Endocrine Abstracts

Background: Anaplastic thyroid carcinoma (ATC) is a rare but highly aggressive malignancy, accounting for <2% of thyroid cancers but up to 50% of thyroid-related mortality. UK median survival is around 3 months. Timely diagnosis, molecular profiling and multidisciplinary care are critical to optimize outcomes. This audit evaluated diagnostic and early management pathways for ATC at a single trust in reference to 2021 American Thyroid Association (ATA) guidelines.

Methods: A retrospective audit identified all ATC cases between January 2013 and December 2024 using SNOMED codes M8021/3, M8020/3, M8050/3, and M0950/3. Data were collected from electronic and pathology records and MDT minutes. Audit standards were derived from the 2021 ATA guidelines for ATC, focusing on tissue diagnosis, staging, molecular testing and MDT coordination.

Results: 16 ATC cases were diagnosed over 11 years (median age 71 years; 11 females). 14 patients (88%) had died at analysis. Median survival was 99 days, with one long-term survivor of approximately 5 years. All patients underwent FNA or core biopsy, with both performed in 6 cases. Surgery was amenable in 4 patients (25%). 5 patients (31%) completed BRAF V600E testing with 1 positive. Broader molecular profiling was done in 2 cases (13%). All underwent radiological staging with CT/MRI +/-PET. Documentation of vocal cord assessment at presentation was inconsistent. All but 2 patients were discussed at MDT (incomplete records).

Conclusion: A revised ATC pathway now recommends mandatory molecular testing, rapid inpatient FNA plus core biopsy and MDT discussion with early palliative input. A re-audit is planned after 12 months.