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Consequences of RET Proto-oncogene Mutation Analysis in Multiple Endocrine Neoplasia, Type 2

Diana L. Learoyd, MB, BS, FRACP; Debbie J. Marsh, PhD; Anne-Louise Richardson; Stephen M. Twigg, MB, BS, FRACP; Leigh Delbridge, MD, FRACS; Bruce G. Robinson, MD, MSc, FRACP

Arch Surg. 1997;132(9):1022-1025.

Abstract
Objective
To assess clinician use and acceptance of RET proto-oncogene mutation testing in multiple endocrine neoplasia, type 2 (MEN 2) family members.

Design
A retrospective survey of clinicians managing 26 MEN 2 families with documented RET mutations to assess the effect of genetic screening on subsequent investigation and management of family members.

Setting
Tertiary referral center for RET mutation testing.

Main Outcome Measures
The screening procedures used by clinicians and the altered incidence of C-cell hyperplasia vs medullary thyroid carcinoma in genetically as opposed to biochemically identified affected family members.

Results
Among RET mutation–positive patients, thyroidectomy performed for clinical or biochemical indications disclosed medullary thyroid carcinoma in 44 (98%) of 45 patients and precursor C-cell hyperplasia in only 1 (2%) patient. When prophylactic thyroidectomy was performed based on a positive genetic result, medullary thyroid carcinoma occurred in 3 (43%) of 7 patients and C-cell hyperplasia in 4 (57%) of 7 patients (P<.001). RET mutation–negative patients were not subjected to further biochemical testing, but 4 had already undergone thyroidectomy based on abnormal results of pentagastrin stimulation tests, including 2 patients who were known to be RET mutation–negative at the time of surgery. RET mutation testing was well accepted and resulted in additional family members consenting to screening in more than 85% of families.

Conclusion
Genetic screening for RET proto-oncogene mutations in MEN 2 is a powerful diagnostic tool that enables prophylactic thyroidectomy to be performed in RET mutation–positive patients at an earlier stage of the disease process than does traditional biochemical screening.

Arch Surg. 1997;132:1022-1025

Author Affiliations
From the Kolling Institute of Medical Research (Drs Learoyd, Marsh, Twigg, and Robinson and Ms Richardson), and the Departments of Endocrinology (Drs Learoyd, Twigg, and Robinson) and Surgery (Dr Delbridge), Royal North Shore Hospital and University of Sydney, Sydney, Australia.

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