To Patient

A doctor becomes a patient, thyroid cancer.


Dr Kitayama and I wrote an essay for patients to understand thyroid cancer.

Please read it at a link below;   I hope it helps patients to understand it before surgery.  

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Thyroid FNA Cytology, Differential Diagnoses and Pitfalls


Thyroid FNA Cytology, Differential Diagnoses and Pitfalls

Thyroid FNA Cytology, Differential Diagnoses and Pitfalls

The second edition, Thyroid FNA Cytology, Differential Diagnoses and Pitfalls, was published, both online and print edition, from Springer in May, 2019. Please visit at There are significant differences in our practice, particularlly between Asian and Western practice. As a results, quality measures (proportions of cytological categories, resecttion rates, risks of malignancy and AUS/M ratio) were significantly different among us even all usees the Bethesda system reporting thyroid FNA cytology. For the purpose of providing individualized guides to readers who are practicing in various geographic areas with different medical settings and social resources, the second edition tries to cover more than those provided by the first edition, and authors from 15 countries (Australia, Canada, China, Korea, Japan, Italy, Philippine, Portugal, Switzerland, Taiwan, Thailand, Turkey, Ukraine, United Kingdom, United States of America) invited to participate.The editor of Thyroid FNA Cytology, Differential Diagnoses and Pitfalls has intentionally provided several topics in duplicate chapters by different authors to show you how they are handled differently, so that readers may select the most suitable and appropriate one related to each reader’s thyroid practice and FNA cytology. This book offers a comprehensive guide to thyroid fine needle aspiration (FNA) cytology. Borderline/precursor tumors, which were introduced in the 4th edition of the WHO classification of thyroid tumors, are also incorporated. In this second edition, prominent international experts discuss the different approaches to thyroid FNA cytology employed in various countries such as Australia, Canada, China, Korea, Portugal, Switzerland, Taiwan, Thailand, Turkey, Ukraine, the USA, UK, Italy and Japan. The book not only covers key principles of thyroid cytopathology but also addresses technical aspects such as procedural complications, liquid-based cytology, immunocytochemistry, staining procedures, and potential pitfalls. Case-based descriptions and clinical findings, radiologic imaging, cytology, and histopathologic diagnosis – all complemented by a wealth of detailed photographs – will help reader understand and overcome many common dilemmas in daily practice. As such, the book represents an indispensable reference work for all cytopathologists, especially those practicing thyroid cytopathology.

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Differences of Clinical Managements between Asia and Western Countries.


Education in medical school should be the same among countries and medical science should be the same in any countries. However, medical practice is not the same among countries due to different economic condition and different ratial back ground. I found one more important factor impacts on clinical managements of patients, and it was different logic and way of thinking among us. I wrote how it was different between Asian countries’ practice and western countries’ practice in the following two publications. I believe these differences count very much for patients. They are free access and please visit them if you are interested in.
  1. Kakudo K, Higuchi M, Horokawa M et al.: Thyroid FNA cytology in Asian practice – Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas. Cytopathology 2017; Nov 2. doi: 10.1111/cyt.12491. [Epub ahead of print]

  2. Kakudo K: How to handle borderline/precursor thyroid tumors in management of patients with thyroid nodules. Gland Surg 2017. doi: 10.21037/gs.2017.08.02

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Borderline Thyroid Tumors in WHO Classification of Endocrine Organs


4th edition WHO Classification

4th edition WHO Classification

The 4th edition of WHO Classification Tumors of Endocrine Organs was published in July, 2017. Borderline tumors of follicular cell origin were incotporated in this thyroid tumor classification very first time. I hope the introduction of the borderline tumor category in thyroid tumor classification will open a new era where pathologists have 3 choices for their diagnoses: benign, borderline, or malignant. Pathologists are no longer forced to decide between benign and malignant—it can be a borderline or precursor tumor. I believe this causes significant changes not only in pathology practice, but also brings significant impacts on clinical management of patients. It opens a new era for endocrinologists and endocrine surgeons to have 3 treatment options for patients with thyroid nodules, treat, not treat, or close follow-up (active surveillance), which would be different from the current clinical management with 2 choices (treat or not treat).  

Borderline/Precursor Tumours in the 4th Edition, 2017 WHO Classification of Thyroid Tumours.


Hyalinizing Trabecular Tumour


Other encapsulated follicular patterned thyroid tumours


Uncertain malignant potential (UMP)

2A-1-1:Follicular tumour of Uncertain malignant potential (FT-UMP)

2A-1-2:Well differentiated tumour of Uncertain malignant potential (WDT-UMP)


Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)

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NIFTP Special Issue in JBCM.


I have published a special issue on NIFTP (non-invasive encapsulated follicular neoplasm with papillary-like nuclear features) in the Journal of Basic and Clinical Medicine ( This is a very first special issue focussing on NIFTP in any scientific journals, and which covered both histological and cytological aspects. It is also characterized by international authors from 8 countries, Eastern and Western practice. This approach elucidated significal differences between the two practice. Please enjoy find those differences and underlining different way of thinking and logics.

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