Department of Medicine, University of California, Davis Medical Center, Sacramento, CA, USA.
Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA.
Ann Surg Oncol. 2017 Oct;24(11):3300-3305. doi: 10.1245/s10434-017-6038-5. Epub 2017 Aug 11.
The newly termed tumor 'noninvasive follicular thyroid neoplasm with papillary-like nuclear features' (NIFTP) acts in an indolent manner and can likely be safely managed with a thyroid lobectomy. Preoperative fine-needle aspiration (FNA) is the cornerstone of surgical planning, but the ability of FNA to distinguish NIFTP from other variants of papillary thyroid carcinoma (PTC) has not been well-evaluated.
A 9-year retrospective review of the preoperative cytology and surgical pathology of PTC patients who underwent a thyroidectomy at our tertiary referral center.
Overall, 174 patients with 177 PTCs had a preoperative FNA followed by a thyroidectomy, and met our inclusion criteria. Of the 21 patients with NIFTP, the preoperative cytology was read as malignant in three (14%), suspicious for malignancy in three (14%), follicular neoplasm in ten (48%), atypia of undetermined significance in four (19%), and benign in one (5%) nodule. When comparing patients with NIFTP with other variants of PTC, patients with NIFTP were younger (p = 0.023) and less likely to have malignant cytology (p < 0.001). On multivariable regression modeling, malignant cytology was independently associated with a decreased risk of a final diagnosis of NIFTP (odds ratio 0.064, 95% confidence interval 0.018-0.233, p < 0.001).
Patients with a final diagnosis of NIFTP are less likely to have preoperative FNA diagnosis of malignancy than those with final pathology of classical or other variants of PTC. Surgeons should take this into consideration when considering between a lobectomy and total thyroidectomy for patients with suspected PTC.
新命名的肿瘤“具有滤泡状甲状腺肿瘤特征的非浸润性滤泡性甲状腺肿瘤”（NIFTP）表现为惰性，很可能可以通过甲状腺叶切除术安全治疗。术前细针穿刺（FNA）是手术计划的基石，但 FNA 区分 NIFTP 与其他类型的甲状腺乳头状癌（PTC）的能力尚未得到很好的评估。
对在我们的三级转诊中心接受甲状腺切除术的 PTC 患者的术前细胞学和手术病理学进行了 9 年的回顾性研究。
共有 174 例 177 例 PTC 患者接受了术前 FNA 检查，然后进行了甲状腺切除术，符合我们的纳入标准。在 21 例 NIFTP 患者中，术前细胞学检查结果为恶性的有 3 例（14%），可疑恶性的有 3 例（14%），滤泡性肿瘤的有 10 例（48%），意义未明的不典型性的有 4 例（19%），良性的有 1 例（5%）。将 NIFTP 患者与其他类型的 PTC 患者进行比较，NIFTP 患者年龄较小（p=0.023），恶性细胞学检查的可能性较低（p<0.001）。在多变量回归模型中，恶性细胞学检查与最终诊断为 NIFTP 的风险降低独立相关（优势比 0.064，95%置信区间 0.018-0.233，p<0.001）。
与最终病理为经典型或其他类型 PTC 的患者相比，最终诊断为 NIFTP 的患者术前 FNA 诊断为恶性的可能性较低。当考虑对疑似 PTC 患者进行甲状腺叶切除术或全甲状腺切除术时，外科医生应考虑到这一点。
