Abstract
In 2016, encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). In 2018 the criteria for NIFTP were widened by the inclusion of the complete lack of papillae. Secondary criteria, which include molecular examination, are helpful but not required for NIFTP diagnose.The aim of this study was to assess the molecular background of NIFTP and to answer the question if the aplication of revised criteria for NIFTP diagnosis is associated with the lack of oncogenic mutation.Repeat histopathological assessment of 1117 cases of papillary thyroid carcinoma (PTC) from 2000-2016 was conducted. Using initial (2016) and revised (2018) diagnostic criteria, NIFTP was diagnosed in 23 and 13 patients respectively. 50 tumor genes hotspots mutation analysis was conducted. BRAFV600E mutations were detected in patients who fulfilled only initial NIFTP criteria. Other high-risk mutations (TP53) were found in both groups of patients.The application of restrictive, revised diagnostic criteria for NIFTP negates the need for BRAFV600E examination, but these tumors still can harbor other high-risk oncogenic mutations nonetheless. Thus, molecular examination should be considered as a necessary step in NIFTP diagnostic process.
Highlights
Worldwide, increasing numbers of people are developing cancer, including cancer of the thyroid gland [1]
Data on the clinical and pathomorphological features of patients diagnosed with papillary thyroid carcinoma (PTC), including cancer stage according to the 8th Edition on American Joint Committee on Cancer Staging (AJCC 8th Edition), risk stratification for cancer recurrence and response to treatment according to 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer (ATA), are presented in
Despite the increasing rate of FVPTC in recent years, only 15,5% of all PTC in our study were identified as the FVPTC subtype [13]
Summary
Worldwide, increasing numbers of people are developing cancer, including cancer of the thyroid gland [1]. An increase in the diagnosis of thyroid cancer has resulted from the introduction of more precise diagnostic methods and wider access to them, and is associated with over-diagnosis [2]. Despite the increase in cases of thyroid cancer, the 10-year overall survival rate for papillary thyroid carcinoma (PTC) is approximately 97% [4]. The American Thyroid Association (ATA) accepted the suggested change and included limitation of aggressive treatments in its recommendations, relative to the treatment of thyroid neoplasms (scope of operation, lobectomy, without 131 I treatment or suppressive doses of L-T4) [8]. Periodic monitoring based on serum thyroglobulin levels and neck ultrasound should be considered for patients with NIFTP, but longterm results of this kind of approach are still the subject of ongoing research and more data for more precise recommendation regarding follow-up procedures are needed [8]
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