{"doi":"10.1089/thy.2023.0035","title":"A Comprehensive Study on the Diagnosis and Management of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features","abstract":"Background: Since the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) was introduced in 2016, most retrospective studies have included cases diagnosed as encapsulated follicular variant of papillary thyroid carcinoma. We investigate a cohort diagnosed with NIFTP at resection. Methods: Retrospective institutional cohort of NIFTP from 2016 to 2022, including clinical, cytological, and molecular data for 319 cases (6.6% of thyroid surgeries, 183 cases as NIFTP-only). Results: The patient cohort had unifocal or multifocal thyroid nodules. Female:male ratio was 2.7:1, mean age was 52 years and median NIFTP size was 2.1 cm. NIFTP was associated with multiple nodules in 23% patients ( n = 73) and 12% of NIFTP were multifocal ( n = 39). Fine needle aspiration (FNA) of NIFTP ( n = 255) were designated as nondiagnostic = 5%, benign = 13%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) = 49%, follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) = 17%, suspicious for malignancy = 12%, or malignant = 4%. Molecular alterations were identified in 93% ( n = 114), RAS or RAS -like. Thyroid Imaging Reporting and Data System (TI-RADS) score 4 was recorded in 50% of NIFTP, followed by scores 3 and 5 (26% and 20%, respectively). We also investigated the factors associated with extent of surgery. In our NIFTP-only group ( n = 183), 66% were identified after hemithyroidectomy (HT) and 34% after total thyroidectomy (TT). On univariate analysis, TT patients demonstrated higher Bethesda category by FNA, more often had aberrant preoperative thyroid function, and/or underwent an FNA of additional nodule(s). With multivariable regression, Bethesda V NIFTP, in the presence of other nodules being evaluated by FNA and aberrant preoperative thyroid function, independently predicts TT. Bethesda II NIFTP correlated significantly with HT. Fifty-two patients (28%) with NIFTP-only had at least one postoperative surveillance ultrasound. In the NIFTP-only cohort, no HT patients had completion thyroidectomy or received postoperative radioactive iodine. No recurrence or metastases were recorded with median follow-up of 35 months (6–76 months; n = 120). Conclusions: Given this large cohort of NIFTP, including a large subset of isolated NIFTP-only, some with >6 years of follow-up and no tumor recurrences, consensus practical guidelines are needed for adequate postoperative management. Given the American Thyroid Association (ATA) provides guidelines for management of low-risk malignancies, guidance regarding that for borderline/biologically uncertain tumors, including NIFTP, is a reasonable next step.","journal":"Thyroid","year":2023,"id":335204,"datarank":0.8560768768315729,"base_score":3.044522437723423,"endowment":3.044522437723423,"self_citation_contribution":0.4566783656585135,"citation_network_contribution":0.39939851117305936,"self_endowment_contribution":0.4566783656585135,"citer_contribution":0.39939851117305936,"corpus_percentile":76.51427245300533,"corpus_rank":3037,"citation_count":20,"citer_count":18,"citers_with_citation_signal":10,"citers_with_endowment":10,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.869,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":283061,"name":"Lauren N. Krumeich","orcid":"0000-0002-3261-1557","position":1,"is_corresponding":false},{"id":955705,"name":"Reagan A. Collins","orcid":"0000-0003-2945-5634","position":2,"is_corresponding":false},{"id":1065139,"name":"Timothy Kravchenko","orcid":null,"position":3,"is_corresponding":false},{"id":614313,"name":"Emad Ababneh","orcid":"0000-0002-8896-1409","position":4,"is_corresponding":false},{"id":257706,"name":"Adam S. Fisch","orcid":"0000-0002-4742-8165","position":5,"is_corresponding":false},{"id":13443,"name":"William C. Faquin","orcid":"0000-0002-9043-7171","position":6,"is_corresponding":false},{"id":63524,"name":"Vânia Nosé","orcid":"0000-0002-3934-6610","position":7,"is_corresponding":false},{"id":68698,"name":"Maria Martinez-Lage","orcid":"0000-0002-5859-7562","position":8,"is_corresponding":false},{"id":1064566,"name":"Gregory W. Randolph","orcid":"0000-0002-2542-3830","position":9,"is_corresponding":false},{"id":955707,"name":"Rajshri M. Gartland","orcid":"0000-0003-2678-2111","position":10,"is_corresponding":false},{"id":327622,"name":"Carrie C. Lubitz","orcid":null,"position":11,"is_corresponding":false},{"id":414416,"name":"Peter M. Sadow","orcid":"0000-0003-1036-6367","position":12,"is_corresponding":false},{"id":629824,"name":"Bayan Alzumaili","orcid":"0000-0001-5628-6384","position":0,"is_corresponding":true}],"reference_count":47,"raw_metadata":null,"created_at":"2026-07-19T01:09:58.338267Z","pmid":"36960710","pmcid":"PMC10171954","fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}