2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

IV. Endocrine

A. Reclassification of thyroid cancers Baloch ZW, Harrell RM, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology disease state commentary: managing thyroid tumors diagnosed as noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Endocr Pract . 2017; 23(9):1150-1155. EBM level 5.......................................................................................................116-121 Summary : This article reviews the recent change in nomenclature for encapsulated follicular variant of papillary thyroid carcinoma to neoplasm with papillary-like nuclear features. This article seeks to address changes in clinical management of patients as a result of these changes, particularly the effect of the change on the risk for cancer for the indeterminant categories on fine-needle biopsy, Bethesda III-V. Also, the issue of reevaluation of previous diagnoses of follicular variant of papillary thyroid cancer is addressed. Summary : This article updates the Bethesda System for Reporting Thyroid Cytopathology for 2017. Major changes include alterations in risks of malignancy, incorporation of molecular testing, and the diagnosis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features. Layfield LJ, Baloch ZW, Esebua M, et al. Impact of the reclassification of the non-invasive follicular variant of papillary carcinoma as benign on the malignancy risk of the Bethesda System for reporting thyroid cytopathology: a meta-analysis study. Acta Cytol . 2017; 61(3):187-193. EBM level 1...............................................................................................................................................128-134 Summary : This article addresses the change in the predicted rate of malignancy for each of the Bethesda category diagnoses for fine-needle aspiration with the recent change in nomenclature for encapsulated follicular variant of papillary thyroid carcinoma to neoplasm with papillary-like nuclear features. The greatest impact is on the categories of atypia of undetermined significance/follicular lesion of undetermined significance, Bethesda category III, and suspicious for malignancy, Bethesda category V. Nikiforov YE, Seethala RR, Tallini G, et al. Nomenclature revision for encapsulated follicular variant of papillary thyroid carcinoma: a paradigm shift to reduce overtreatment of indolent tumors. JAMA Oncol . 2016; 2(8):1023-1029. EBM level 3..................................................................................135-141 Summary : This article refines the pathologic diagnostic criteria for the diagnosis of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) and reviews the outcomes for patients with EFVPTC. Based on the findings from these outcomes studies, this group suggests that this pathologic entity no longer be considered a cancer, and should be renamed non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This change in categorization will facilitate less surgery and avoid radioactive iodine therapy for these patients. B. Molecular testing Roth MY, Witt RL, Steward DL. Molecular testing for thyroid nodules: review and current state. Cancer . 2018; 124(5):888-898. EBM level 5................................................................................142-152 Summary : This paper reviews the development of molecular testing for thyroid nodules and summarizes the current commercial tests available. It highlights the advantages and disadvantages of each test and touches on future directions. Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid . 2017; 27(11):1341-1346. EBM level 5.....................................................................................................122-127