Prevention of total thyroidectomy in noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) based on combined interpretation of ultrasonographic and cytopathologic results

Summary

Objective

To explore the potential preoperative ultrasonography (US) and cytopathological features to avoid total thyroidectomy in NIFTP

Context

Recently, it has been proposed that that non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) be classified as tumors, rather than cancer.

Patients

A total of 142 surgically proven follicular variant papillary thyroid carcinomas (FVPTCs; 45 NIFTP, 97 non-NIFTP; mean size: 20.4±11.0 mm, range: 10.0–65.0 mm) from 142 patients were included in this study.

Measurements

Three preoperative features of thyroid nodules (each US finding, US and Bethesda category) were compared in NIFTP and non-NIFTP groups. The preoperative decision making process to avoid total thyroidectomy in NIFTP was evaluated based on combination of those features.

Results

In each US finding, there was only significantly less macrocalcification in the NIFTP group than in the non-NIFTP group (8.8% [4/45] vs 32.0% [31/97], P=0.006). In US category, all of the NIFTP nodules were a low or intermediate suspicion (100% [45/45]). In Bethesda category, 26.7% [12/45] of the NIFTP was diagnosed as either suspicious malignancy or malignant, which increased the risk of a total thyroidectomy. In our study, a total thyroidectomy might be avoided in all of the NIFTP cases if lobectomy was selected for the nodules classified as a low or intermediate suspicion in US, despite being classified as a suspicious malignancy or malignant by cytopathology.

Conclusions

Combining the US and cytopathological results could sensitively reduce total thyroidectomy in cases of NIFTP.

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