Does telomerase activity add to the value of fine needle aspirations in evaluating thyroid nodules?

Background: Telomerase replaces DNA sequences that are lost with cell division. Increased activity has been documented in malignant cells. Fine needle aspiration (FNA) has a 90% sensitivity for diagnosis of papillary carcinomas, but a specificity of 52%. This often leads to unnecessary surgery. Methods: Telomeric repeat amplification protocol assays were performed on FNA specimens of thyroid nodules in 19 patients. These results were compared with the surgical pathology using chi-square analysis. Results: There were 5 malignant and 14 benign nodules. Telomerase activity was found in 3 of 5 malignant (60%) and 9 of 14 benign (64%): sensitivity was 60%, specificity was 36%. Conclusion: Telomerase assays did not add any additional information to FNA alone. Inflammatory changes associated with benign and malignant lesions can possess telomerase activity independent of the malignant state.