title: NONINVASIVE FOLLICULAR TUMOR WITH PAPILLARY-LIKE NUCLEAR FEATURES: NOT A TEMPEST IN A TEAPOT.
abstract: OBJECTIVE
  Encapsulated non-invasive follicular variant papillary thyroid cancer (ENIFVPTC) has recently been retermed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This designation specifically omits the word "cancer" to encourage conservative treatment since patients with NIFTP tumors have been shown to derive no benefit from completion thyroidectomy or adjuvant radio-active iodine (RAI) therapy.
  
  
  METHODS
  This was a retrospective study of consecutive cases of tumors from 2007 to 2015 that met pathologic criteria for NIFTP. The conservative management (CM) group included patients managed with lobectomy alone or appropriately indicated total thyroidectomy. Those included in the aggressive management (AM) group received either completion thyroidectomy or RAI or both.
  
  
  RESULTS
  From 100 consecutive cases of ENIFVPTC reviewed, 40 NIFTP were included for the final analysis. Of these, 10 (27%) patients treated with initial lobectomy received completion thyroidectomy and 6 of 40 (16%) also received postsurgical adjuvant RAI. The mean per-patient cost of care in the AM group was $17,629 ± 2,865, nearly twice the $8,637 ± 309 costs in the CM group, and was largely driven by the cost of completion thyroidectomy and RAI.
  
  
  CONCLUSIONS
  The term NIFTP has been recently promulgated to identify a type of thyroid neoplasm, formerly identified as a low-grade cancer, for which initial surgery represents adequate treatment. We believe that since the new NIFTP nomenclature intentionally omits the word "cancer," the clinical indolence of these tumors will be better appreciated, and cost savings will result from more conservative and appropriate clinical management.
  
  
  BACKGROUND
  AM = aggressive management CM = conservative management ENIFVPTC = encapsulated noninvasive form of FVPTC FVPTC = follicular variant of papillary thyroid carcinoma NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features PTC = papillary thyroid carcinoma PTMC = papillary thyroid microcarcinoma RAI = radio-active iodine US = ultrasound.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Agrawal
authors.forename: Collette E
authors.initials: CE
authors.lastname: Abbott
authors.forename: Cheng
authors.initials: C
authors.lastname: Liu
authors.forename: Stella
authors.initials: S
authors.lastname: Kang
authors.forename: Laura
authors.initials: L
authors.lastname: Tipton
authors.forename: Kepal
authors.initials: K
authors.lastname: Patel
authors.forename: Mark
authors.initials: M
authors.lastname: Persky
authors.forename: Lizabeth
authors.initials: L
authors.lastname: King
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Deng
authors.forename: Michael
authors.initials: M
authors.lastname: Bannan
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Ogilvie
authors.forename: Keith
authors.initials: K
authors.lastname: Heller
authors.forename: Steven P
authors.initials: SP
authors.lastname: Hodak
mesh_terms: D000328:Adult; D018265:Carcinoma, Papillary, Follicular / Q000191:economics / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002467:Cell Nucleus / Q000473:pathology; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000191:economics / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D047368:Tumor Burden
chemical_list: D007457:Iodine Radioisotopes