Can we diagnose noninvasive follicular thyroid neoplasm with papillary-like nuclear features before surgery?

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) can be differentiated from invasive encapsulated follicular variant of papillary thyroid carcinoma (eFV-PTC) by the presence of a tumor capsule or blood vessel invasion in histological examination. The objective of this study was to investigate whether it is possible to distinguish between NIFTP and invasive eFV-PTC before surgery. Patients diagnosed with NIFTP and invasive eFV-PTC from 2017 to 2023 were analyzed for biochemical, ultrasonographic, and cytological features. No differences were found in thyroid function tests, thyroid autoantibody levels, tumor size, or ultrasonographic characteristics. However, patients with invasive eFV-PTC had higher preoperative neutrophil-to-lymphocyte ratio (NLR) values and a higher Bethesda cytology category compared to those with NIFTP. In the multivariable analysis, NLR was the only significant predictor of invasive eFV-PTC. Nevertheless, there was no reliable NLR cutoff for distinguishing between the two entities. Overall, this study substantiates considerable overlap in demographic and clinical data between NIFTP and invasive eFV-PTC. Although the higher NLR observed in thyroid cancer does not provide strong discrimination, it suggests that the invasive nature of tumor cells might elicit a more profound systemic inflammatory or immune response.