Parente David N, Kluijfhout Wouter P, Bongers Pim J, Verzijl Raoul, Devon Karen M, Rotstein Lorne E, Goldstein David P, Asa Sylvia L, Mete Ozgur, Pasternak Jesse D
Division of General Surgery, University Health Network, Toronto General Hospital, 200 Elizabeth St. Room 10EN-214, Toronto, ON, M5G 2C4, Canada.
Department of Surgery, Womens College Hospital, Toronto, ON, Canada.
World J Surg. 2018 Feb;42(2):321-326. doi: 10.1007/s00268-017-4182-5.
Renaming encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was recently suggested to prevent the overtreatment, cost and stigma associated with this low-risk entity. The purpose of this study is to document the incidence and further assess the clinical outcomes of reclassifying EFVPTC to NIFTP.
We searched synoptic pathologic reports from a high-volume academic endocrine surgery hospital from 2004 to 2013. The standard of surgical pathology practice was based on complete submission of malignant thyroid nodules along with the nontumorous thyroid parenchyma. Rigid morphological criteria were used for the diagnosis of noninvasive EFVPTC, currently known as NIFTP. A retrospective chart review was conducted looking for evidence of malignant behavior.
One hundred and two patients met the strict inclusion criteria of NIFTP. The incidence of NIFTP in our cohort was 2.1% of papillary thyroid cancer cases during the studied time period. Mean follow-up was 5.7 years (range 0-11). Five patients were identified with nodal metastasis and one patient with distant metastasis. Overall, six patients showed evidence of malignant behavior representing 6% of patients with NIFTP.
Our study demonstrates that the incidence of NIFTP is significantly lower than previously thought. Furthermore, evidence of malignant behavior was seen in a significant number of NIFTP patients. Although the authors fully support the de-escalation of aggressive treatment for low-risk thyroid cancers, NIFTP behaves as a low-risk thyroid cancer rather than a benign entity and ongoing surveillance is warranted.
最近有人建议将甲状腺乳头状癌的包膜内滤泡型变体（EFVPTC）重新命名为具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP），以避免对这种低风险病变进行过度治疗、降低成本并减少污名化。本研究的目的是记录NIFTP的发病率，并进一步评估将EFVPTC重新分类为NIFTP的临床结果。
我们检索了一家大型学术性内分泌外科医院2004年至2013年的概要病理报告。手术病理实践标准基于完整提交恶性甲状腺结节以及非肿瘤性甲状腺实质。采用严格的形态学标准诊断非侵袭性EFVPTC，即目前所知的NIFTP。进行了一项回顾性图表审查，以寻找恶性行为的证据。
102例患者符合NIFTP的严格纳入标准。在研究期间，我们队列中NIFTP的发病率为甲状腺乳头状癌病例的2.1%。平均随访时间为5.7年（范围0 - 11年）。5例患者被确定有淋巴结转移，1例患者有远处转移。总体而言，6例患者表现出恶性行为证据，占NIFTP患者的6%。
我们的研究表明，NIFTP的发病率显著低于先前的认识。此外，相当数量的NIFTP患者出现了恶性行为证据。尽管作者完全支持对低风险甲状腺癌降低积极治疗强度，但NIFTP表现为一种低风险甲状腺癌而非良性病变，仍需持续监测。
