Coelho Sabrina Mendes, Vaisman Mário, de Carvalho Denise Pires
Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Potiguara 325/104, 22750-290 Rio de Janeiro, RJ.
Arq Bras Endocrinol Metabol. 2006 Jun;50(3):427-35. doi: 10.1590/s0004-27302006000300004.
Despite the excellent prognosis, differentiated thyroid carcinoma (DTC) may recur in 20-40%, and prognosis is particularly related to early detection of recurrent disease. Therefore, long-term follow-up with sensitive tests is need. Serum thyroglobulin (Tg) has an established role as a tumor marker of relapse. However, there are technical limitations of Tg immunoassays, in special, the interference of anti-Tg antibodies and the method sensitivity is dependent on TSH stimulation. Detection of circulating malignant cells by amplification of tumor-specific mRNA showed initial promising results. However, almost one decade of studies of Tg mRNA detection in peripheral blood, its real contribution for DTC follow-up had not yet been established. After a critical analysis of published data, it is clear that there are many protocol differences and conflicting results. Therefore, it seems that amplification of thyroid-specific mRNAs is not superior to sensitive Tg assays and illegitimate transcription and alternative splicing of Tg are factors that may influence mRNA test specificity.
尽管分化型甲状腺癌（DTC）预后良好，但仍有20%-40%的患者可能复发，而预后尤其与复发病灶的早期检测有关。因此，需要通过敏感检测进行长期随访。血清甲状腺球蛋白（Tg）作为复发的肿瘤标志物已确立其作用。然而，Tg免疫测定存在技术局限性，特别是抗Tg抗体的干扰，且方法灵敏度依赖于促甲状腺激素（TSH）刺激。通过扩增肿瘤特异性mRNA检测循环恶性细胞显示出初步的良好结果。然而，经过近十年对外周血中Tg mRNA检测的研究，其对DTC随访的实际贡献尚未确立。在对已发表数据进行批判性分析后，很明显存在许多方案差异和相互矛盾的结果。因此，甲状腺特异性mRNA的扩增似乎并不优于敏感的Tg检测，并且Tg的非法转录和可变剪接可能是影响mRNA检测特异性的因素。
