title: The Impact of Noninvasive Follicular Variant of Papillary Thyroid Carcinoma on Rates of Malignancy for Fine-Needle Aspiration Diagnostic Categories.
abstract: BACKGROUND
  Increased recognition of the indolent nature of noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) along with greater insight into the molecular alterations of these tumors has prompted endocrine pathologists to question whether these tumors warrant a diagnosis of carcinoma. However, a change in terminology would affect the rates of malignancy of fine-needle aspiration (FNA) diagnostic categories. Therefore, the aim of this study was to determine the percentage decrease in associated risk of malignancy for each FNA diagnostic category if NFVPTCs were no longer termed carcinomas.
  
  
  METHODS
  We evaluated a cohort of 655 FNAs with subsequent resection specimens over a 22-month time period. The diagnoses of the preceding FNAs were recorded according to the Bethesda System for Reporting Thyroid Cytopathology. For cases with more than one preceding FNA, the FNA diagnosis associated with the highest risk of malignancy was identified. Slides for all resection specimens with a diagnosis of FVPTC were reviewed to identify noninvasive tumors. By definition, all of these tumors were encapsulated, partially encapsulated, or well circumscribed and lacked any indication of infiltrative growth, capsular penetration, or lymphovascular invasion.
  
  
  RESULTS
  Our cohort of 655 FNAs with subsequent resection specimens included 53 (8.1%) nondiagnostic (ND), 167 (25.5%) benign, 97 (14.8%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 88 (13.4%) suspicious for follicular neoplasm (SFN), 94 (14.4%) suspicious for malignancy (SUS), and 156 (23.8%) malignant cases (POS). Surgical resections demonstrated benign findings in 309 (47.2%) and malignant tumors in 346 (52.8%), including 85 NFVPTCs accounting for 24.6% of malignancies. Our rates of malignancy for ND, benign, AUS/FLUS, SFN, SUS, and POS were 18.9%, 13.2%, 39.2%, 45.5%, 87.2%, and 98.7%, respectively. If NFVPTC were no longer termed carcinoma, these rates would drop to 17.0% (10% decrease), 5.4% (59% decrease), 21.6% (45% decrease), 37.5% (18% decrease), 45.7% (48% decrease), and 93.6% (5% decrease), respectively.
  
  
  CONCLUSIONS
  Our findings demonstrate that if terminology were changed and NFVPTCs were not considered carcinomas, the rates of malignancy for FNA diagnostic categories would be substantially decreased, with the most clinically significant decrease seen in the SUS category, which demonstrated a relative decrease of nearly 50%.
authors.affiliation: 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Strickland
authors.affiliation: 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Brooke E
authors.initials: BE
authors.lastname: Howitt
authors.affiliation: 2 Division of Endocrinology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Ellen
authors.initials: E
authors.lastname: Marqusee
authors.affiliation: 2 Division of Endocrinology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Erik K
authors.initials: EK
authors.lastname: Alexander
authors.affiliation: 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Edmund S
authors.initials: ES
authors.lastname: Cibas
authors.affiliation: 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Krane
authors.affiliation: 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Justine A
authors.initials: JA
authors.lastname: Barletta
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis* / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002277:Carcinoma / Q000175:diagnosis* / Q000503:physiopathology*; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000503:physiopathology; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D016606:Thyroid Nodule / Q000503:physiopathology; D055815:Young Adult