Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma

TLDR

Encapsulated follicular variant of papillary thyroid carcinoma is increasingly recognized as highly indolent, yet patients are still treated as conventional thyroid cancer. The study aimed to evaluate clinical outcomes, refine diagnostic criteria, and develop a nomenclature reflecting EFVPTC’s biology and clinical behavior. The authors conducted a multinational retrospective cohort of 210 EFVPTC patients, reviewed digitized histologic slides by 24 pathologists, and used teleconferences and a face‑to‑face meeting to reach consensus diagnostic criteria and create new nomenclature. Noninvasive EFVPTC patients had no disease recurrence over a median 13‑year follow‑up, whereas invasive cases had a 12% adverse event rate, leading the authors to rename noninvasive EFVPTC as NIFTP and validate a highly accurate nuclear scoring system, thereby potentially reducing the clinical impact of a cancer diagnosis worldwide.

Abstract

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