Human telomerase reverse transcriptase gene expression and the surgical management of suspicious thyroid tumors

Christopher B. Umbricht, George T. Conrad, Douglas P. Clark, William H. Westra, Dañelle C. Smith, Marianna Zahurak, Motoyasu Saji, Robert Christian Smallridge, Steven Goodman, Martha A. Zeiger

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Purpose: Patients with a preoperative cytologic diagnosis of a suspicious thyroid nodule present a therapeutic dilemma because surgery differs for benign and malignant lesions. To address this issue, several molecular markers, including human telomerase reverse transcriptase (TERT), have been tested as markers of thyroid cancer. Because most studies select cases falling into well-defined categories to test new markers, they may overestimate their discriminatory power when applied to samples that are difficult to classify. Fine-needle aspirates (FNAs) of the thyroid with indeterminate cytology are an example of such cases. Experimental Design: We examined whether assessing TERT mRNA by reverse transcription-PCR could have improved the surgical management in a cohort of 100 patients undergoing thyroidectomy for indeterminate FNA results. Results: Ninety percent of 48 cancers were TERT positive, as were 35% of 52 benign lesions. When 10 cases with concomitant lymphocytic thyroiditis were excluded, the overall sensitivity of TERT was 91% (95% confidence interval, 80-98%) and specificity was 79% (64-90%). No clinical or tumor variable contributed to the predictive ability of TERT except for tumor size, which added only marginally. Basing the surgical approach on the TERT assay alone would have reduced lobectomies performed for malignant disease from 11 to 4 cases and reduced total thyroidectomies for benign lesions from to 15 to 9, an overall 50% reduction in suboptimal treatment. Conclusions: The overall performance of preoperative differential diagnosis for thyroid tumors with indeterminate FNA results can be substantially improved by the inclusion of molecular markers such as TERT.

Original languageEnglish (US)
Pages (from-to)5762-5768
Number of pages7
JournalClinical Cancer Research
Volume10
Issue number17
DOIs
StatePublished - Sep 1 2004

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Telomerase
Thyroid Gland
Gene Expression
Needles
Neoplasms
Thyroidectomy
Autoimmune Thyroiditis
Thyroid Nodule
Thyroid Neoplasms
Reverse Transcription
Cell Biology
human TERT protein
Differential Diagnosis
Research Design
Confidence Intervals
Polymerase Chain Reaction
Messenger RNA
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Umbricht, C. B., Conrad, G. T., Clark, D. P., Westra, W. H., Smith, D. C., Zahurak, M., ... Zeiger, M. A. (2004). Human telomerase reverse transcriptase gene expression and the surgical management of suspicious thyroid tumors. Clinical Cancer Research, 10(17), 5762-5768. https://doi.org/10.1158/1078-0432.CCR-03-0389

Human telomerase reverse transcriptase gene expression and the surgical management of suspicious thyroid tumors. / Umbricht, Christopher B.; Conrad, George T.; Clark, Douglas P.; Westra, William H.; Smith, Dañelle C.; Zahurak, Marianna; Saji, Motoyasu; Smallridge, Robert Christian; Goodman, Steven; Zeiger, Martha A.

In: Clinical Cancer Research, Vol. 10, No. 17, 01.09.2004, p. 5762-5768.

Research output: Contribution to journalArticle

Umbricht, CB, Conrad, GT, Clark, DP, Westra, WH, Smith, DC, Zahurak, M, Saji, M, Smallridge, RC, Goodman, S & Zeiger, MA 2004, 'Human telomerase reverse transcriptase gene expression and the surgical management of suspicious thyroid tumors', Clinical Cancer Research, vol. 10, no. 17, pp. 5762-5768. https://doi.org/10.1158/1078-0432.CCR-03-0389
Umbricht, Christopher B. ; Conrad, George T. ; Clark, Douglas P. ; Westra, William H. ; Smith, Dañelle C. ; Zahurak, Marianna ; Saji, Motoyasu ; Smallridge, Robert Christian ; Goodman, Steven ; Zeiger, Martha A. / Human telomerase reverse transcriptase gene expression and the surgical management of suspicious thyroid tumors. In: Clinical Cancer Research. 2004 ; Vol. 10, No. 17. pp. 5762-5768.
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