ATA Guidelines Tools

Diagnosis 6 Recommendation 1 ➤ Non-invasive follicular tumors with papillary-like nuclear features (NIFTP) and other tumors of uncertain malignant potential (Follicular Tumor of Uncertain Malignant Potential and Hyalinizing Trabecular Tumor) are diagnosed pathologically and have a very low malignant potential (lower than the lowest-risk DTC). Further treatment with completion thyroidectomy/lymphadenectomy and/or RAI is not advised routinely. The optimal approach to postoperative monitoring of these tumors is uncertain. (GPS) Recommendation 2 ➤ Germline genetic testing may be offered in the following scenarios (Table 4): a. Clinical suspicion for Cowden/PTEN Hamartoma Tumor syndrome due to a combination of DTC and non-thyroid malignancy/tumors/features. (C-M) b. In patients who were diagnosed with familial non-medullary thyroid cancer (FNMTC) as children, clinical and family history should be evaluated for features of DICER1 tumor predisposition. Consideration may be given to germline DICER1 testing in patients from families with pediatric patients with DTC. (C-VL) c. Pathologic diagnosis of cribriform morular thyroid carcinoma (APC gene). (C-M) d. Other combinations of tumors and/or cancers in a patient and/or their family members may raise concern for a hereditary predisposition condition, including rare conditions such as Carney complex or Werner syndrome. In these patients, genetic counseling and testing may be offered. (C-M) Recommendation 3 ➤ There is a lack of evidence to suggest the utility of clinical germline genetic testing in non-syndromic FNMTC. In non-syndromic FNMTC, the non-thyroid malignancies in the family may drive decision-making regarding genetic testing. (C-M) Recommendation 4 ➤ Individuals with a family history of FNMTC should have a careful history and directed neck examination as a part of regular health maintenance. Ultrasound screening may be considered in first- degree family members of individuals who meet criteria for a clinical diagnosis of FNMTC due to the presence of three or more (first or second degree) related individuals with diagnoses of non-medullary thyroid cancer (NMTC). Ultrasound screening may also be considered in families with only two affected individuals showing other concerning features (such as particularly young ages of diagnosis) or with limited family structure. The age for initiation of such screening requires further study and should be carefully weighed against the risk of overtreatment. (C-VL)

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