LIST DO CZYTELNIKÓW/LETTER TO READERS
Dear Colleagues and Readers,
I feel honored to be invited by Prof. Beata Kos-Kudła, The Editor in Chief of the “Endokrynologia Polska” to write this letter. Most of all I would like to thank Prof. Kos-Kudła for allowing us to publish the papers concerning thyroid cancer.
As probably many of you know the V Conference “Thyroid Cancer and other Endocrine Malignancies” was organized in Wisła, in November 2015. Three-day sessions were devoted to thyroid cancer. All thyroidologists were self-motivated to analyze their experiences. The undoubted achievement was a fruitful discussion and subsequent actualization of the Polish guidelines concerning the diagnostics and treatment of thyroid carcinoma. These updated Recommendations are published in the Postgraduate education section. Before I go to their more detailed presentation I would like to draw your attention to other papers, especially to an extremely important review entitled “Well-differentiated thyroid cancer – are you overtreating your patients?”, written by well-acknowledged surgeon, Dr. Ian Nixon from NHS Lothian University, Edinburgh UK. Dr. Nixon presented an excellent lecture during the conference and agreed to write a paper to our journal. I recommend it because this experienced surgeon precisely defines the assumptions leading to prepare the updated guidelines of American Thyroid Association, written in 2015 and already published in January 2016, as well as the Polish recommendations. Dr. Nixons’s paper unequivocally demonstrates that all of us should assume that our current opinion referred to thyroid cancer has been significantly revised on the basis of careful and believable studies evaluating the course of the disease and its treatment.
The current issue of the Polish Journal of Endocrinology also involves very interesting original reports, presented during the conference of independently sent to Editorial Office.
The first one comes form Gliwice Institute of Oncology (Krajewska et al.) and presents Polish experiences related to a widely discussed ongoing risk stratification.
The next 3 papers touch another important problem, as they focus on diagnostic aspects of thyroid carcinoma. The classification of cytological findings, named Bethesda classification, implemented by NCI in 2008, is currently widely approved in Poland. These 3 reports demonstrate the data related to its use, important for practitioners. In my opinion they result from an excellent cooperation between endocrinologists and pathologists, especially under the Polish Group for Endocrine Tumors. Słowińska-Klencka et al. evaluate indeterminate cytological findings classified as Bethesda III-V, whereas 2 papers from Gliwice (Stanek-Widera et al.) analyze the risk of cancer in a case of follicular lesion of undetermined significance (FLUS, Bethesda III) and suspicion for follicular neoplasm, separately.
Interestingly, in Lodz Center equivocal findings including not only follicular lesion of undetermined significance but also lesions suspicious for follicular neoplasm and for malignancy were selected. In total 648 such diagnoses, with a significant predominance of FLUS were collected during 5 years. I would like to emphasize some differences between these two centers related to their role: Lodz University is a typical endocrinological center – the authors mention that patients are referred by outpatient endocrinological clinics. On the other hand, Gliwice is an oncological hospital and therefore cytological findings among referred subjects are expected to show a higher risk of malignancy. Nevertheless, the frequency of FLUS (Bethesda III) are similar at both centers: it was 3.7–5.1% in Lodz and 2.3% in Gliwice. It clearly speaks for that Polish pathologists are careful using the diagnosis of follicular lesion of undetermined significance (AUS/FLUS) and we may lean on further follow-up, recommended by NCI. The risk of malignancy is relatively low and, what’s more important, comparable in both analyses: 2.4–2.8% and 2.9–5.9% in Gliwice and Lodz, respectively. Author of both reports do not base their assessment only on operated patients but also on patients subjected for follow-up, however, they do not precise its duration.
The significance of molecular diagnostics in a fine needle aspiration biopsy (FNAB), especially the evaluation of BRAF mutation, has been recently widely discussed by thyrologists. As we may remember, BRAF mutation is a mutation that initiates papillary thyroid cancer and is not observed in benign nodules. We may easily conclude that the detection of BRAF mutation in FNAB aspirate is unequivocal with thyroid cancer diagnosis. Lithuanian investigators from Vilnius and independently Polish investigators from Kielce decided to practically verify this hypothesis. The conclusions coming from both studies are interesting and complementary. Beiša et al. assessed the presence BRAF mutation in all thyroid nodules subjected for FNAB. On the other hand, the authors from Kielce (Kowalska et al.) aimed an ambitious challenge to check whether molecular evaluation towards BRAF mutation complements cytological examination and increases its specificity and sensitivity. They decided to confine this analysis to these patients only in whom FNAB finding was equivocal (Bethesda III and IV). The authors consider, whether molecular evaluation may be helpful in treatment planning, please read an interesting discussion that clearly demonstrates that it is not easy to draw a conclusion.
The other article (Gabalec et al.) comes from Czech and constitutes a valuable complementation to the discussion carried out during our conference. The authors retrospectively considered the risk of malignancy in autoimmune Hashimoto thyroiditis (HT) and referred it to TSH level and the presence antithyroid antibodies detected at thyroid FNAB. The authors did not confirm a relationship between HT and thyroid cancer. They did not observe any relation between cancer risk and antithyroid antibodies either. This important conclusion constitutes an addition to the data questioning the coincidence between autoimmune thyroid disorder and thyroid cancer, widely present in endocrinologists’ knowingness.
I think we may close the presentation of original papers – I would like to encourage our Readers to a careful reading of those articles. Please let me mention also an interesting clinical case described by Authors from Warsaw and Poznan (Kunikowska et al.). This paper refers to the imaging possibilities in medullary thyroid cancer with peptides traced with positron gallium.
Reading through this issue of Journal of Polish Endocrinology we encounter “Postgraduate Education” section, where we find Revised Guidelines of Polish National Societies Prepared on the initiative of the Polish Group for Endocrine Tumors. I am well aware of the risk related to the time pressure we felt during preparation of this wide manuscript – it is being published already 2 months after the Conference. Here, I would like to express my sincere gratitude to the Members of the Program Organizing Committee, who put their hearts in intensive preparation of the guidelines immediately after the Conference. Moreover, I would like to thank Professor Beata Kos-Kudła, Associate Professor Dariusz Kajdaniuk, Editor Olga Hollek-Roszak and whole Editorial Team without whom the completion of this challenging task would be impossible. Thanks to them Polish thyroidologists have now the opportunity to refer to the recently published ATA guidelines. I would like to invite all of you to discuss this document with us. We are open to criticism, which, we hope, will stimulate an interesting discussion being a possible introductory elaboration to the revision of our Guidelines in year 2016. Please send your e-mails to the following address: firstname.lastname@example.org.
I wish you interesting reading