Potential NIFTP Patients: Your Pathologist May not Feel an Ethical Obligation to Review Your Case

A blog was published on Medscape by the pathologist Thomas Wheeler in which he seems to opine that it’s optional for pathologists to inform recent patients with non-invasive encapsulated FVPTC that their “cancer” has been reclassified, and also unnecessary for them to undertake an investigation into potential cases which are not considered to be “recent”.  Entitled ” Thyroid Cancer Yesterday, Benign Thyroid Today!“,  the blog post appears to criticize the principle author of the JAMA article which called for the reclassification of  N-EFVPTC, Yuri Nikiforov.  Nikiforov stated in a New York Times article that he felt there was an ethical obligation to inform impacted thyroid cancer patients that their cancer had been reclassified to a non-malignant condition.

Thomas Wheeler’s article, which is potentially disturbing to affected patients, can be found on Medscape by running a google search on the article’s title.  A free membership to Medscape may be required to view the article which includes a poll of pathologists. According to the poll,  many pathologists do not have firm plans to review past cancer cases that may not be considered as malignant under the new diagnostic criteria.

Given recent research which quantified the deleterious psychological impact of a thyroid cancer diagnosis, why would some pathologists not feel obligated to “correct” the record for NIFTP cases which are on their books as “cancer” diagnoses?  A portion of the reason may be purely logistical in nature.  It is likely that in many older cases, the original samples are no longer available for re- evaluation.  In other instances, there simply may not be enough resources within a department to undertake a comprehensive review.  For these types of situations, the responsible pathologists may feel it’s better to “let sleeping dogs lie.”

But in his post, Dr. Wheeler mentions another possible reason for not evaluating past cases that could be reclassified as NIFTP.  He writes, “if on review another expert did not consider that the nuclear features were diagnostic of EFVPTC even by the old criteria, that would be problematic”.  He is concerned that EFVPTC’s checkered history of “diagnostic disagreements” will come back to haunt pathology departments, creating embarrassment and other possible repercussions.  There may be a modicum of validity to his concerns. However the implication that some pathologists would be willing to let a patient go on believing that they had “cancer” rather than owning up to the uncomfortable truth makes it appear that the professionals involved are more interested in covering for themselves and their colleagues than they are in patient care.