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<p>Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a borderline follicular-patterned thyroid tumor, redefined in the WHO 2022 classification to minimise overtreatment of indolent lesions. Accurate identification of NIFTP is crucial due to its excellent prognosis and conservative management approach. However, diagnostic challenges persist due to overlap with other follicular-patterned lesions, especially Invasive Encapsulated/Well-Demarcated Follicular Variant of Papillary Thyroid Carcinoma (IEFVPTC), follicular variant of papillary thyroid carcinoma- classic (FVPTC) and follicular adenoma (FA).&#xa0;To accurately identify and reclassify NIFTP cases from follicular-patterned thyroid neoplasms using the WHO 2022 criteria, and to assess the utility of immunohistochemical markers—CD56, HBME-1, and CK19—in distinguishing NIFTP from its mimics.&#xa0;In this retrospective study of 184 thyroidectomy cases received over a period of three years, 79 cases with solitary or dominant nodules showing an almost exclusive follicular growth pattern were reviewed and reclassified according to WHO 2022 guidelines. Cases fulfilling the histologic criteria for NIFTP including encapsulation/ circumscription (after thorough evaluation of the interface with normal thyroid), absence of capsular/ lympho-vascular invasion, and presence of papillary-like nuclear features were identified. Morphology (lack of circumscription, nuclear PTC features, capsular-invasion, angio invasion, papillae, solid/ trabecular growth patterns and necrosis) and/ or BRAFV600E immunohistochemistry (IHC) was used to exclude infiltrative FVPTC. Results: Ten cases (12.7%) were of NIFTP were identified. These patients had a mean age of 35.6 years and a female predominance (Male: Female = 1:4). All NIFTP cases were encapsulated / well circumscribed, non-invasive, and exhibited diffuse or patchy nuclear features of PTC. BRAFV600E IHC was negative in all NIFTP cases. CK19 was strongly expressed in all 10 cases (100%), while HBME-1 and CD56 were positive in 60% (6/10) and 40% (4/10) of cases, respectively. NIFTP was most often misdiagnosed as follicular adenoma (2 cases) or oncocytic adenoma (1 case) prior to re-evaluation. Further, 3 cases of IEFVPTC were initially misdiagnosed as NIFTP and were found to have unequivocal capsular invasion on through evaluation. All patients had undergone lobectomy or total thyroidectomy without radioactive iodine therapy and remained disease-free on follow-up (mean duration: 14 months).&#xa0;Accurate classification of NIFTP based on WHO 2022 criteria enables appropriate conservative management and avoids overtreatment. Immunohistochemistry, especially BRAFV600E negativity and CK19 positivity, supports diagnosis but must be interpreted in conjunction with morphology. Consistent application of WHO guidelines improves diagnostic precision in follicular-patterned thyroid lesions and enhances patient outcomes.</p>

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When Cancer Isn’t Cancer: A 3-Year Tertiary Centre Experience with NIFTP Diagnosis in the WHO 2022 Era

  • 期刊论文

  • 发表日期：

    2025年12月20日

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  • Sunayana Misra,
  • Md Ali Osama,
  • Shashi Dhawan,
  • Sonia Badwal,
  • Seema Rao

摘要

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a borderline follicular-patterned thyroid tumor, redefined in the WHO 2022 classification to minimise overtreatment of indolent lesions. Accurate identification of NIFTP is crucial due to its excellent prognosis and conservative management approach. However, diagnostic challenges persist due to overlap with other follicular-patterned lesions, especially Invasive Encapsulated/Well-Demarcated Follicular Variant of Papillary Thyroid Carcinoma (IEFVPTC), follicular variant of papillary thyroid carcinoma- classic (FVPTC) and follicular adenoma (FA). To accurately identify and reclassify NIFTP cases from follicular-patterned thyroid neoplasms using the WHO 2022 criteria, and to assess the utility of immunohistochemical markers—CD56, HBME-1, and CK19—in distinguishing NIFTP from its mimics. In this retrospective study of 184 thyroidectomy cases received over a period of three years, 79 cases with solitary or dominant nodules showing an almost exclusive follicular growth pattern were reviewed and reclassified according to WHO 2022 guidelines. Cases fulfilling the histologic criteria for NIFTP including encapsulation/ circumscription (after thorough evaluation of the interface with normal thyroid), absence of capsular/ lympho-vascular invasion, and presence of papillary-like nuclear features were identified. Morphology (lack of circumscription, nuclear PTC features, capsular-invasion, angio invasion, papillae, solid/ trabecular growth patterns and necrosis) and/ or BRAFV600E immunohistochemistry (IHC) was used to exclude infiltrative FVPTC. Results: Ten cases (12.7%) were of NIFTP were identified. These patients had a mean age of 35.6 years and a female predominance (Male: Female = 1:4). All NIFTP cases were encapsulated / well circumscribed, non-invasive, and exhibited diffuse or patchy nuclear features of PTC. BRAFV600E IHC was negative in all NIFTP cases. CK19 was strongly expressed in all 10 cases (100%), while HBME-1 and CD56 were positive in 60% (6/10) and 40% (4/10) of cases, respectively. NIFTP was most often misdiagnosed as follicular adenoma (2 cases) or oncocytic adenoma (1 case) prior to re-evaluation. Further, 3 cases of IEFVPTC were initially misdiagnosed as NIFTP and were found to have unequivocal capsular invasion on through evaluation. All patients had undergone lobectomy or total thyroidectomy without radioactive iodine therapy and remained disease-free on follow-up (mean duration: 14 months). Accurate classification of NIFTP based on WHO 2022 criteria enables appropriate conservative management and avoids overtreatment. Immunohistochemistry, especially BRAFV600E negativity and CK19 positivity, supports diagnosis but must be interpreted in conjunction with morphology. Consistent application of WHO guidelines improves diagnostic precision in follicular-patterned thyroid lesions and enhances patient outcomes.