Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors | Endocrinology | JAMA Oncology | JAMA Network
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    1 Comment for this article
    Progression of unresected noninvasive to invasive EFVPT and Interpretation of Fine Needle Aspiration Cytology
    KyoungWoo Kim | Inje University Seoul Paik Hospital
    As reported earlier, South Korea has an explosive growth rate in diagnosis of thyroid cancer in 2014. This article is very timely and welcomed.
    I just wonder 2 things as a clinician.
    First, we do fine needle aspiration (FNA) for thyroid nodules already found by thyroid sonography. Can FNA of thyroid be reported as non-invasive EFVPT and be reliable that we can just wait and see?
    Second, can unresected noninvasive EFVPT be progressed to invasive EFVPT?
    I hope FNA diagnosis of NEFVPT be accurate enough and the possibility to progress of unresected NEFVPT be ignorable that we can avoid
    Original Investigation
    August 2016

    Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A Paradigm Shift to Reduce Overtreatment of Indolent Tumors

    Author Affiliations
    • 1Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 2Anatomic Pathology, Department of Medicine (DIMES), University of Bologna School of Medicine, Bologna, Italy
    • 3Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia
    • 4Department of Surgical, Medical and Molecular Pathology, University of Pisa, Pisa, Italy
    • 5Southern California Permanente Medical Group, Woodland Hills
    • 6Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
    • 7Department of Pathology, Mount Sinai Health System, New York, New York
    • 8Department of Medical Biology and Pathology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
    • 9Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Japan
    • 10Department of Pathology, University of Michigan, Ann Arbor
    • 11Comprehensive Cancer Center, University of Michigan, Ann Arbor
    • 12Department of Pathology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
    • 13Department of Pathology, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
    • 14Department of Pathology, University of California San Francisco
    • 15Department of Pathology, University Health Network, Toronto, Ontario, Canada
    • 16Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston
    • 17Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
    • 18Division of Endocrinology and Metabolism, New York University School of Medicine, New York
    • 19University of Wisconsin School of Medicine and Public Health, Madison
    • 20Department of Psychiatry, Massachusetts General Hospital, Boston
    • 21Department of Pathology, Massachusetts General Hospital, Boston
    • 22Department of Pathology Harvard Medical School, Boston, Massachusetts
    • 23Department of Oncology, University of Turin, Torino, Italy
    • 24University of Portsmouth, Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, United Kingdom
    • 25Department of Pathology and Laboratory Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts
    • 26Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York
    • 27Thyroid Cancer Survivors Association Inc, Raleigh, North Carolina
    • 28General and Thyroid and Parathyroid Endocrine Surgery Division, Massachusetts Eye and Ear Infirmary, Boston
    • 29Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
    JAMA Oncol. 2016;2(8):1023-1029. doi:10.1001/jamaoncol.2016.0386

    Importance  Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are treated as having conventional thyroid cancer.

    Objective  To evaluate clinical outcomes, refine diagnostic criteria, and develop a nomenclature that appropriately reflects the biological and clinical characteristics of EFVPTC.

    Design, Setting, and Participants  International, multidisciplinary, retrospective study of patients with thyroid nodules diagnosed as EFVPTC, including 109 patients with noninvasive EFVPTC observed for 10 to 26 years and 101 patients with invasive EFVPTC observed for 1 to 18 years. Review of digitized histologic slides collected at 13 sites in 5 countries by 24 thyroid pathologists from 7 countries. A series of teleconferences and a face-to-face conference were used to establish consensus diagnostic criteria and develop new nomenclature.

    Main Outcomes and Measures  Frequency of adverse outcomes, including death from disease, distant or locoregional metastases, and structural or biochemical recurrence, in patients with noninvasive and invasive EFVPTC diagnosed on the basis of a set of reproducible histopathologic criteria.

    Results  Consensus diagnostic criteria for EFVPTC were developed by 24 thyroid pathologists. All of the 109 patients with noninvasive EFVPTC (67 treated with only lobectomy, none received radioactive iodine ablation) were alive with no evidence of disease at final follow-up (median [range], 13 [10-26] years). An adverse event was seen in 12 of 101 (12%) of the cases of invasive EFVPTC, including 5 patients developing distant metastases, 2 of whom died of disease. Based on the outcome information for noninvasive EFVPTC, the name “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP) was adopted. A simplified diagnostic nuclear scoring scheme was developed and validated, yielding a sensitivity of 98.6% (95% CI, 96.3%-99.4%), specificity of 90.1% (95% CI, 86.0%-93.1%), and overall classification accuracy of 94.3% (95% CI, 92.1%-96.0%) for NIFTP.

    Conclusions and Relevance  Thyroid tumors currently diagnosed as noninvasive EFVPTC have a very low risk of adverse outcome and should be termed NIFTP. This reclassification will affect a large population of patients worldwide and result in a significant reduction in psychological and clinical consequences associated with the diagnosis of cancer.