Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillarylike Nuclear Features and Total Thyroidectomies for Patients with Papillary Thyroid Neoplasms

Lisa Caulley*, Antoine Eskander, Weining Yang, Edel Auh, Lydia Cairncross, Nancy L. Cho, Bahar Golbon, Subramania Iyer, Jeffrey C. Liu, Paul J. Lee, Brenessa Lindeman, Charles Meltzer, Nicole Molin, Alessandra Moore, Julia Noel, Halie Nozolino, Jesse Pasternak, Brendon Price, Tim Ramsay, Lars RolighedMirabelle Sajisevi, Arun Sharma, Catherine Sinclair, Meredith Sorensen, Kyung Tae, Alice L. Tang, Gabriel Tsao, Michelle Williams, Sean Wrenn, Monica H. Xing, Mark Zafereo, Brendan C. Stack, Greg Randolph, Louise Davies

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

8 Citations (Scopus)


Importance: Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment. Objective: To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size. Design, Setting, and Participants: This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. Main Outcomes and Measures: Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. Results: Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]). Conclusions and Relevance: Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.

Original languageEnglish
Pages (from-to)99-106
Number of pages8
JournalJAMA Otolaryngology - Head and Neck Surgery
Issue number2
Early online date24 Nov 2021
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
reported grants from the Canadian Institutes of Health Research and the PSI Foundation outside the submitted work. Dr Eskander reported grants from Merck and personal fees from Bristol Myers Squibb outside the submitted work. Dr Williams reported serving as a member of the Bayer scientific advisory board. Dr Zafereo reported grants from Eli Lilly, Merck, and GenePro Diagnostics outside the submitted work. No other disclosures were reported.

Publisher Copyright:
© 2022 American Medical Association. All rights reserved.


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