Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): Trading Six for a Risky Half Dozen: Reply

World Journal of Surgery, Feb 2018

David N. Parente, Pim J. Bongers, Raoul Verzijl, Lorne E. Rotstein, Sylvia L. Asa, Wouter P. Kluijfhout, Karen M. Devon, David P. Goldstein, Ozgur Mete, Jesse D. Pasternak

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Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): Trading Six for a Risky Half Dozen: Reply

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): Trading Six for a Risky Half Dozen: Reply David N. Parente 0 1 2 3 4 Pim J. Bongers 0 1 2 3 4 Raoul Verzijl 0 1 2 3 4 Lorne E. Rotstein 0 1 2 3 4 Sylvia L. Asa 0 1 2 3 4 Wouter P. Kluijfhout 0 1 2 3 4 Karen M. Devon 0 1 2 3 4 David P. Goldstein 0 1 2 3 4 Ozgur Mete 0 1 2 3 4 Jesse D. Pasternak 0 1 2 3 4 0 Division of General Surgery, University Health Network , 200 Elizabeth St. Room 10EN-2017, Toronto, ON M5G 2C4 , Canada 1 David N. Parente 2 & Jesse D. Pasternak 3 Department of Pathology, University Health Network , 200 Elizabeth Street, Toronto, ON M5G 2C4 , Canada 4 Otolaryngology, Head and Neck Surgery, University Health Network, 610 University Ave. Room 3-952 , Toronto, ON M5G 2M9 , Canada - Since the term noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) was introduced, its existence has been controversial. The resultant debate has left clinicians confused as to how to counsel and follow their patients diagnosed with this entity. The authors would like to thank Dr. Rosa`rio for his support with respect to our recent article on the clinical safety of renaming encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) [ 1 ]. The authors believe that a continued academic discourse as well as further research on the topic is necessary to clarify the ongoing uncertainty. After Nikiforov et al. [ 2 ] published their article suggesting that the nomenclature for the low-risk thyroid cancer variant EFVPTC be changed to NIFTP, the authors found that the experience at the University Health Network was significantly different with respect to both incidence and malignant potential [ 1 ]. In addition to Parente et al., there have been several studies indicating that EFVPTC has both malignant potential and a low incidence [ 1, 3, 4 ]. The authors certainly support the de-escalation of treatment of these low-risk thyroid cancers including the use of thyroid lobectomy and more selective radioactive iodine ablation. However, the avoidance of the term ‘‘cancer’’ for an entity with malignant potential may result in undertreatment or inappropriate lack of surveillance of patients with these tumors. In this regard, change in terminology is not a substitute for meaningful patient education and multidisciplinary discussion to highlight the low-risk nature of these cancers. Until future research can clarify the current controversy in the literature, clinicians should continue to follow and counsel patients about this low-risk malignant entity. Furthermore, ongoing capture of this diagnostic category by Cancer Registries is essential for both quality improvement and investigational study. 1. Parente DN , Kluijfhout WP , Bongers PJ et al ( 2017 ) Clinical safety of renaming encapsulated follicular variant of papillary thyroid carcinoma: is NIFTP truly benign? World J Surg 42 : 321 - 326 . https://doi.org/10.1007/s00268-017-4182-5 2. Nikiforov YE , Seethala RR , Tallini G et al ( 2016 ) Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors . JAMA Oncol 2 : 1023 - 1029 3. Cho U , Mete O , Kim MH et al ( 2017 ) Molecular correlates and rate of lymph node metastasis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features and invasive follicular variant papillary thyroid carcinoma: the impact of rigid criteria to distinguish non-invasive follicular thyroid neoplasm with papillary-like nuclear features . Mod Pathol 30 : 810 - 825 4. Aburjania Z , Jang S , Montemayor-Garcia C et al ( 2017 ) Encapsulated follicular variant of papillary thyroid cancer: are these tumors really benign? J Surg Res 216 : 138 - 142


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David N. Parente, Pim J. Bongers, Raoul Verzijl, Lorne E. Rotstein, Sylvia L. Asa, Wouter P. Kluijfhout, Karen M. Devon, David P. Goldstein, Ozgur Mete, Jesse D. Pasternak. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): Trading Six for a Risky Half Dozen: Reply, World Journal of Surgery, 2018, 1-1, DOI: 10.1007/s00268-018-4505-1