Differences in Treating NIFTP Versus Thyroid Cancer

Yuri E. Nikiforov, MD, PhD, professor of pathology and director of the Division of Molecular Anatomic Pathology at the University of Pittsburgh School of Medicine, discusses the approach to treating noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), which is now classified distinctly from thyroid cancers.

Previously a type of encapsulated follicular variant of papillary thyroid cancer, a study of real-world data from multiple countries showed that NIFTP was low-grade and indolent. After evidence showed that this type of tumor is low-risk, NIFTP was classified as noncancerous. Still, Nikiforov says that patients with NIFTP require a lobectomy performed on the thyroid so they can receive a diagnosis from a pathologist based on microscopic examination.

Previously, patients with NIFTP would have been diagnosed with cancer and receive an additional surgery to remove the second thyroid lobe, plus treatment with radioactive iodine. Nikiforov says that if patients are histopathologically or microscopically diagnosed with NIFTP now, they do not need surgery or radioactive iodine treatment. Additionally, they do not require observation with frequent surveillance as they would for an indolent cancer. This classification has reduced overtreatment of patients with potential thyroid malignancies.

TRANSCRIPTION:

0:08 | Still, for NIFTP, you need surgery. Surgery performed on the thyroid is frequently the removal of 1 lobe of the thyroid, which is called a lobectomy. And then at that time, patients get a diagnosis based on microscopic examination or a pathologist-issued diagnosis. In the past, patients get a diagnosis of cancer and therefore, if it's a large nodule, the patient had to have the second surgery to remove the second lobe of thyroid and receive treatment with radioactive iodine. Now, when these tumors are histopathologically or microscopically diagnosed as noncancerous NIFTP, no further treatment is needed. There is no need for second surgery, there is no need for radioactive iodine, and there is not even a need for frequent surveillance that patients usually undergo with true cancer.