[Skip to Navigation]
Views 549
Citations 0
Original Investigation
November 24, 2021

Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
  • 2Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
  • 3Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  • 4Department of Otolaryngology–Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
  • 5Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  • 6Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 7Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
  • 8Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
  • 9Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  • 10Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 11Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  • 12Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India
  • 13Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
  • 14Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
  • 15Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
  • 16Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
  • 17The Permanente Medical Group, Santa Rosa, California
  • 18Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
  • 19Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
  • 20Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
  • 21Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington
  • 22Department of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
  • 23Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, New York, New York
  • 24Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 25Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
  • 26Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 27Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
  • 28The Thyroid, Head, and Neck Cancer Foundation, New York, New York
  • 29Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
  • 30Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
  • 31VA Outcomes Group, White River Junction, Vermont
  • 32Section of Otolaryngology–Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
JAMA Otolaryngol Head Neck Surg. Published online November 24, 2021. doi:10.1001/jamaoto.2021.3277
Key Points

Question  What has been the result of 2 recent efforts to prevent overtreatment of papillary thyroid carcinomas (PTCs): the new diagnostic category, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and the change in guideline support for hemithyroidectomy for selected PTCs up to 4 cm in size?

Findings  In this cohort study of 3368 pathology records from 18 hospitals in 6 countries during 2015 and 2019, 4.8% of papillary thyroid neoplasms were diagnosed as NIFTP in 2019. The proportion of eligible PTCs treated with hemithyroidectomy increased between 2015 and 2019.

Meaning  Overtreatment prevention strategies have had mixed success: NIFTP diagnosis has only been applied to a small proportion of cancers, but more patients received hemithyroidectomy when eligible.

Abstract

Importance  Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment.

Objective  To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size.

Design, Setting, and Participants  This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed.

Main Outcomes and Measures  Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period.

Results  Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, −16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, −1.2% to 35.2%]).

Conclusions and Relevance  Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×