Diagnostics and Treatment of Thyroid Carcinoma.

Revised Guidelines of Polish National Societies Prepared on the initiative of the Polish Group for Endocrine Tumours approved in their final version between November 16th and 28th, 2015 by the Scientific Committee of the V Conference "Thyroid Cancer and other malignancies of endocrine glands" organised between November 14th and 17th, 2015 in Wisla, Poland; called by the following Societies: Polish Endocrine Society, Polish Society of Oncology, Polish Thyroid Association, Polish Society of Pathologists, Society of Polish Surgeons, Polish Society of Surgical Oncology, Polish Society of Clinical Oncology, Polish Society of Radiation Oncology, Polish Society of Nuclear Medicine, Polish Society of Paediatric Endocrinology, Polish Society of Paediatric Surgeons, Polish Society of Ultrasonography Gliwice-Wisla, 2015 DECLARATION: These recommendations are created by the group of delegates of the National Societies, which declare their willingness to participate in the preparation of the revised version of the Polish Guidelines. The members of the Working Group have been chosen from the specialists involved in medical care of patients with thyroid carcinoma. Directly before the preparation of the Polish national recommendations the American Thyroid Association (ATA) published its own guidelines together with a wide comment fulfilling evidence-based medicine (EBM) criteria. ATA Guidelines are consistent with National Comprehensive Cancer Network (NCCN) Recommendation. According to the members of the Working Group, it is necessary to adapt them to both the specific Polish epidemiological situation as well as to the rules referring to the Polish health system. Therefore, the Polish recommendations constitute a consensus of the experts' group, based on ATA information. The experts analysed previous Polish Guidelines, published in 2010, and other available data, and after discussion summed up the results in the form of these guidelines. It should be added that Part II, which constitutes a pathological part, has been available at the website of the Polish Society of Pathologists for acceptance of the members of the Society, and no essential comments have been proposed. The Members of the Group decided that a subgroup elected from among them would update the Guidelines, according to EBM rules, every year. The Revised Guidelines should help physicians to make reasonable choices in their daily practice; however, the final decision concerning an individual patient should be made by the caring physician responsible for treatment, or optimally by a therapeutic tumour board together with the patient, and should take into consideration the patient's health condition. It should be emphasised that the recommendations may not constitute a strict standard of clinical management imposed on medical staff. The data from clinical trials concerning numerous clinical situations are scarce. In such moments the opinion of the management may differ from the recommendations after considering possible benefits and disadvantages for the patient.

Fine-needle aspiration biopsy of the thyroid in an area of endemic goitre: influence of restored sufficient iodine supplementation on the clinical significance of cytological results.

OBJECTIVE: The iodine status of the population of Poland has markedly improved over the past years. The aims of this paper were: (i) to examine the diagnostic value of fine-needle aspiration biopsy (FNAB) of the thyroid in goitre endemic regions (in conditions of improved iodine supply), and (ii) to find whether the changes in iodine supply have already influenced the clinical interpretation of cytological results. METHODS: Cytological diagnoses, based on 3782 aspirates, obtained from 3572 patients during the years 1985-1999, were verified by reference to the results of postoperative examinations. The relative occurrences of selected cytological results in 1992-1999 were also compared (patients not subjected to surgery were included). RESULTS: We have found that the frequency of neoplastic lesions significantly decreased throughout the examined period (P<0.02). The ratio of the papillary carcinoma frequency to the follicular carcinoma frequency increased from 1.7 during 1992-1993 up to 8.0 during 1998-1999 (P<0.05). The frequency of cytologically diagnosed chronic thyroiditis increased from 1.5% in 1992 to 5.7% in 1999 (P<0.001); the percentage of cytological diagnosis of "follicular neoplasm" decreased during the same time (P<0.001). The risk of malignancy significantly lowered in the cytological diagnoses of "follicular neoplasm" from 15% during 1985-1993 to 6% during 1996-1999 (P<0.05). CONCLUSIONS: The diagnostic value of FNAB during the period without proper iodine prophylaxis did not differ significantly from that during the last examined period. However, the changes in iodine supply have markedly and promptly affected the clinical significance of particular cytological results.