NIFTP in Asian Practice

Pathologists initiated and promoted the introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). An ample amount of knowledge about NIFTP has been contributed by Asian studies. Our original data and meta-analysis indicate that the incidence of NIFTP in Asia (2.1%, 95% CI 1.2-3.6%) is significantly lower than its global rate (6.0%, 95% CI 4.4-8.2%). This discrepancy is attributed to varying perceptions of histological diagnostic thresholds, the different nature of papillary thyroid carcinoma, and distinct approaches in the management of thyroid nodules. The lower prevalence of NIFTP in Asia suggests that it has a minor effect on the malignancy risk change in cytopathology and the performance of commercial molecular tests, which are primarily used for preoperative risk stratification of indeterminate thyroid nodules in the USA. However, these tests are rarely available outside the North America, leading Asian institutions to develop alternative approaches for clinical triage and management of thyroid nodules. Japanese institutions have proposed a concept of active surveillance for indeterminate nodules and NIFTP, commonly found in indeterminate cytologic categories, which has established a new paradigm to reduce overtreatment of these patients.