Journal of Clinical & Experimental Pathology
Open Access

Abstract

Background: Encapsulated Follicular Variant of Papillary Thyroid Carcinoma (EFV-PTC) is a common subtype of Papillary Thyroid Carcinoma (PTC) with low malignant potential. Based on capsular and vascular invasion they are divided into Non- Invasive and Invasive subtypes (NIEFV-PTC and IEVV-PTC, respectively). Recently a proposal by international groups of thyroid disease experts has been made to re-classify non-invasive encapsulated follicular variant of papillary thyroid carcinoma as a non-malignant thyroid neoplasm and to use the term: “Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP)”. In this study, we identified the clinic-pathological characteristics and management of NIEFV-PTC at King Abdul-Aziz Medical City, Jeddah during 2011-2015. Methods: A retrospective review of all pathological reports of thyroidectomy specimen with a malignant diagnosis. All cases of EFV-PTC were included as well as other common variants of PTC for comparison. All pathological diagnoses were reviewed by a board-certified pathologist. Additional needed data were obtained by reviewing patient’s charts. Results: A total of 69 EFV-PTCs (44 non-invasive, 25 invasive) accounting for 28% of all PTC. EFV-PTC had significantly larger tumor size than PTC (P<0.001). NIEFV-PTC tend to be uni-focal compared to invasive EFV-PTC (p=0.006). None of the NIEFV-PTCs showed peri-neural invasion/extra-thyroidal extension/lympho-vascular invasion/lymph node metastasis. 56.8% (n=25) of NIEFV-PTC were managed by surgery and radioactive iodine ablation with a mean dose of 92.82 MCI. Conclusion: Our local institutional experience indicates that NIEFV-PTC tumors were over staged and treated as conventional thyroid cancer despite an indolent behavior. Adopting the NIFTP terminology in accordance with the recent recommendations might significantly reduce the over-treatment and its associated complications. Where are the conventional PTC cases?? NIEFV-PTC is an indolent thyroid tumor with very low-likelihood of metastases. To avid over-treatment, we recommend the incorporation of the recently coined term (NIFTP) into the diagnosis and management algorithms for patients with thyroid tumors.

Biography

Hatim Al Maghrabi is the Deputy Regional Program Director for Saudi Board in Pathology at Saudi Commission for Health Specialties (SCFHS) and also Adunct Assistant Professor at KSU-HS at King Saud bin Abdulaziz University for Health Sciences. Currently, he is a Program Director for Anatomical Pathology at Ministry of National Guard Health Affairs (MNG-HA). He has obtianed Clinical Fellowship in Liver/Kidney Pathology and Cytopathology at University of Toronto.

E-mail: drpathology@gmail.com