Illustration of thyroid gland intertwined with DNA, symbolizing complexity of thyroid cancer diagnosis.

Thyroid Nodules: Are We Overdiagnosing Cancer?

Mira Elwood in Health & Wellness November 2025 • 4 min read.

"A closer look at Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) and its impact on pre-operative assessment."

The diagnosis and management of thyroid nodules have evolved significantly in recent years. One area of particular interest and concern is the classification and treatment of Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features, or NIFTP. This type of thyroid tumor, while having some characteristics that resemble cancer, is generally considered indolent, meaning it grows slowly and is less aggressive than traditional thyroid cancers.

Historically, NIFTP nodules were often treated with total thyroidectomy, a surgical procedure that removes the entire thyroid gland. However, the understanding of NIFTP as a less aggressive entity has led to a re-evaluation of treatment strategies. Current recommendations often favor a more conservative approach, such as hemithyroidectomy, which removes only half of the thyroid gland. This change aims to reduce the burden of a cancer diagnosis on patients and avoid unnecessary extensive surgery and its potential complications.

Despite these advances, the diagnosis of NIFTP remains challenging. Distinguishing NIFTP from more aggressive forms of thyroid cancer requires careful examination of the nodule's cellular structure. The concern is that over-interpreting certain nuclear features during pre-operative assessments could lead to an overdiagnosis of malignancy, resulting in potentially unnecessary surgery.

Navigating NIFTP: Understanding the risk of overdiagnosis

Illustration of thyroid gland intertwined with DNA, symbolizing complexity of thyroid cancer diagnosis.

A recent study from Glasgow and Clyde provides valuable insights into the pre-operative assessment of NIFTPs. The researchers reviewed the cytology and ultrasonography results of 12 patients diagnosed with NIFTP between September 2016 and March 2018. This retrospective analysis aimed to estimate the risk of overcalling NIFTPs as malignant based on pre-operative assessments.

The study focused on correlating cytological findings (based on Royal College of Pathologists Guidance) and ultrasonography results (using the British Thyroid Association 'U' classification) to assess the accuracy of pre-operative diagnoses. The findings shed light on the challenges and potential pitfalls in differentiating NIFTPs from malignant thyroid nodules.

Cytological findings: Most NIFTPs displayed a microfollicular architecture with subtle nuclear changes. In this study, seven cases were reported as Thy3f (equivalent to SFN/FN in TBSRTC), four as Thy3a (equivalent to AUS/FLUS), and one was insufficient (Thy1).
Ultrasonography results: The majority of nodules (83%) were classified as U3 (indeterminate), mostly solid, isoechoic nodules. Only two (17%) were classified as U4 (suspicious).
Study aim: To estimate the pre-operative risk of overcalling NIFTPs malignant.

These findings highlight the importance of correlating cytological and ultrasonographic results to avoid misdiagnosis. While ultrasound can identify suspicious features, it isn't always definitive. The subtlety of nuclear changes in NIFTPs often requires close scrutiny, emphasizing the expertise needed in cytological interpretation.

The Path Forward: Reducing Overdiagnosis in Thyroid Nodules

While the Glasgow and Clyde study, along with other research, suggests that most NIFTPs are not diagnosed as malignant preoperatively, it is crucial to remain vigilant. Encouraging the correlation of cytology with ultrasound, combined with molecular testing when appropriate, can further refine diagnostic accuracy and help avoid false-positive diagnoses. By carefully considering all available information, healthcare professionals can provide the most appropriate and personalized care for individuals with thyroid nodules.

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This article is based on research published under:

DOI-LINK: 10.1111/cyt.12644, Alternate LINK

Title: What Is The Risk Of An Overdiagnosis Of Malignancy In The Preoperative Assessment Of Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features? A Review Of The Cytology And Ultrasonography Of 12 Cases

Subject: General Medicine

Journal: Cytopathology

Publisher: Wiley

Authors: Foon Ng Kee Kwong, Clare Fenlon, Cynthia Van Der Horst

Published: 2018-11-23

Everything You Need To Know

What exactly is Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP), and how has its understanding changed treatment approaches?

Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features, or NIFTP, is a type of thyroid tumor that has some characteristics that resemble cancer, but it is generally considered indolent. This means it grows slowly and is less aggressive than traditional thyroid cancers. Because of this, the treatment approach has shifted from total thyroidectomy to more conservative methods like hemithyroidectomy to avoid unnecessary surgery and complications.

Can you summarize the key objectives and methodology of the Glasgow and Clyde study concerning the pre-operative assessment of Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP)?

The Glasgow and Clyde study reviewed cytology and ultrasonography results of 12 patients diagnosed with NIFTP. The aim was to estimate the risk of overcalling NIFTPs as malignant based on pre-operative assessments. The findings correlated cytological findings (using Royal College of Pathologists Guidance) and ultrasonography results (using the British Thyroid Association 'U' classification) to assess the accuracy of pre-operative diagnoses.

According to the Glasgow and Clyde study, what were the common cytological findings observed in Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) cases, and what do these classifications signify?

Cytological findings revealed that most NIFTPs displayed a microfollicular architecture with subtle nuclear changes. Specifically, in the Glasgow and Clyde study, seven cases were reported as Thy3f (equivalent to SFN/FN in TBSRTC), four as Thy3a (equivalent to AUS/FLUS), and one was insufficient (Thy1). These classifications indicate varying degrees of follicular neoplasm or atypia, reflecting the challenge in definitively diagnosing NIFTP through cytology alone.

Based on the Glasgow and Clyde study, what were the typical ultrasonography classifications of Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) nodules, and what does this tell us about the role of ultrasound in diagnosing these nodules?

In the Glasgow and Clyde study, the majority of nodules (83%) were classified as U3, indicating they were indeterminate, mostly solid, isoechoic nodules. Only two nodules (17%) were classified as U4, suggesting suspicious features. This distribution highlights that while ultrasound can identify suspicious characteristics, it is not always definitive in distinguishing NIFTP from malignant thyroid nodules. Ultrasound findings must be carefully correlated with cytological results and potentially molecular testing to improve diagnostic accuracy.

What strategies can be implemented to minimize the risk of overdiagnosing Non-Invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) as malignant, and why is this important?

To reduce overdiagnosis of NIFTP as malignant, it's crucial to correlate cytology with ultrasound results, and when appropriate, incorporate molecular testing. This comprehensive approach enhances diagnostic accuracy, helping to avoid false-positive diagnoses and unnecessary surgeries. This strategy ensures patients receive the most appropriate and personalized care based on a thorough evaluation of all available information.