In this population-based, retrospective cohort study, the researchers reclassified 318 of 725 follicular variant papillary thyroid cancer (FVPTC) cases as potential NIFTP (NIFTPs were previously identified as a subset of FVPTC). For correct diagnosis, NIFTP tumors must meet very stringent criteria—all related to how the tumor looks under the microscope. Your follow up plan will require discussion with your treating provider, but will likely be far less intensive than follow up for thyroid cancer. A 55-year-old male patient presented with a 19 mm thyroid nodule in the … Papillary thyroid microcarcinoma (PTMC) generally is a cancer with excellent prognosis, but the term “cancer” sounds severe and harsh, which can elicit emotional and physical responses from patients. Because a study showed that patients with NIFTP had an excellent prognosis … Only 1/39 (2.6%) MALIGNANT cases favored to be classical PTC proved to be NIFTP. “The entire industry depends on studies performed before this new entity of NIFTP was established, and has been justifying the [high] cost of these tests on the fact that they can distinguish benign from malignant tumors. NIFTP can be distinguished from classical PTC Cytologist Favored: Surgical Pathology #/total % Classical PTC Classical PTC 38/40 95% FVPTC/NIFTP Follicular-patterned tumor 8/9 89% Overall Agreement 46/49 94% Excluding 7 indeterminate cases (12% of cohort). What is NIFTP? The tumor, sometimes referred to as a nodule or lesion, has been renamed NIFTP, for Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Non-invasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP) is a new name for a very low risk thyroid tumor previously known as an Encapsulated Non-invasive Follicular Variant Papillary Thyroid Carcinoma. Although the cells in a NIFTP have features that look like papillary thyroid cancer, this finding alone does not mean NIFTPs are malignant. Despite its recent re-classification as non-cancer, NIFTP is still considered to be of low but uncertain biological potential and remains a surgical target, as do follicular adenomas. areas of dead tumor cells that can be related to outgrowing its blood supply) or increased mitotic rate (i.e. The new proposed terminology, NIFTP, reflects key histopathologic features of this lesion, ie, lack of invasion, follicular growth pattern, and nuclear features of PTC. Molecular identification and classification have been instrumental in aiding clinical management decisions and targeted therapy selections in recent years. Umbricht cautions that the study methodology may have overestimated the incidence of NIFTP, as well as its recurrence rate. This case was accepted as a valid critical illness claim as this cancer was showing signs of invasion with involvement of the tumor capsule. All rights reserved. No histological sections were reanalyzed, and the review was limited to the old archival pathology reports that were written long before NIFTP was defined as a distinct diagnostic entity, he said. So, a borderline tumor - NIFTP defined "it's not cancer yet" - correctly diagnosed, it will certainly have a benign evolution. Why create a new name? Abstract: Since its first official definition in 2016, the new histo-pathological entity of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) has attracted much interest among “thyroidologists” worldwide. “What was concerning in this study is that 10% of the NIFTPs had recurrence, which contradicts the notion that the NIFTPs are benign,” Christopher Umbricht, MD, PhD, associate professor of oncology at Johns Hopkins Sidney Kimmel Cancer Center. “This is probably the first of many papers that will be used to reassess the value and impact of molecular testing of thyroid tumors,” said Umbricht. Alternative: Since NIFTP is still a relatively new diagnosis, many experts continue to suggest that patients with NIFTP have at least a yearly follow up with an endocrinologist or surgeon for a neck examination. Sometimes, very aggressive PTMC cases might be observed. nuclear features (NIFTP)is arecently recognizedindolent neo-plasm separated from invasive follicular variant of papillary thyroid carcinoma (FVPTC). Disease failure occurred in 79 FVPTC patients (19.4%) and 30 NIFTP patients (9.4%) (P < .01). NIFTP encompasses tumors that have a well-defined complete capsule with smooth muscle-walled vessels, those that are partly encapsulated, and those that … Report NIFTP and assign ICD-O-3 morphology code 8343/2. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features is an indolent thyroid NIFTP is completely cured by surgical removal, and no further treatment following surgery is necessary. Of note, the results of this study defy earlier research in 2016, the results of which originally supported changing the nomenclature of a subset of FVPTC to NIFTP. Noninvasive follicular thyroid neoplasm with papillary-like features (NIFTPs), which are considered benign lesions according to the current American Thyroid Association guidelines, account for about 16.8% of well-differentiated thyroid 3. The traditional management of PTC includes total thyroidectomy, central neck dissection as well … NIFTP is the new nomenclature for non-invasive encapsulated FVPTC, which is no longer considered malignant because of its distinctively benign clinical course. To eliminate the word “cancer,” the term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced. The tumor may not show evidence of invasion. The investigators used a conservative decision rule to subtype select FVPTCs into NIFTPs following pathology report review. These previous researchers found that NIFTP was benign in a cohort of 109 patients, with no recurrence. The incidence of NIFTP in our cohort was 2.1% of papillary thyroid cancer cases during the studied time period. The tumor CAN NOT have any necrosis (i.e. Notably, subsequent studies have found that the recurrence rate of NIFTP was higher than zero and advised against de-escalation of treatment and loss of follow-up. The change to NIFTP means that this… On FNA cytology it is not possible to make a definitive diagnosis of NIFTP, but NIFTP should be considered in any specimen with a predominantly microfollicular pattern and subtle nuclear features of PTC. With respect to the ever-rising incidence of clinically detected thyroid nodules, The Cancer Genome Atlas (TCGA) has characterized the genetic alterations of approximately 90% of papillary thyroid carcinomas (PTCs), thus filling in several gaps in the identification of driver mutations in thyroid cancer.1 Until the early 2000s, genetic alterations in thyroid … NIFTP is a noninvasive, partially to completely encapsulated thyroid follicular neoplasm arranged in almost exclusively follicular architecture, showing papillary carcinoma-like nuclear features in an adequately sampled tumor. Some authors suggest that one of the risk factors for poor … These tumors were therefore renamed Non-invasive follicular thyroid neoplasm with papillary-like nuclear features—NIFTP. The median follow-up time was 15.3 years for the entire cohort and 15.9 years for those alive at the last follow-up visit. NIFTP-Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features Brochure PDF, For information on thyroid patient support organizations, please visit the Patient Support Links section on the ATA website at www.thyroid.org, Thyroid Journal Program  Thyroid®, Clinical Thyroidology®, and VideoEndocrinology™ Latest Impact Factor: 5.309 Special Collection: Virtual Review…, Christian Nasar. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) C739 is no longer reportable for cases diagnosed 1/1/2021 forward. Experts agree that following a diagnosis of NIFTP, additional surgery and radioactive iodine are not necessary and these treatments would only expose the person to greater side effects and risks without providing benefits. After conducting an international, retrospective study of EFVPTC patients, a panel of endocrinologists 1) reclassified EFVPTC to a non-malignant condition: non-invasive follicular thyroid neoplasms with papillary-like nuclear features or NIFTP; and 2) developed consensus-based, histopathologic diagnostic criteria to appropriately distinguish NIFTP from malignant thyroid cancer. it avoids the label of ‘cancer’ for a very low-risk tumour.2 NIFTP tumours are follicular- derived tumours with a very low risk of malignancy that may harbour RAS gene mutations, PAX8/PPARG translocations and THADA fusions. Therefore, if NIFTP is categorized in cancer registries as a nonmalignant diagnosis, this may have a significant impact on the incidence of thyroid cancers. Michael Tuttle, MD, of Memorial Sloan Kettering Cancer Center in New York, who was a member of both the international panel that called for reclassification of NIFTP and the ATA’s guidelines panel, agrees that what’s “new” here is the name, not the approach to treatment of this tumor. However, the NIFTP diagnosis can only be made following surgical removal of the thyroid tumor and careful inspection of the tumor by a surgical pathologist to confirm the diagnostic criteria are met. Fig. Patients diagnosed with NIFTP tumors should continue to have at least yearly follow up that includes a neck examination with their endocrinologist or surgeon. © 2021 MJH Life Sciences and Cancer Network. … This means the tumor cannot penetrate into its capsule, the blood vessel or the lymphatic channels within the tumor or thyroid. Until 2016 this tumour was called non-invasive encapsulated follicular variant papillary thyroid carcinoma and was considered a type of thyroid cancer. All rights reserved. NIFTP is short for ‘non-invasive follicular thyroid neoplasm with papillary-like nuclear features’. A slide review was not performed. This is now all up in the air until the impact of NIFPT reclassification is assessed.”, Improved Overall Survival Observed With Lenvatinib for Patients With Thyroid Cancer and Lung Metastases, Study Identifies Effectiveness of RNA, DNA-RNA Tests for Diagnosis of Indeterminate Thyroid Nodules, FDA Approves Pralsetinib to Treat RET-Altered Thyroid Cancers, Biochemical Recurrence in Prostate Cancer, Insights Into Treatment Challenges in HER2+ Breast Cancer, NCCN Guidelines Update for HR+ Breast Cancer. This diagnosis can only be made after the entire tumour has been removed and sent to a pathologist for examination. The histological details on which this distinction is made today may or may not have been mentioned in the reports, leaving it to the study team to interpret them as best they could. An article about the impact of NIFTP (noninvasive follicular thyroid neoplasm with papillary-like nuclear features) appeared in the New York Times on April 14th. Treatment was provided as for invasive thyroid cancer. If left untreated, NIFTP is considered to have the potential to eventually develop invasive features and metastasize. Thyroid neoplasm with Papillary-like nuclear features“ (NIFTP) Importantly, this tumor can progress to cancer and therefore should be removed by limited surgery, but no more extensive surgery or any other subsequent treatment is required. “That means that it might be a bit dangerous to write off NIFTPs as benign or premalignant tumors, which you can ignore or [else] opt for limited surgery.”. This tumor’s prior name (follicular variant papillary thyroid cancer) contained the word cancer, leading to anxiety and mental anguish because of a “cancer” diagnosis, and frequent over-treatment with unnecessarily extensive surgery and radioactive iodine therapy. The overall decreased positive predictive value in cytologically indeterminate thyroid nodules may encourage clinicians and patients to choose thyroid lobectomy over total thyroidectomy and to avoid … • ThyroSeq can predict this tumor by detecting mutations characteristic of NIFTP. “It’s quite possible that some of the cases that were called NIFTP would be classified as FVPTC on review of the histological tissue sections, and if so, they presumably would be the ‘NIFTP cases’ most likely to recur,” Umbricht noted. © 2021 MJH Life Sciences™ and Cancer Network. “cancer” sounds severe and harsh, which can elicit emotional and physical responses from patients. Written by Gina Kolata, it informs readers of a change in nomenclature for a type of thyroid cancer known as noninvasive encapsulated follicular variant. The tumor must have no or minimal (<1%) papillary appearance, and CAN NOT have the appearance of other thyroid cancer variants (some examples include insular, oncocytic, tall cell, columnar cell, diffuse sclerosing). All patients who received definitive surgery for WDTC in Ontario between 1990 and 2001 who were followed until 2014 were included in the study. Non-invasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP) is a new name for a very low risk thyroid tumor previously known as an Encapsulated Non-invasive Follicular Variant Papillary Thyroid Carcinoma. NIFTP is the proposed terminology for neoplasms previously classified as noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC), which account for 10 to 20 percent of all diagnoses of PTC. Because NIFTP tumors are not invasive and are contained within the tumor capsule, they are considered to have an extremely low risk of adverse outcomes like tumor recurrence or spread (metastasis). Mean follow-up was 5.7 years (range 0-11). In 2016, the encapsulated follicular variant of papillary thyroid cancer with no evidence of spread into the thyroid capsule or into the blood vessels seen under the microscope was renamed as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and was suggested that it was a non-cancer diagnosis. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should. Since NIFTP is not 'malignant', tumor staging is not necessary and patients are not submitted to thyroid cancer protocols or guidelines. MD Cleveland Clinic Foundation, Cleveland, OH September 21, 2020   Thyroid nodules are…, October 2, 2018—The American Thyroid Association (ATA) will hold its 88th Annual Meeting on October…, Change In Thyroid Nodule Volume Calculator, Find an Endocrinology – Thyroid Specialist, Complementary and Alternative Medicine in Thyroid Disease, Novel Coronavirus (COVID-19) and the Thyroid, Toxic Nodule and Toxic Multinodular Goiter, FNA Biopsy of Thyroid Nodules in Children & Adolescents, Hyperthyroidism in Children and Adolescents, Hypothyroidism in Children and Adolescents, Thyroid Nodules in Children and Adolescents, Clinical Thyroidology for the Public (CTFP). Noninvasive follicular thyroid neoplasm with papillary-like features (NIFTPs), which are considered benign lesions according to the current American Thyroid Association guidelines, account for about 16.8% of well-differentiated thyroid cancers (WDTCs) in Ontario, Canada, according to a recent study published in the Annals of Surgical Oncology. A thyroid lobectomy should … faster speed of growth). Key among these are the following requirements: The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. However, not all PTMCs can be classified as NIFTP. Case 2: Partially encapsulated FVPTC . The implication of NIFTP not being classified as a malignant entity is important as it spares patients the burden of a cancer diagnosis. NIFTP is therefore best thought of as a tumor in the very earliest stages of transition from a benign nodule to a true cancer. To decrease overtreatment and better reflect the extremely low risk associated with this tumor, an international panel of experts recommended that the name should be changed to remove the word “cancer”. Extensive literature has shown that NIFTP tumors are easily cured by conservative surgical removal, and do not require the aggressive treatments that are appropriate for other thyroid cancers.