Division of Endocrinology and Metabolism, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada.
Division of Pathology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada.
J Otolaryngol Head Neck Surg. 2020 Jan 2;49(1):1. doi: 10.1186/s40463-019-0397-9.
An international group of experts recommended reclassifying non-invasive follicular variant of papillary thyroid cancers (FVPTC) as 'non-invasive follicular thyroid neoplasm with papillary-like nuclear features' (NIFTP) in April 2016. The purpose of this study was to establish preoperative clinical, laboratory, ultrasonographic, and cytological variables, which can differentiate NIFTP from FVPTC.
We conducted a retrospective chart review of consecutive patients from a single institution evaluated between January 2012 and December 2017. 203 adult patients underwent lobectomy or total thyroidectomy for a FVPTC during that period. Each patient's medical chart was reviewed and information on pre-operative variables was recorded. An expert pathologist reviewed all surgical specimens and reclassified a subset of FVPTC as NIFTP according to the specific criteria.
Overall, 44 patients were included in the NIFTP group and 159 in the non-NIFTP group. Mean age was 50.1 years in the NIFTP group and 50.7 in the non-NIFTP group. Most patients were female (86.4% (38/44) in the NIFTP group vs 79.8% (127/159) in the non-NIFTP group). More patients underwent lobectomy in the NIFTP group (50% (22/44) vs 16.4% (26/159) in the non-NIFTP group, p = < 0.0001). Less patients received radioactive iodine in the NIFTP group (31.8% (14/44) vs 52.2% (83/159) in the non-NIFTP group, p = 0.0177). Preoperative thyroglobulin levels were lower in NIFTP patients (Median 25.55 mcg/L +/- 67.8 vs 76.06 mcg/L +/- 119.8 in Non-NIFTP, p = 0.0104). NIFTP nodules were smaller (Mean size 22.97 mm +/- 12.3 vs 25.88 mm +/- 11.2 for non-NIFTP, p = 0.0448) and more often solid than non-NIFTP (93.2% (41/44) vs 74.8% (119/159) for non-NIFTP, p = 0.0067). 2017 ACR TIRADS nodule category of 1-4 on ultrasound had a negative predictive value and a sensitivity of 100% for NIFTP. ROC Curve Analysis demonstrated that a preoperative thyroglobulin level of 31.3 mcg/L had a sensitivity of 75% and a specificity of 62.5% to differentiate NIFTP from non-NIFTP cancers.
Lower preoperative thyroglobulin levels, smaller nodule size, solid texture and 2017 ACR TIRADS Category of 1-4 are more strongly associated with NIFTP than FVPTC and can favour less invasive surgical options such as lobectomy.
国际专家组于 2016 年 4 月建议将非侵袭性滤泡型甲状腺癌（FVPTC）重新分类为“具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤”（NIFTP）。本研究的目的是建立术前临床、实验室、超声和细胞学变量，以区分 NIFTP 与 FVPTC。
我们对 2012 年 1 月至 2017 年 12 月期间在单一机构接受治疗的连续患者进行了回顾性图表审查。在此期间，203 例成年患者因 FVPTC 接受了甲状腺叶切除术或甲状腺全切除术。每位患者的病历均进行了审查，并记录了术前变量的信息。一位专家病理学家审查了所有手术标本，并根据具体标准将部分 FVPTC 重新分类为 NIFTP。
总体而言，44 例患者被纳入 NIFTP 组，159 例患者被纳入非-NIFTP 组。NIFTP 组的平均年龄为 50.1 岁，非-NIFTP 组为 50.7 岁。大多数患者为女性（NIFTP 组 86.4%（38/44），非-NIFTP 组 79.8%（127/159））。NIFTP 组中更多的患者接受了甲状腺叶切除术（50%（22/44）vs 非-NIFTP 组的 16.4%（26/159），p < 0.0001）。NIFTP 组中接受放射性碘治疗的患者较少（31.8%（14/44）vs 非-NIFTP 组的 52.2%（83/159），p = 0.0177）。NIFTP 患者的术前甲状腺球蛋白水平较低（中位数 25.55 mcg/L +/- 67.8 与非-NIFTP 的 76.06 mcg/L +/- 119.8，p = 0.0104）。NIFTP 结节较小（NIFTP 的平均大小 22.97 mm +/- 12.3 与非-NIFTP 的 25.88 mm +/- 11.2，p = 0.0448），且更常为实性（NIFTP 组 93.2%（41/44），非-NIFTP 组 74.8%（119/159），p = 0.0067）。2017 年 ACR TIRADS 1-4 级超声结节类别对 NIFTP 具有 100%的阴性预测值和灵敏度。ROC 曲线分析表明，术前甲状腺球蛋白水平为 31.3 mcg/L 时，对 NIFTP 的灵敏度为 75%，特异性为 62.5%。
较低的术前甲状腺球蛋白水平、较小的结节大小、实性质地和 2017 年 ACR TIRADS 1-4 类与 NIFTP 的相关性强于 FVPTC，可支持采用甲状腺叶切除术等侵袭性较小的手术选择。
