NIFTP diagnostic and therapeutic approach.

Abstract

Background: Non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) still spark controversy regarding histological diagnostic criteria and therapeutic management.

Aim: To elucidate the clinicopathological characteristics of NIFTP tumors and discuss their therapeutic management.

Methods: A retrospective study including 23 patients (26 nodules) operated on and followed up for NIFTP tumors according to the 2017 WHO classification over a 5-year period (January 2016-December 2020). The 2017 EUTIRADS classification was used for ultrasound nodule characterization. Fine-needle aspiration cytology was reported according to the 2017 Bethesda system.

Results: All patients were female, with a mean age of 47 years [19-71]. The average consultation delay was 9 months [2 months-7 years]. Thyroid nodules were incidentally discovered in 6 cases (26%). Examination revealed a solitary thyroid nodule in 20 cases. Nodules were classified as EUTIRADS III or IV in 82%. Fine-needle aspiration cytology, performed in 61% of cases, showed Bethesda III in 64% and IV in 14%. Total thyroidectomy was performed in 74%. Three cases of bifocal NIFTP were identified. Association with thyroid carcinoma was noted in 7 cases. No locoregional or distant recurrence was reported during a mean follow-up of 3 and a half years.

Conclusion: Recent revisions of NIFTP morphological criteria underscore the importance of strict adherence to inclusion and exclusion histo-morphological criteria.