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Suspicious ultrasound and clinicopathological features of papillary thyroid carcinoma predict the status of TERT promoter

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Abstract

Purpose

To investigate the value of ultrasound (US) and clinicopathological features of papillary thyroid cancer (PTC) in predicting Telomerase Reverse Transcriptase (TERT) promoter mutations.

Methods

Preoperative US images of 351 surgically confirmed PTCs were evaluated in terms of PTCs size and US features. The basic clinicopathological features were also retrieved. Univariate and multivariate analyses were performed to identify the risk factors for TERT promoter mutations. A scoring system was developed based on the cumulative number of risk factors. The area under the receiver operating characteristic curve (AUC) and cut-off value were calculated to evaluate the diagnostic performance of the scoring system for predicting TERT promoter mutations.

Results

TERT promoter mutations were found in 4.84% (17/351) of patients with PTCs. Patient age >50 years (OR: 6.244, P = 0.006), multifocality (OR: 21.071, P = 0.022), taller-than-wide shape (OR: 4.934, P = 0.029), microlobulated margin (OR: 4786, P = 0.032), and capsule contact or involvement (OR: 4.668, P = 0.030) were independent risk factors for TERT promoter mutations. TERT promoter mutations were relevant to more suspicious US and clinicopathological features than TERT promoter wild-type PTC (median, 4 vs. 1, P < 0.001). The cut-off value was 2.5 and the associated AUC was 0.908 (P < 0.001).

Conclusions

The probability of TERT promoter mutations increases along with the suspicious US features and clinicopathological characteristics, which may help to recognize patients who deserve a different approach, in terms of management and follow-up, in view of the worst outcome associated to this mutation.

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Funding

This work was supported in part by the National Natural Science Foundation of China (Grants 81671695, 81725008, and 81927801), Fundamental Research Funds for the Central Universities (Grants 22120190213, 22120190021 and 22120190137), Shanghai Municipal Health Commission (Grants 2019LJ21 and SHSLCZDZK03502), and the Science and Technology Commission of Shanghai Municipality (Grants 19441903200).

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Authors and Affiliations

  1. Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, 200072, China

    Hui Shi, Le-Hang Guo, Yi-Feng Zhang, Han-Xiang Wang, Chong-Ke Zhao & Hui-Xiong Xu

  2. Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China

    Hui Shi, Le-Hang Guo, Yi-Feng Zhang, Hui-Jun Fu, Jia-Yi Zheng, Han-Xiang Wang, Chong-Ke Zhao & Hui-Xiong Xu

  3. Shanghai Center for Thyroid Diseases, Shanghai, 200072, China

    Hui Shi, Le-Hang Guo, Yi-Feng Zhang, Hui-Jun Fu, Jia-Yi Zheng, Han-Xiang Wang, Chong-Ke Zhao & Hui-Xiong Xu

  4. Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, China

    Hui-Jun Fu & Jia-Yi Zheng

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  1. Hui Shi
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Shi, H., Guo, LH., Zhang, YF. et al. Suspicious ultrasound and clinicopathological features of papillary thyroid carcinoma predict the status of TERT promoter. Endocrine 68, 349–357 (2020). https://doi.org/10.1007/s12020-020-02214-7

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