臨床医の方へ
第5回奈良甲状腺研究会
2014/09/21
9月20日、第5回奈良甲状腺研究会が、奈良県立医科大学の厳橿会館で開かれました。参加したのは2回目で、今回より顧問としておよびいただき、甲状腺細胞診について20分の講演時間を頂きました。今甲状腺細胞診は大きく変化し、分子診断が取り入れられるなど変革の時代を迎えています。甲状腺細胞診の概念を変えて、臨床での役割を向上させたいと考え、喜んでお引き受けいたしました。
この後、10月30日福岡の第47回甲状腺外科学会でもランチョンとして、細胞診で講演させていただく予定です。また、来春の4月25日日本内分泌学会での教育講演でも、甲状腺細胞診を予定しています。現状の一般の細胞診では、半数程度以上が結論の出ない診断（検体不適+鑑別困難+悪性疑い）が帰ってくるなど、臨床医の信頼の得られない、役に立たない甲状腺細胞診となっています。これを変えていきたい。目標は、（結論の出ない診断を20％以下に抑え）信頼される、頼られる細胞診に変えたいと思っています。興味のある方は是非ご参加ください。
なお、この第5回奈良甲状腺研究会には、昔の同僚である和歌山県立医科大学赤水教授も特別講演で参加され、和歌山のことを懐かしく思い出しました。甲状腺学会理事長として活躍されており、来年の国際甲状腺学会シンポジウムに演者として推薦したと伺いました。私の仕事が広がることに感謝しています。
category: 病理医の方へ , 細胞診専門医、細胞検査士の方へ , 臨床医の方へ comment: (0)
バーチャル臨床甲状腺カレッジ
2014/09/06
日本甲状腺学会はバーチャル臨床甲状腺カレッジを設定し、専門医をめざす修練医、甲状腺疾患を学ぶ人々に教材として提供しています。私も基礎解剖学と、ＩｇＧ４甲状腺炎を担当しています。2014年9月内容が更新されました。以下のアドレスよりご覧いただけます。お時間のある時に試してください。
ＵＲＬ： http://www.thyroid-college.jp/
category: 細胞診専門医、細胞検査士の方へ , 臨床医の方へ comment: (0)
伊藤病院クリニカルカンファレンス
2014/08/02
6月17日に伊藤病院クリニカルカンファレンスにお招きいただきました。「IgG4甲状腺炎」について我々の仕事を紹介させていただく機会となりました。伊藤病院クリニカルカンファレンスでは、いつか一度しゃべってみたいと思っていたのですが、長崎大学におられた長瀧先生、帝京大学におられた高見先生などがおられる前での、講演でしたので、少し緊張しました。日本から発信されたIgG4関連疾患と、甲状腺炎の観点で、現在の到達点を紹介させていただきました。
category: 臨床医の方へ comment: (0)
Shan先生がopen access journal(J Basic Clinical Medine)を発行しました。
2014/04/09
Shan先生がopen access journal(J Basic Clinical Medine)を発行しました。応援を兼ねて、第2号に甲状腺特集を組み、日本から4編の論文を特集として掲載しています。是非 http://sspublications.org/index.php/JBCM をご覧ください。私からは甲状腺微小癌について、総説を書きました。微小乳頭癌は本当に癌と呼ぶべき腫瘍なのか？どのように治療すべきかについて私の疑問を書いています。open accessですので、ぜひご覧ください。中村美砂先生は彼女のライフワークカルシトニンとプロカルシトニンの不思議について彼女の切り口で解説してくれました。若狭先生は甲状腺炎に見られた異常細胞を記録しています。
category: 同門会 , 病理医の方へ , 細胞診専門医、細胞検査士の方へ , 臨床医の方へ comment: (0)
A patient’s message from Turkey
2013/12/25
Dear Dr Kakudo
I wanted to write to you about how I feel on your second opinion diagnosis. For people who will read this story for the first time I would like to simply explain my situation. I’m a male at my 37. I had lobectomy operation due to a thyroid nodule of 2.7cm in size at my left thyroid lobe. Pathology report after surgery said “Follicular Variant of Papillary Carcinoma” and I was advised to go for completion surgery and radioactive iodine (RI) treatment.
After reading many articles including yours about borderline lesions I started to question if surgery was the best option for my health or not. Then I started to follow “thyroid cancer survivors association group” at “inspire.com”. Following this site gave me a better understanding of how people feel without thyroid gland, short and long term side effects. And based on an advice from a friend from that group I decided to contact you and you kindly accepted to give me your second opinion.
Your diagnosis result says “findings are incomplete and do not fulfill histopathologic criteria for either follicular carcinoma or papillary carcinoma”. And this type of tumor are “practically benign after simple excision”. This difference in opinion obviously makes a big change for management of the disease. No need for completion surgery and no need for RI treatment.
As a patient going through all this on one hand I feel lucky because it’s not a genuine cancer case where none of above mentioned discussion could be possible. I also feel lucky because I had a chance to read and better understand risks and downsides of surgery and RI treatment before deciding anything further. On the other hand not going down that road may have other risks in specific cases and today we are not 100% sure about long term outcome for each individual. However statistically there is a strong evidence that we are almost 100% sure (your study shows 0,03% missing malignancy judging) there will be no recurrence or distant metastasis.
Reflecting on my case and many others it’s clear to me that there is a difference in opinion between pathologists and this has a direct impact on management of the disease. Important point to me is to give enough information to patients so that they can make their own decisions. Not just say this is your problem and this is the one and only solution. Take it or not! I could have felt much better if risks of surgery and RI and not doing that was explained to me objectively. At the end it’s my life and I have to make a decision. Why should I have to find out difficulties in diagnosis and even classification of borderline lesions by myself? How many people will (be able to) do what I did? And how many people will just do what is told? Therefore how many people will possibly be treated for nothing? And their quality of life and feeling about their health is impacted adversely for the rest of their lives.
I hope answers to above questions will be discussed more and more in the coming years. And until we find a clear method to identify what is definitely malignant and what is not I hope doctors around the world will give more information to their patients and explain real difficulty to make this identification. And let people decide what is best for themselves.
Finally I want to say thank you for your second opinion diagnosis which made a big change in my life. And a big thank you for your life time studies and sharing what you believe is right to make a change in people’s lives.
I wanted to write to you about how I feel on your second opinion diagnosis. For people who will read this story for the first time I would like to simply explain my situation. I’m a male at my 37. I had lobectomy operation due to a thyroid nodule of 2.7cm in size at my left thyroid lobe. Pathology report after surgery said “Follicular Variant of Papillary Carcinoma” and I was advised to go for completion surgery and radioactive iodine (RI) treatment.
After reading many articles including yours about borderline lesions I started to question if surgery was the best option for my health or not. Then I started to follow “thyroid cancer survivors association group” at “inspire.com”. Following this site gave me a better understanding of how people feel without thyroid gland, short and long term side effects. And based on an advice from a friend from that group I decided to contact you and you kindly accepted to give me your second opinion.
Your diagnosis result says “findings are incomplete and do not fulfill histopathologic criteria for either follicular carcinoma or papillary carcinoma”. And this type of tumor are “practically benign after simple excision”. This difference in opinion obviously makes a big change for management of the disease. No need for completion surgery and no need for RI treatment.
As a patient going through all this on one hand I feel lucky because it’s not a genuine cancer case where none of above mentioned discussion could be possible. I also feel lucky because I had a chance to read and better understand risks and downsides of surgery and RI treatment before deciding anything further. On the other hand not going down that road may have other risks in specific cases and today we are not 100% sure about long term outcome for each individual. However statistically there is a strong evidence that we are almost 100% sure (your study shows 0,03% missing malignancy judging) there will be no recurrence or distant metastasis.
Reflecting on my case and many others it’s clear to me that there is a difference in opinion between pathologists and this has a direct impact on management of the disease. Important point to me is to give enough information to patients so that they can make their own decisions. Not just say this is your problem and this is the one and only solution. Take it or not! I could have felt much better if risks of surgery and RI and not doing that was explained to me objectively. At the end it’s my life and I have to make a decision. Why should I have to find out difficulties in diagnosis and even classification of borderline lesions by myself? How many people will (be able to) do what I did? And how many people will just do what is told? Therefore how many people will possibly be treated for nothing? And their quality of life and feeling about their health is impacted adversely for the rest of their lives.
I hope answers to above questions will be discussed more and more in the coming years. And until we find a clear method to identify what is definitely malignant and what is not I hope doctors around the world will give more information to their patients and explain real difficulty to make this identification. And let people decide what is best for themselves.
Finally I want to say thank you for your second opinion diagnosis which made a big change in my life. And a big thank you for your life time studies and sharing what you believe is right to make a change in people’s lives.
