Extended RET gene analysis in patients with apparently sporadic medullary thyroid cancer: clinical benefits and cost.
RET sequencing has become an important tool in medullary thyroid cancer (MTC) evaluation and should be performed even in the absence of family history of MTC. The most commonly studied exons in index cases are 8, 10, 11, and 13-16. To address the ATA guidelines regarding the sequencing of the entire coding region of RET, we selected 50 patients with sporadic MTC (sMTC) without mutations in the hot spot regions of RET for extended investigation of exons 1-7, 9, 12, 17, 18, and 19. Twenty-seven of 50 patients presented with one or more features suggesting familial disease. We found only a new RET variant (p.Gly550Glu) in one patient with MTC. Several polymorphisms were observed, and their frequency was histogram scaled by exons and introns. Eight patients were also included for somatic mutation search. We estimated the sequencing cost by stratifying into four investigation approaches: (1) hot spot exons in a new patient, (2) the remaining exons if the hot spots are negative in a patient with suspected familial disease, (3) a relative of a carrier for a known RET mutation, and (4) tumor sequencing. In spite of the increasing number of variants being described in MTC, it appears that there is no direct clinical benefit in extending RET germ line analysis beyond the hot spot regions in sMTC. The cost evaluation in apparent sMTC using a tiered approach may help clinicians make more suitable decisions regarding the benefits of investigating only the hot spots against the entire coding region of RET.
Laboratory of Molecular and Translational Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo 04039-032, Brazil.
Susan C
SC
Lindsey
Ilda S
IS
Kunii
Fausto
F
Germano-Neto
Misaki Y
MY
Sittoni
Cléber P
CP
Camacho
Flávia O F
FO
Valente
Ji H
JH
Yang
Priscila S
PS
Signorini
Rosana
R
Delcelo
Janete M
JM
Cerutti
Rui M B
RM
Maciel
Magnus R
MR
Dias-da-Silva
D000328:Adult; D000368:Aged; D000595:Amino Acid Sequence; D001483:Base Sequence; D018278:Carcinoma, Neuroendocrine; D015331:Cohort Studies; D005091:Exons; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D010375:Pedigree; D011110:Polymorphism, Genetic; D051096:Proto-Oncogene Proteins c-ret / Q000235:genetics*; D017422:Sequence Analysis, DNA / Q000379:methods; D013964:Thyroid Neoplasms / Q000191:economics / Q000201:enzymology* / Q000235:genetics* / Q000473:pathology
D051096:Proto-Oncogene Proteins c-ret; C099282:RET protein, human