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SHR Neuro Cancer Cardio Lipid Metab Microb

Totsch, M; Schmid, KW.
Impact on the assessment of fine needle biopsy of the thyroid after the introduction of NIFTP
ONKOLOGE. 2019; 25(7): 590-595. Doi: 10.1007/s00761-019-0593-2
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Leading authors Med Uni Graz: Tötsch Martin
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Abstract:: BackgroundThe explicit aim of the introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in the 4th edition of the WHO classification of tumors of the thyroid gland (2017) was to spare patients with the diagnosis of this subgroup of encapsulated follicular variants of PTC with indolent clinical course, both overtreatment and the psychological burden of a cancer diagnosis; however, the establishment of NIFTP has deprived the characteristic nuclear features of PTC of their status as astand-alone malignancy criterion, necessitating not only aredefinition of the diagnostic criteria for PTC (WHO 2017) but also fundamental changes in the cytological assessment of thyroid FNB.Results and conclusionCytologically, PTC can nowadays only be reliably diagnosed (diagnostic groupV according to Ting etal.) if, besides the characteristic nuclear features, true papillary structures, psammoma bodies and/or aBRAF V600E mutation can be demonstrated immunohistochemically or molecular pathologically. This results in an increase of cases within the diagnostic groupIV (suspected malignancy). In this group (a)neoplasms with PTC-equivalent nuclear changes (histologically corresponding to aNIFTP or aPTC) and (b)rarely the suspicion for medullary, poorly differentiated or anaplastic carcinoma, malignant lymphomas or metastases have to be assigned. In addition, for groupIV cases the probability that amalignant tumor is diagnosed in the postoperative histological preparation is less than before (previously 60-75%, now 45-60%). The introduction of NIFTP has already resulted in areassessment of the risk of malignancy in the Bethesda classification. The Bethesda classification groupsIII (atypical with unclear significance AUS, follicular alterations with unclear significance, FLUS) andIV (follicular neoplasm, FN, suspicion of follicular neoplasm, SFN) now show avery similar risk of malignancy. As already pointed out earlier, the still existing (arbitrary) separation of these two diagnostic groups for the management of the affected patients, in particular with respect to the expectations of its role in the preoperative FNB of the thyroid gland in Germany and Austria, has to be critically called into question. By contrast, the necessary adaptation of the cytological conditions following the introduction of NIFTP can be implemented without problems in the 5-stage diagnostic scheme used by the authors.
Find related publications in this database (Keywords): Thyroid carcinoma; Cytology; BRAF V600E mutation; Neoplasia with uncertain malignant potential; Bethesda