Τρίτη, 19 Απριλίου 2016

A CHENGE IN THYROID CANCER CLASSIFICATION

An international panel of pathologists and clinicians has reclassified a type of thyroid cancer to reflect that it is noninvasive and has a low risk for recurrence.
The panel renamed encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).
"To my knowledge, this is the first time in the modern era a type of cancer is being reclassified as a noncancer. I hope that it will set an example for other expert groups to address nomenclature of various cancer types that have indolent behavior to prevent inappropriate and costly treatment," senior investigator Yuri Nikiforov, MD, PhD, director of the Division of Molecular and Genomic Pathology, University of Pittsburgh School of Medicine, Pennsylvania, said in a statement.
The panel's research that led to the name change is described in an article published online April 14 in JAMA Oncology.
"The change in nomenclature could affect the clinical care and management of more than 45,000 patients worldwide per year," comments Kepal N. Patel, MD, of the Division of Endocrine Surgery, Thyroid Cancer Interdisciplinary Program, New York University Langone Medical Center, New York City.
In an accompanying editorial, Dr Patel says, "the reclassification of noninvasive EFVPTC to NIFTP is a timely and appropriate change.
"By removing the word cancer, the term NIFTP acknowledges the low malignant potential of these tumors," Dr Patel writes. "This will potentially affect the way the disease is viewed by caregivers and patients. It will eliminate the psychological impact of receiving a cancer diagnosis.
"Furthermore, the new designation recognizes the appropriate biological behavior of this tumor and should decrease the overtreatment that the term cancer often breeds, which in turn will reduce treatment costs and also reduce the risk of patients being exposed to unnecessary risk."
Incidence Rising in Recent Years
Dr Nikiforov and colleagues point out that the incidence of EFVPTC has risen two- to threefold during the past 20 to 30 years and makes up 10% to 20% of all thyroid tumors diagnosed in Europe and North America. This increased incidence has been explained by improvements in diagnosis. It has been described as an "epidemic of diagnosis" rather than a true increase in disease.
The researchers also note that although mounting evidence points to highly indolent behavior of EFVPTC, most patients with this tumor type receive treatment as if they had conventional thyroid cancer, which includes surgery to have the thyroid gland removed followed by radioactive iodine treatment.
"Aside from the stigma of a 'cancer' diagnosis and the morbidity of aggressive treatment for PTC, patients and health care professionals have to cope with the rapidly increasing costs of care for patients with thyroid cancer, which were estimated to exceed $1.6 billion in 2013 in the United States alone," the team writes.
At the recommendation of the National Cancer Institute, the panel sought to revise the terminology and to see whether the word "cancer" could be dropped from the name.
An international team of pathologists independently reviewed 268 tumor samples diagnosed as EFVPTC from 13 institutions. They established diagnostic criteria, including cellular features, tumor invasion, and other factors. In 109 patients with noninvasive EFVPTCs, there were no recurrences or other manifestations of the disease at a median follow-up of 13 years, the panel found. On the basis of this information regarding outcomes, as well as other information, the panel decided to rename EFVPTC as NIFTP.
"We determined that if NIFTP is carefully diagnosed, the tumor's recurrence rate is extremely low, likely less than 1% within the first 15 years," Dr Nikiforov said in the statement.
"The cost of treating thyroid cancer in 2013 was estimated to exceed $1.6 billion in the US. Not only does the reclassification eliminate the psychological impact of the diagnosis of 'cancer,' it reduces the likelihood of complications of total thyroid removal and the overall cost of healthcare," he added.
Move Away From "Cancer" Sets a Precedent
This move to stop using the term "cancer" to describe a tumor set a precedent, but will it have an impact in other areas of oncology? There have been discussions for some time now regarding the move away from the word "cancer" in the description of early stages of both breast and prostate cancer.
In 2013, a working group sanctioned by the National Cancer Institute proposed that a number of premalignant conditions, including ductal carcinoma in situ and high-grade prostatic intraepithelial neoplasia, should no longer be called "cancer."
Instead, the conditions should be labeled something more appropriate, such as indolent lesions of epithelial origin (IDLE), the working group suggested. "Use of the term 'cancer' should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated," the group said at the time.
The proposal to move away from the word "cancer" for slow-growing prostate tumors had been aired earlier, in 2011, by an independent panel of the National Institutes of Health, but at the time, oncologists argued against the move, saying a change in name would confuse patients and arguing that "slow-growing cancer is still real cancer."
Dr Nikiforov acts as a consultant for Quest Diagnostics, and two coauthors have relationships with industry. Dr Asa is a member of the Medical Advisory Board of Leica Aperio, and Dr LiVolsi is a consultant for Veracyte, Inc. Dr Patel reports no relevant financial relationships.
JAMA Oncol. Published online April 14, 2016

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