Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): Are We All on the Same Page?

Noninvasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a new histology of the thyroid that became reportable to the cancer surveillance community in the United States on January 1, 2017. The significance of the new histology NIFTP and its impact on reportability, histology, staging, and treatment is described. Secondly, some of the current challenges encountered by cancer registrars to process NIFTP cases, include contrasting responses on standard setters' resources, is presented. Third, central registries nationwide were queried to show the reported incidence of NIFTP in 2017.

The goals of this paper are to provide a certified tumor registrar's (CTR's) insight in trying to understand the domino effect of a new histology on reportability guidelines and the challenges determining the most accurate code for these reportable data items.

Review of 24 inquiries on the Commission on Cancer CAnswer Forum from 2016 to 2019 showed that there were questions regarding histology, staging, and reportability for NIFTP. Analysis of these queries and follow-up queries by the author shows that each standard setter has a different time frame for updating their guidelines. Due to these different time frames, it can be challenging for CTRs to understand when and how to apply these changes as they process NIFTP cases. In addition, the NIFTP incidence count in 2017 is provided and compared to predicted estimates of NIFTP for the United States. Forty-seven of 52 central cancer registries nationwide participated in a survey demonstrating that 89% of reporting central registries (42 of 47) had a NIFTP case count in the range of 0-19, while 11% (5 of 47) were in other ranges, including the highest range of 100-119 cases. The total estimated incident count of NIFTP in 2017 is 475.

In sharing lessons learned, the primary hope for this paper is to provide a helpful guide in maneuvering within the many standard setters' resources, and in the case of NIFTP, to highlight why changes may not always be consistent across standard setters. Perhaps the solution is to have 1 location, agreed upon by all standard setters, which would provide announcements and coding information for specific histologies and primary sites.