltrative follicular variant of papillary thyroid carcinoma. J. Basic Clin. Med. 6, 51–56 (2017)

    Article  CAS  Google Scholar 

  46. M. Afkhami, A. Karunamurthy, S. Chiosea et al. Histopathologic and clinical characterization of thyroid tumors carrying the BRAF(K601E) mutation. Thyroid 26, 242–247 (2016)

    Article  CAS  PubMed  Google Scholar 

  47. K.C.E.M. Strickland, R. Paschke, T.E. Angell, E.K. Alexander et al. Molecular Testing of Nodules with a Suspicious or Malignant Cytologic Diagnosis in the Setting of Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP). Endocr. Pathol. 29, 68–74 (2018)

    Article  PubMed  Google Scholar 

  48. M. Vivero, S. Kraft, J.A. Barletta, Risk stratification of follicular variant of papillary thyroid carcinoma. Thyroid 23, 273–279 (2013)

    Article  CAS  PubMed  Google Scholar 

  49. F.M.E. Basolo, C. Ugolini, D.N. Polle, Z. Baloch, The Molecular Landscape of Noninvasive Follicular Thyroid Neoplasm With Papillary-like Nuclear Features (NIFTP): a literature review. Adv. Anat. Pathol. 24, 252–258 (2017)

    Article  CAS  PubMed  Google Scholar 

  50. N.D.M. Borrelli, C. Ugolini, A.M. Poma, M. Miccoli, P. Vitti, P. Miccoli, F. Basolo, miRNA expression profiling of ‘noninvasive follicular thyroid neoplasms with papillary-like nuclear features’ compared with adenomas and infiltrative follicular variants of papillary thyroid carcinomas. Mod. Pathol. 30, 39–51 (2017)

    Article  CAS  PubMed  Google Scholar 

  51. X.S.H.G. Jiang, M.B. Datto, Young investigator challenge: molecular testing in noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Cancer Cytopathol. 124, 893–900 (2016)

    Article  CAS  PubMed  Google Scholar 

  52. T.H.L.M. Kim, A.Y. Kwon, J.H. Choe, J.H. Kim et al. Molecular genotyping of the non-invasive encapsulated follicular variant of papillary thyroid carcinoma. Histopathology 72, 648–661 (2018)

    Article  PubMed  Google Scholar 

  53. R.C.D.M. Jug, X.S. Jiang, Molecular testing for indeterminate thyroid nodules: performance of the Afirma gene expression classifier and ThyroSeq panel. Cancer Cytopathol. 126, 471–480 (2018).

    Article  CAS  PubMed  Google Scholar 

  54. Z.T.S.P. Sahli, C.B. Umbricht, M.A. Zeiger, Preoperative molecular markers in thyroid nodules. Front Endocrinol. 9, 179 (2018)

    Article  Google Scholar 

  55. G.V.M. Acquaviva, A. Repaci, K.J. Rhoden, D. de Biase, A. Pession, T. Giovanni, Molecular pathology of thyroid tumours of follicular cells: a review of genetic alterations and their clinicopathological relevance. Histopathology 72, 6–31 (2018)

    Article  PubMed  Google Scholar 

  56. G.P.O. Fu, C. MacMillan, R. Ralhan, P.G. Walfish, Programmed Death-Ligand 1 Expression Distinguishes Invasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma from Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features. EBio Med. 18, 50–55 (2017)

    Google Scholar 

  57. B.R.A.E. Haugen, K.C. Bible, G.M. Doherty, S.J. Mandel et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26, 1–133 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  58. B.R.S.A. Haugen, E.K. Alexander, K.C. Bible, P. Caturegli et al. American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Thyroid 27, 481–483 (2017)

    Article  CAS  PubMed  Google Scholar 

  59. A.A.R.H. Ghuzlan, M. Schlumberger, Noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Curr. Opin. Endocrinol. Diabetes Obes. 24, 377–380 (2017)

    Article  PubMed  Google Scholar 

  60. P.W. Rosario, Long-Term Outcomes of Patients with Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) > / = 4 cm Treated Without Radioactive Iodine. Endocr. Pathol. 28, 367–368 (2017)

    Article  PubMed  Google Scholar 

  61. Z.J.S. Aburjania, C. Montemayor-Garcia, R.V. Lloyd, D.F. Schneider, R.S. Sippel, H. Chen, D.M. Elfenbein, Encapsulated follicular variant of papillary thyroid cancer: are these tumors really benign? J. Surg. Res. 216, 138–142 (2017)

    Article  PubMed  PubMed Central  Google Scholar 

  62. V.A.F.K.K. Alves, V. LiVolsi, R.V. Lloyd, Y.E. Nikiforov, V. Nose, M. Papotti, L.D.R. Thompson, Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP): Achieving Better Agreement By Refining Diagnostic Criteria. Clin. (Sao Paulo). 73, e576 (2018)

    Article  Google Scholar 

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  1. Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran

    Bita Geramizadeh

  2. Division of Cytopathology, Department of Pathology, The Johns-Hopkins Hospital, Baltimore, USA

    Zahra Maleki

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  1. Bita Geramizadeh
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Geramizadeh, B., Maleki, Z. Non-invasive follicular thyroid neoplasm with papillary-like nuclearfeatures (NIFTP): a review and update. Endocrine 64, 433–440 (2019). https://doi.org/10.1007/s12020-019-01887-z

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