Clinical Impact of Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features on the Risk of Malignancy in the Bethesda System for Reporting Thyroid Cytopathology: A Meta-Analysis of 14,153 Resected Thyroid Nodules |
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| Institution: | 1. Department of Pathology, University of Yamanashi, Chuo, Japan;2. Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam;3. Department of Pathology, Kameda Medical Center, Kamogawa City, Chiba, Japan;4. Department of Hospital Pathology, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea;5. Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma city, Nara, Japan.;1. From the Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California;2. From the Department of Endocrinology, LMC Diabetes and Endocrinology, Calgary, Alberta, Canada;3. From the Department of Information Science/Biostatistics, City of Hope National Medical Center, Duarte, California;4. From the Department of Pathology, City of Hope National Medical Center, Duarte, California;5. From the Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, California;6. From the Department of Endocrinology, City of Hope National Medical Center, Duarte, California.;1. From the Department of Medicine, Division of Endocrinology and Metabolism, Duke University Medical Center, Durham, North Carolina;2. Department of Biostatistics, Duke Cancer Institute, Durham, North Carolina;3. Department of Pathology, Duke University Medical Center, Durham, North Carolina;4. Department of Surgery, University of California at San Francisco-UCSF, San Francisco, California. |
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| Abstract: | Objective: It is still controversial as to how the reclassification of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) affects the risk of malignancy (ROM) in The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). This meta-analysis was aimed to investigate the impact of NIFTP on the ROM in each TBSRTC category.Methods: We accessed three electronic databases including PubMed, Web of Science, and Scopus to search for relevant data from January, 2016 to July, 2018. Relative risk and meta-analysis of proportions using the DerSimonian-Laird method, and each corresponding 95% confidence interval (CI) was pooled using a random-effect model.Results: A total of 14 studies consisting of 14,153 resected nodules were included for meta-analyses. Overall, there was a significant reduction in ROM in all TBSRTC categories following the NIFTP reclassification, except TBSRTC category I. The largest absolute and relative decrease in ROM was observed in TBSRTC category V (16%; 95% CI = 8 to 24) and category III (32%; 95% CI = 24 to 39), respectively. There was a positive correlation between the rate of NIFTP and resection rate (r = 0.83; P = .02). The decreases in ROM were more prominent in Western than in Asian cohorts.Conclusion: We confirmed the decrease in ROM due to the NIFTP reclassification for most of TBSRTC categories, which was more significant in Western than in Asian practice. The incidence of NIFTP was higher in institutions where surgical resection rates were high in patients with indeterminate cytology nodules.Abbreviations: AUS/FLUS = atypia of undetermined significance/follicular lesion of undetermined significance; CI = confidence interval; FNA = fine-needle aspiration; FN/SFN = follicular neoplasm/suspicious for follicular neoplasm; NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features; NI-FVPTC = noninvasive follicular variant of papillary thyroid carcinoma; ROM = risk of malignancy; RR = relative risk; SM = suspicious for malignancy; TBSRTC = The Bethesda System for Reporting Thyroid Cytopathology |
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