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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.

Endocrine Practice 2019 January 19
Introduction It is still controversial as to how the reclassification of non-invasive 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 (RR) and meta-analysis of proportion using the DeSimonian-Laird method and their 95% confidence intervals (CIs) were pooled using 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 = 8-24) and category III (32%; 95% CI = 24-39), respectively. There was a positive correlation between the rate of NIFTP and resection rate (r = 0.83; p = 0.02). The ROM decreases were more prominent in Western than in Asian cohorts. Conclusions We confirmed the decrease in ROM after 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.

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