Endocrine Abstracts

Some thyroid neoplasms recur, metastasise, or become treatment-resistant, while the majority of these increasingly frequently reported cancers are indolent and readily cured. Standard histology is only partially successful in predicting behaviour and likely treatment response. What patients need is tissue based stratified medicine, principally to spare the majority from the relatively aggressive treatment that only the minority really need. Gene expression profiling, microRNA studies, genome-wide association and single-nucleotide polymorphism studies are advancing our understanding of thyroid tumour development and progression, offering chances of diagnostic refinement in certain areas, and are suggesting avenues for the development of targeted therapies e.g. against the mitogen-activated kinase pathway. Particular advances are being made in the further analysis of common Thy3 aspirates, where the few papillary carcinomas of certain types amidst these can be identified by specific BRAF mutations. Thy4 aspirates which come from many papillary carcinomas may be upgraded to Thy5 by similar technology. For follicular tumours, where similar genetic profiles are found in adenomas and carcinomas, results have so far been less helpful. Molecular studies on non-invasive encapsulated follicular variant papillary thyroid cancers and are showing that these are similar to follicular tumours. Analysis for BRAF mutations / RET rearrangements in papillary cancers may stratify tumours as to aggressiveness and radio iodine sensitivity. Much work is needed on application of these techniques to small cytology samples. The fact that follicular adenomas and carcinomas have similar genetic profiles might mean that some follicular adenomas are actually follicular carcinomas that have not yet shown invasion. It is possible that molecular profile rather than histology may reveal the true potential of some neoplasms.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.