七年的具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP）：不同大洲的接受率及诊断方法的差异

Seven years of Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP): Rate of Acceptance and Variation of Diagnostic Approaches Across Different Continents.

作者信息

Williams Michelle D, Liu Zhiyan, Rossi Esther Diana, Agarwal Shipra, Ryška Aleš, Ghuzlan Abir Al, Bychkov Andrey, Baloch Zubair, Chernock Rebecca, Chiosea Simion L, Cipriani Nicole A, Erkilic Suna, Fridman Michael, Hang Jen-Fan, Harahap Agnes Stephanie, Jung Chan Kwon, Kakudo Kennichi, Khalil Moosa, Khanafshar Elham, Kumarasinghe Priyanthi, Lloyd Ricardo, Nguyen Truong Phan-Xuan, Ocal Idris Tolgay, Prasad Manju L, Pusztaszeri Marc, Rana Chanchal, Sadow Peter, Sajed Dipti P, Seethala Raja, Tallini Giovanni, Vuong Huy Gia, Yegen Gülçin, LiVolsi Virginia A, Nikiforov Yuri E

机构信息

Department of Anatomical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

Department of Pathology, Shanghai Sixth People's Hospital, Shanghai 201306, China.

出版信息

J Clin Endocrinol Metab. 2024 Dec 18;110(1):166-175. doi: 10.1210/clinem/dgae354.

DOI:10.1210/clinem/dgae354

PMID:38874075

Abstract

CONTEXT

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a new entity replacing the diagnosis of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC). Significant variability in the incidence of NIFTP diagnosed in different world regions has been reported.

OBJECTIVE

To investigate the rate of adoption of NIFTP, change in practice patterns, and uniformity in applying diagnostic criteria among pathologists practicing in different regions.

METHODS

Two surveys distributed to pathologists of the International Endocrine Pathology Discussion Group with multiple-choice questions on NIFTP adoption into pathology practice and whole slide images of 5 tumors to collect information on nuclear score and diagnosis. Forty-eight endocrine pathologists, including 24 from North America, 8 from Europe, and 16 from Asia/Oceania completed the first survey and 38 the second survey.

RESULTS

A 94% adoption rate of NIFTP by the pathologists was found. Yet, the frequency of rendering NIFTP diagnosis was significantly higher in North America than in other regions (P = .009). While the highest concordance was found in diagnosing lesions with mildly or well-developed PTC-like nuclei, there was significant variability in nuclear scoring and diagnosing NIFTP for tumors with moderate nuclear changes (nuclear score 2) (case 2, P < .05). Pathologists practicing in North America and Europe showed a tendency for lower thresholds for PTC-like nuclei and NIFTP than those practicing in Asia/Oceania.

CONCLUSION

Despite a high adoption rate of NIFTP across geographic regions, NIFTP is diagnosed more often by pathologists in North America. Significant differences remain in diagnosing intermediate PTC-like nuclei and respectively NIFTP, with more conservative nuclear scoring in Asia/Oceania, which may explain the geographic differences in NIFTP incidence.

摘要

背景

具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP）作为一种新的实体被引入，取代了非侵袭性包裹性滤泡状甲状腺癌（PTC）的诊断。据报道，不同世界地区诊断出的NIFTP发病率存在显著差异。

目的

调查NIFTP的采用率、实践模式的变化以及不同地区病理学家应用诊断标准的一致性。

方法

向国际内分泌病理讨论小组的病理学家分发了两份调查问卷，其中包含关于NIFTP纳入病理实践的多项选择题以及5个肿瘤的全切片图像，以收集核评分和诊断信息。48名内分泌病理学家完成了第一次调查，其中包括24名来自北美、8名来自欧洲和16名来自亚洲/大洋洲的病理学家；38名完成了第二次调查。

结果

发现病理学家对NIFTP的采用率为94%。然而，北美地区做出NIFTP诊断的频率显著高于其他地区（P = 0.009）。虽然在诊断具有轻度或发育良好的PTC样核的病变时一致性最高，但对于核变化中等（核评分为2）的肿瘤（病例2，P < 0.05），在核评分和诊断NIFTP方面存在显著差异。与在亚洲/大洋洲执业的病理学家相比，在北美和欧洲执业的病理学家对PTC样核和NIFTP的阈值倾向于更低。