Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran.
Division of Cytopathology, Department of Pathology, The Johns-Hopkins Hospital, Baltimore, USA.
Endocrine. 2019 Jun;64(3):433-440. doi: 10.1007/s12020-019-01887-z. Epub 2019 Mar 13.
The nomenclature "Non-invasive Follicular Neoplasm with Papillary-like Nuclear Features (NIFTP)" was introduced in 2016. While NIFTP differs from classic papillary thyroid carcinoma (PTC) in imaging, cytomorphology, histology, molecular profile, treatment, follow up, outcome, and behavior, it largely overlaps with follicular variant of PTC at imaging and cytomorphology. Herein, we review the literature for better understanding NIFTP, and its impact on patient care.
The English literature was thoroughly evaluated with the key word of "Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP)".
NIFTP presents as a thyroid nodule. On imaging, it is a round-to-oval, well circumscribed mass with solid internal content. Aspirated material shows a microfollicular pattern with focal nuclear features of PTC mostly reported in categories 3-5 of the Bethesda System for Reporting Thyroid Cytology (TBRSTC). NIFTP has decreased risk of malignancy in TBRSTC categories 3-6. Histologic examination of NIFTP reveals an encapsulated neoplasm with follicular pattern and nuclear features of PTC with no capsular or vascular invasion. No papillary structure, atypia, or mitosis is present. In contrast to PTC, only 4% of NIFTP cases harbor a BRAF mutation. Because NIFTP carries an excellent prognosis and indolent behavior, the tumor behavior was changed from malignant to a neoplasm with tumor with extremely indolent behavior. The recommended treatment is lobectomy with no further ablation therapy. Until better understanding of NIFTP, patient's follow up should be occasionally performed by neck ultrasonography and serum thyroglobulin measurement.
NIFTP carries an excellent prognosis. It is critical for both clinicians and patients to be aware of extremely indolent behavior of NIFTP in order to prevent unnecessary, aggressive treatment.
“非浸润性滤泡型肿瘤伴甲状腺滤泡细胞乳头状核特征（NIFTP）”这一命名于 2016 年提出。NIFTP 在影像学、细胞学形态、组织学、分子特征、治疗、随访、结局和行为方面与经典的甲状腺乳头状癌（PTC）不同，但在影像学和细胞学形态上与 PTC 的滤泡型变体有很大的重叠。在此，我们回顾了文献，以更好地了解 NIFTP 及其对患者护理的影响。
我们使用关键词“Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP)”，对英文文献进行了彻底评估。
NIFTP 表现为甲状腺结节。在影像学上，它是一个边界清楚的圆形至椭圆形肿块，内部有实性内容物。抽吸物显示出微滤泡模式，伴有 PTC 的核特征，主要报告在甲状腺细胞报告术语（TBRSTC）的 3-5 类中。在 TBRSTC 的 3-6 类中，NIFTP 的恶性风险降低。NIFTP 的组织学检查显示出包膜性肿瘤，具有滤泡模式和 PTC 的核特征，没有包膜或血管侵犯。没有乳头状结构、非典型性或有丝分裂。与 PTC 不同，只有 4%的 NIFTP 病例携带 BRAF 突变。由于 NIFTP 具有极好的预后和惰性的行为，肿瘤的行为从恶性改为具有极惰性行为的肿瘤。推荐的治疗方法是甲状腺叶切除术，无需进一步的消融治疗。在更好地了解 NIFTP 之前，建议偶尔通过颈部超声和血清甲状腺球蛋白测量来对患者进行随访。
NIFTP 具有极好的预后。临床医生和患者都必须意识到 NIFTP 的极惰性行为，以避免不必要的、激进的治疗。
