Thyroid Cancer Research Update – April 2020

Dr James Lee continues to pursue his passion in academic surgery, in both research and education. He is the Principle Investigator for a first-in-Victoria molecular study of thyroid nodule biopsy samples, and supervises research students in other clinical studies in various areas of endocrine surgery. For the 5th consecutive year, in 2019, James co-convened the Royal Australasian College of Surgeons Annual Academic Meeting. This year, the invited speakers included Winthrop Professor of Plastic Surgery and Australian of the Year (2005) Fiona Woods, and Chair of Department of Surgery at College of Medicine Tucson Professor Taylor Riall.

The thyroid cancer molecular research program based at The Alfred, so generously supported by The Aftershock, has commenced the multicentre trial Accuracy and Clinical Utility of Genomic Profiling using Next Generation Sequencing (NGS) (FNA-NGS). This study aims to improve the ability for needle biopsy samples of thyroid nodules to provide a definitive diagnosis of cancer or benign disease. At present, 20 to 25% of needle biopsies return an indeterminate result, and this negatively impacts on the clinician’s ability to provide a definitive recommendation for surgery or be precise about the extent of required surgery. Mr. Lee’s research revealed, that, in 2019, up to 60% of patients with indeterminate needle biopsy results are potentially over-or under-treated in their first surgery, compared to only 11% in patients with a definitive diagnosis on needle biopsy. These findings we republished in the prestigious European Journal of Surgical Oncology. Another study that links in with this research and was published in 2019 in the World Journal of Surgery added to the growing body of literature that our current routinely available clinical and biochemical information is insufficient in improving the accuracy of needle biopsy samples with indeterminate results this research concluded that further studies, of the needle biopsy samples, especially in the area of molecular testing, have the potential to improve preoperative diagnostic accuracy. This statement echoes the guidelines for future research in the widely quoted 2015 American Thyroid Association Guidelines.

Over the last 12 months, the FNA-NGS study has progressed steadily in collaboration with The Epworth, the Peter MacCallum Cancer Centre (PMCC), Monash Health, Epworth HealthCare, Cabrini Hospital and The Alfred Hospital. Ethics has been approved by the Human Research Ethics Committee of Monash Health, under the National Mutual agreement. Governance approval has also been granted at Monash Health and Epworth Health Care, and is in progress at The Alfred and Cabrini.

Stage 1 of patient recruitment commenced in September 2019 at Monash Health and Epworth HealthCare, with the view to commence patient recruitment at The Alfred and Cabrini in early 2020.

In addition to his academic work, Mr. James Lee is part of the Monash Endocrine Surgery Unit and has public appointments at both The Alfred and Monash Health, thus providing service in the public sector for a large catchment area. Mr. Lee also treats patients in the private sector at Epworth Richmond Private Hospital and Knox Private Hospital. In 2019, Mr. James Lee performed over 140 endocrine surgical procedures, including surgery of the thyroid, parathyroid and adrenal glands, which puts him in the high-volume category for endocrine surgeons. Mr. Lee also performed surgery for trauma patients needing laparotomy, acute general surgical conditions, and various types of hernias.

Next Steps

While patient recruitment is ongoing for the Accuracy and Clinical of Genomic Profiling using Next Generation Sequencing (NGS) (FNA-NGS) study, in 2020, Mr. Lee is looking forward to setting up further studies and a thyroid cancer molecular tumour board to provide multi-disciplinary opinions on the clinical implications of molecular testing results for patients from all over Victoria.

Another area of research for 2020 is in-patient reported outcomes measures (PROM). Mr. Lee and the Monash University Endocrine Surgery Unit will collaborate with the Australia-New Zealand Thyroid Cancer Registry to set up studies based on patient-reported outcomes. The aims of these studies will be to better understand clinical outcomes form the patients perspective, and for clinicians t learn how better to treat patients with thyroid disease who may require surgery.

In combination, the molecular studies and PROM studies will greatly advance or ability to provide personalized and patient-centred care for an increasing pool of patients with thyroid nodules, and those who may need thyroid surgery.