Bin Xu1, Nada Farhat2, Justine A Barletta3,4, Yin P Hung3, Dario de Biase5, Gian Piero Casadei6, Ayse Mine Onenerk7, R Michael Tuttle8, Benjamin R Roman9, Nora Katabi2, Vania Nosé4,7, Peter Sadow4,7, Giovanni Tallini10, William C Faquin4,7, Ronald Ghossein11. 1. Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 2. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 3. Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Pathology, Harvard Medical School, Boston, MA, USA. 5. Department of Pharmacy and Biotechnology (Dipartimento di Farmacia e Biotecnologie), University of Bologna, Bologna, Italy. 6. Anatomic Pathology Unit, Ospedale Maggiore, Bologna, Italy. 7. Departments of Pathology, Massachusetts General Hospital, Boston, MA, USA. 8. Departments of Medicine, and Memorial Sloan Kettering Cancer center, New York, NY, USA. 9. Department of Surgery, Memorial Sloan Kettering Cancer center, New York, NY, USA. 10. Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale), University of Bologna School of Medicine, Bologna, Italy. 11. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. ghosseir@mskcc.org.
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.
OBJECTIVE: In 2016, non-invasive, well-circumscribed and encapsulated, follicular variant of papillary thyroid carcinoma (NI-EFVPTC) 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.
Entities:
Keywords:
Follicular variant; Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP); Papillary microcarcinoma; Papillary thyroid carcinoma
Authors: Salvatore Vaccarella; Silvia Franceschi; Freddie Bray; Christopher P Wild; Martyn Plummer; Luigino Dal Maso Journal: N Engl J Med Date: 2016-08-18 Impact factor: 91.245
Authors: Bin Xu; Giovanni Tallini; Theresa Scognamiglio; Benjamin R Roman; R Michael Tuttle; Ronald A Ghossein Journal: Thyroid Date: 2017-02-24 Impact factor: 6.568
Authors: Jeffrey Liu; Bhuvanesh Singh; Giovanni Tallini; Diane L Carlson; Nora Katabi; Ashok Shaha; R Michael Tuttle; Ronald A Ghossein Journal: Cancer Date: 2006-09-15 Impact factor: 6.860
Authors: Zhaowen Zhu; Manoj Gandhi; Marina N Nikiforova; Andrew H Fischer; Yuri E Nikiforov Journal: Am J Clin Pathol Date: 2003-07 Impact factor: 2.493
Authors: Michael Rivera; R Michael Tuttle; Snehal Patel; Ashok Shaha; Jatin P Shah; Ronald A Ghossein Journal: Thyroid Date: 2009-02 Impact factor: 6.568
Authors: Hee Young Na; Ji Won Woo; Jae Hoon Moon; June Young Choi; Woo-Jin Jeong; Yeo Koon Kim; Ji-Young Choe; So Yeon Park Journal: Endocr Pathol Date: 2019-12 Impact factor: 3.943
Authors: Bin Xu; Rene Serrette; R Michael Tuttle; Bayan Alzumaili; Ian Ganly; Nora Katabi; Giovanni Tallini; Ronald Ghossein Journal: Thyroid Date: 2019-10-10 Impact factor: 6.568
Authors: Zubair W Baloch; Sylvia L Asa; Justine A Barletta; Ronald A Ghossein; C Christofer Juhlin; Chan Kwon Jung; Virginia A LiVolsi; Mauro G Papotti; Manuel Sobrinho-Simões; Giovanni Tallini; Ozgur Mete Journal: Endocr Pathol Date: 2022-03-14 Impact factor: 3.943