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Unravelling the genomic landscape of TC has recently led to the development of novel effective targeted treatments. To date, these treatments have mostly been evaluated in non-randomised single-arm phase II clinical trials and are consequently non-reimbursed in several countries. Furthermore, most of these agents must be tailored to individual patient molecular characteristics, a context known as personalised cancer medicine, necessitating a requirement for predictive molecular biomarker testing. Existing guidelines, both in Europe and internationally, entail mostly therapeutic rather than molecular testing recommendations. This may reflect ambiguity among experts due to lack of evidence and also practical barriers in availability of the preferred molecular somatic screening and\/or targeted treatments. This article reviews existing European recommendations regarding advanced\/metastatic TC management with a special focus on molecular testing, and compares findings with real-world practice based on a recent survey involving TC experts from 18 European countries. Significant disparities are highlighted between theory and practice related to variable access to infrastructure, therapies and expertise, together with the insufficient availability of multidisciplinary tumour boards. In particular, practitioners\u2019 choice of what, how and when to test is shown to be influenced by the expertise of the available laboratory, the financing source and the existence of potential facilitators, such as clinical trial access. Overall, the need of a collaborative initiative among European stakeholders to develop standardised, accessible molecular genotyping approaches in TC is underscored.<\/jats:p>","DOI":"10.1007\/s12020-023-03610-5","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T23:21:55Z","timestamp":1700868115000},"page":"585-593","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Improved guidance is needed to optimise diagnostics and treatment of patients with thyroid cancer in Europe"],"prefix":"10.1007","volume":"83","author":[{"given":"Christelle","family":"de la Fouchardi\u00e8re","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Fugazzola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura D.","family":"Locati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara V.","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin P.","family":"Peeters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Camacho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris M.","family":"Simon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Jarz\u0105b","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9603-0460","authenticated-orcid":false,"given":"Romana","family":"Netea-Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,25]]},"reference":[{"key":"3610_CR1","unstructured":"SEER Cancer Stat Facts: Thyroid Cancer. 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L.D.L. is the Chief of the European Organisation for Research and Treatment of Cancer (EORTC) Endocrine Task Force, member of ESMO, AIOM, ITOG, ITCO, AIOCC, EORTC EnTF and H&N Group; has participated in developing ESMO Thyroid cancers guideline, AIOM Thyroid cancers guideline and ESMO Salivary gland cancers guidelines; she reports speaker and consultant fees from Bayer, Eisai, Eli Lilly and Company, Ipsen, Istituto Gentili Srl, Merck Serono, MSD, NewBridge Pharmaceuticals, Roche, Sanofi and Sun Pharmaceutical Industries Ltd; has received institutional funding by Eisai and Merck and Company. L.F. is President Elect of the European Thyroid Association (ETA) and reports consultant fees from Eisai, Ipsen and Eli Lilly and Company. C.V.A. has no commercial conflicts of interest in this manuscript; she is Secretary of the Thyroid Cancer group of the ETA; member of EORTC and ESE-ETEC Endocrine Cancer Task force. R.P.P. is the Leader of the European Reference Network on Rare Adult Cancers (EURACAN) Endocrine Domain. B.J and R.N-M have no conflict of interest regarding this manuscript. P.C. and I.M.S. are employees and stock holders of Eli Lilly and Company.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}