Outcome of Large Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features
Outcome of Large Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features
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DOI：
10.1089/thy.2016.0649
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发表时间：
2017-04-01
期刊：
影响因子：
6.6
通讯作者：
Ghossein, Ronald A.
中科院分区：
文献类型：
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作者：
Xu, Bin;Tallini, Giovanni;Ghossein, Ronald A.
背景：2016年，无侵袭性的包裹性滤泡型甲状腺乳头状癌被重新命名为具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤(NIFTP)，以减少对这种惰性肿瘤的过度治疗。然而，许多内分泌学家仍然对在没有放射性碘(RAI)治疗的情况下保守地处理大(=4厘米)NIFTP感到不安。本研究的目的是分析大型NIFTP的临床病理特征和预后，以辅助治疗决策。方法：在四家三级医院的病理数据库中搜索大型NIFTP(>；=4 cm)。排除单独癌灶的病例。符合纳入标准的有79例。其中56例(71%)有至少两年的临床随访(FU)，49例(62%)有四年或以上的临床随访期。结果：NIFTP的中位大小为4.5 cm(4.0~8.0 cm)。在50例(63%)肿瘤中，对整个包膜进行了采样，而在其余29例(37%)病例中，提交的包膜具有代表性，每厘米肿瘤检查的中位数为2.1块。大NIFTP以女性为主，男女之比为1：1.8，发病年龄中位数为49岁。所有患者确诊时均无淋巴结转移，25例有淋巴结组织镜检的患者无一例阳性发现。26例(33%)仅接受了甲状腺叶切除术，37例(47%)未接受RAI消融术。在整个队列中没有观察到复发，包括所有32名有两年或两年以上FU的患者，他们没有接受RAI治疗(中位数FU：6.7年)。在有四年或四年以上FU的患者中，所有25名未接受RAI治疗的患者均未复发，中位数FU为11.2年。肿瘤体积较大的患者倾向于接受术后放射治疗(p=0.001)。结论：与肿瘤体积较小的患者相似，肿瘤体积较大的患者的复发风险似乎极低(在该队列中为零)，即使在没有接受放射治疗的情况下进行保守治疗。对于较大的NIFTP，仅手术治疗，包括肺叶切除术，似乎是足够的。
Background: In 2016, encapsulated follicular variant of papillary thyroid carcinoma without invasion was renamed " noninvasive follicular thyroid neoplasm with papillary-like nuclear features'' (NIFTP) in order to reduce overtreatment of this indolent tumor. However, many endocrinologists remain uneasy about managing large (>= 4 cm) NIFTP conservatively without radioactive iodine (RAI) therapy. The objectives of this study are to characterize the clinicopathologic characteristics and outcome of large NIFTP in order to assist therapeutic decision making.Methods: The pathology databases of four tertiary hospitals were searched for large (>= 4 cm) NIFTP. Cases with separate foci of carcinoma were excluded. Seventy-nine cases fulfilled the inclusion criteria. Among them, 56 (71%) had at least two years of clinical follow-up (FU), and 49 (62%) had four or more years of FU. The clinicopathologic characteristics were reviewed and documented by four endocrine pathologists.Results: The median size of the NIFTP was 4.5 cm (range 4.0-8.0 cm). The entire capsule was sampled in 50 (63%) tumors, while in the remaining 29 (37%) cases, it was submitted representatively, with a median of 2.1 blocks per centimeter of tumor examined. Large NIFTP had a female preponderance with a male: female ratio of 1: 1.8, and presented at a median age of 49 years. There were no lymph node metastases at diagnosis in any of the patients, and none of the patients (n = 25) in whom nodal tissue was available for microscopic examination had positive findings. Twenty-six (33%) underwent thyroid lobectomy alone, and 37 (47%) did not receive RAI ablation. No recurrence was observed in the entire cohort, including all 32 patients with two or more years of FU who did not receive RAI therapy (median FU: 6.7 years). Among patients with four or more years of FU, all 25 individuals without RAI therapy did not recur, with a median FU of 11.2 years. Patients with a larger tumor size tended to receive postoperative RAI ablation (p = 0.001).Conclusions: Similar to their small counterparts, large NIFTP appear to have an extremely low risk of recurrence (zero in this cohort), even when treated conservatively without RAI therapy. Surgical treatment alone, including lobectomy, appears to be adequate for large NIFTP.