BACKGROUND: Histopathologic criterion for follicular variant of papillary thyroid cancer (FVPTC) has only recently been utilized universally. The purpose was to determine whether, on review, these criteria would result in a change in diagnosis of follicular neoplasm (FN). METHODS: A ten-year clinical cohort included patients with a diagnosis of a follicular adenoma, follicular carcinoma (FC), or FVPTC. The archived sections were re-examined by two pathologists blinded to the original diagnoses. Clinical follow-up, including ultrasonography, was carried out on all patients with a change in diagnosis. RESULTS: One hundred eighty-five patients met the inclusion criteria. Initially, 118 were benign, 56 were FVPTC, and 11 were FC. Overall, 46 (25%) patients had a change in diagnosis on re-review; 35 were reclassified from a benign diagnosis to a re-reviewed malignant diagnosis, with 5 reclassified as minimally invasive FC, 4 as occult PTC, and 26 (74%) as FVPTC. Of the 26 FVPTC, only 10 (38%) had undergone a total thyroidectomy (TT). The mean follow-up was 105 months (range, 24-156). None of these patients had evidence of recurrent or persistent disease. Eleven patients were reclassified to a benign diagnosis. Eight have undergone a TT, with 3 of these patients receiving I(131) ablation therapy. A third independent thyroid pathologist also reviewed the histopathologic slides of these 46 patients and concurred with the change in diagnosis in 41 of the 46 patients. CONCLUSIONS: Reclassification of FN increased malignant lesions from 36% to 48%. Although there have been no clinical ramifications in the patients with a changed diagnosis, the ethical issues surrounding these 46 patients are important and present a substantive quandary to the clinicians responsible for their care.
BACKGROUND: Histopathologic criterion for follicular variant of papillary thyroid cancer (FVPTC) has only recently been utilized universally. The purpose was to determine whether, on review, these criteria would result in a change in diagnosis of follicular neoplasm (FN). METHODS: A ten-year clinical cohort included patients with a diagnosis of a follicular adenoma, follicular carcinoma (FC), or FVPTC. The archived sections were re-examined by two pathologists blinded to the original diagnoses. Clinical follow-up, including ultrasonography, was carried out on all patients with a change in diagnosis. RESULTS: One hundred eighty-five patients met the inclusion criteria. Initially, 118 were benign, 56 were FVPTC, and 11 were FC. Overall, 46 (25%) patients had a change in diagnosis on re-review; 35 were reclassified from a benign diagnosis to a re-reviewed malignant diagnosis, with 5 reclassified as minimally invasive FC, 4 as occult PTC, and 26 (74%) as FVPTC. Of the 26 FVPTC, only 10 (38%) had undergone a total thyroidectomy (TT). The mean follow-up was 105 months (range, 24-156). None of these patients had evidence of recurrent or persistent disease. Eleven patients were reclassified to a benign diagnosis. Eight have undergone a TT, with 3 of these patients receiving I(131) ablation therapy. A third independent thyroid pathologist also reviewed the histopathologic slides of these 46 patients and concurred with the change in diagnosis in 41 of the 46 patients. CONCLUSIONS: Reclassification of FN increased malignant lesions from 36% to 48%. Although there have been no clinical ramifications in the patients with a changed diagnosis, the ethical issues surrounding these 46 patients are important and present a substantive quandary to the clinicians responsible for their care.
Authors: Yuri E Nikiforov; Raja R Seethala; Giovanni Tallini; Zubair W Baloch; Fulvio Basolo; Lester D R Thompson; Justine A Barletta; Bruce M Wenig; Abir Al Ghuzlan; Kennichi Kakudo; Thomas J Giordano; Venancio A Alves; Elham Khanafshar; Sylvia L Asa; Adel K El-Naggar; William E Gooding; Steven P Hodak; Ricardo V Lloyd; Guy Maytal; Ozgur Mete; Marina N Nikiforova; Vania Nosé; Mauro Papotti; David N Poller; Peter M Sadow; Arthur S Tischler; R Michael Tuttle; Kathryn B Wall; Virginia A LiVolsi; Gregory W Randolph; Ronald A Ghossein Journal: JAMA Oncol Date: 2016-08-01 Impact factor: 31.777
Authors: Raja R Seethala; Zubair W Baloch; Justine A Barletta; Elham Khanafshar; Ozgur Mete; Peter M Sadow; Virginia A LiVolsi; Yuri E Nikiforov; Giovanni Tallini; Lester Dr Thompson Journal: Mod Pathol Date: 2017-10-20 Impact factor: 7.842
Authors: Rajshri Mainthia; Heather Wachtel; Yufei Chen; Elizabeth Mort; Sareh Parangi; Peter M Sadow; Carrie C Lubitz Journal: Surgery Date: 2017-11-13 Impact factor: 3.982
Authors: Michaele J Armstrong; Huaitao Yang; Linwah Yip; N Paul Ohori; Kelly L McCoy; Michael T Stang; Steven P Hodak; Marina N Nikiforova; Sally E Carty; Yuri E Nikiforov Journal: Thyroid Date: 2014-07-16 Impact factor: 6.568