Comprehensive analysis for diagnosis of preoperative non-invasive follicular thyroid neoplasm with papillary-like nuclear features

• Published in: PloS one Vol. 14; no. 7; p. e0218046
• Main Authors: Lee, Hye Seung, Lee, Jae-Wook, Park, Ji Hyun, Kim, Wan-Seop, Han, Hye Seung, Lee, Seung Eun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.07.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Biology and Life Sciences; Cancer diagnosis; Carcinoma, Papillary, Follicular - diagnostic imaging; Carcinoma, Papillary, Follicular - genetics; Carcinoma, Papillary, Follicular - pathology; Carcinoma, Papillary, Follicular - surgery; Cytology; Cytopathology; Diagnosis; Diagnostic systems; Female; Gene mutation; Humans; Iodine 131; Iodine radioisotopes; Lobectomy; Male; Medical diagnosis; Medical imaging; Medicine; Medicine and Health Sciences; Metastasis; Methods; Middle Aged; Mutation; Papillary thyroid carcinoma; Pathology; Patients; Preoperative Care; Proto-Oncogene Proteins B-raf - genetics; Radiology; ras Proteins - genetics; Research and Analysis Methods; Thyroid; Thyroid cancer; Thyroid diseases; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - genetics; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy; Tumors; Ultrasonic imaging; Ultrasonography; South Korea; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0218046

The current paradigm in the treatment of patients with non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a diagnostic lobectomy rather than complete thyroidectomy and postoperative radioiodine treatment. Consequently, preoperative diagnosis of NIFTP is considered to be important. We performed the comprehensive analysis for diagnosis of preoperative 20 NIFTPs in comparison with 41 invasive encapsulated follicular papillary thyroid carcinomas (I-EFVPTCs) using the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and molecular analysis for BRAF and RAS mutations. K-TIRADS 3 was identified as the most common sonographic diagnosis in both NIFTP and I-EFVPTC. Unlike I-EFVPTC, K-TIRADS 5 was not identified in NIFTP. AUS/FLUS was the most common cytopathological diagnosis and none of the cases were classified as malignant category in both groups, although the difference in distribution was not significant between the groups. BRAF mutation was not found in NIFTP but was present in 9.8% of cases in I-EFVPTC. The frequency of RAS mutation in I-EFVPTCs was twice as high as that of NIFTP. Wild-type BRAF and RAS in NIFTP was significantly higher than I-EFVPTC. The existence of overlapping features between the groups was evident, hence conclusive distinction between radiology, cytology and molecular analysis could not be achieved. Apparently, the diagnosis of NIFTP based on comprehensive analysis was not confirmable but could perceive or at least favor the diagnosis of NIFTP.