The utility of peripheral thyrotropin mRNA in the diagnosis of follicular neoplasms and surveillance of thyroid cancers

Mira Milas, Peter Mazzaglia, Su Ynn Chia, Mario Skugor, Eren Berber, Sethu Reddy, Manjula Gupta, Allan Siperstein

    Research output: Contribution to journalArticle

    21 Scopus citations

    Abstract

    Background: Thyroid cells in peripheral circulation express uniquely thyrotropin receptor (TSHR) mRNA, and their detection may aid thyroid cancer management. Methods: Since 2002, 258 patients had prospective TSHR mRNA measurement by quantitative RT-PCR from peripheral blood before and/or after thyroidectomy. Thyroid cancer detection was assessed from known clinical diagnostic criteria and mRNA for patients with follicular neoplasms (n = 64) and long-term cancer follow-up (n = 13). Results: Adding TSHR mRNA to fine-needle aspiration biopsy (FNAB) maintained high sensitivity (90%) but improved specificity (73%) for thyroid cancer diagnosis. When FNAB specimens indicated follicular neoplasm, a decision algorithm combining TSHR mRNA and abnormal thyroid ultrasound features correctly diagnosed all cancer patients (100% sensitivity) and would have spared operation for benign disease in 38%. Elevated TSHR mRNA on postoperative day1 predicted persistent/recurrent cancer. During long-term thyroid cancer surveillance, TSHR mRNA had a 91% concordance with radioactive iodine whole body scan (WBS)-detectable disease, agreed with thyroglobulin (Tg) levels in 64% of patents, missed disease in 5%, but was more sensitive to detecting disease than Tg levels in 31% of patients, including all patients with Tg antibodies. Conclusions: Detecting circulating thyroid cancer cells is useful for initial thyroid cancer diagnosis and postoperatively predicts recurrent cancer. This novel test promises to enhance thyroid cancer patient care by management algorithms that combine histologic, genomic, and clinical criteria.

    Original languageEnglish (US)
    Pages (from-to)137-146
    Number of pages10
    JournalSurgery
    Volume141
    Issue number2
    DOIs
    StatePublished - Feb 1 2007

    ASJC Scopus subject areas

    • Surgery

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  • Cite this

    Milas, M., Mazzaglia, P., Chia, S. Y., Skugor, M., Berber, E., Reddy, S., Gupta, M., & Siperstein, A. (2007). The utility of peripheral thyrotropin mRNA in the diagnosis of follicular neoplasms and surveillance of thyroid cancers. Surgery, 141(2), 137-146. https://doi.org/10.1016/j.surg.2006.12.002