Sharma, Pranjali1, Bingham, Robert2; Saber, Suzan2; Rajamani, KK2
1 Internal Medicine Residency Program, Unity Hospital, Rochester Regional Health, Rochester NY, USA
2 Department of Endocrinology, Unity Hospital, Rochester Regional Health, Rochester NY, USA
Background: The Afirma gene expression classifier (GEC) has been validated to identify cytologically indeterminate nodules likely to be truly benign so that surgery can be avoided. However, detection of thyroid malignancy by the “suspicious” result of the Afirma GEC remains under evaluation.
Objective: Determination of incidence of thyroid cancer by “suspicious” Afirma in a community thyroid center
Methods: A retrospective analysis of Afirma testing conducted at a community thyroid center between October 2013 and January 2017 was performed. The final pathology of Afirma “suspicious” nodules was reviewed.
Results: Of 172 Afirma, 86 were deemed suspicious. There was no follow-up in 8 (9%) cases due to death, or change of location or endocrinologists. Of the remaining 78 cases, 73 (93.5%) underwent surgical resection. Thirty (41%) patients had a thyroid malignancy on pathology, of which 25 (83%) were Papillary Thyroid Cancer (PTC), 3 (10%) Follicular, and 2 (7%) Hurthle Cell type. Of the 25 with PTC, 12 (48%) had PTC alone, while 12 (48%) had a combination of Hashimoto’s Thyroiditis (HT) with PTC. One (4%) had a combination of PTC, HT, Multinodular Goiter (MNG) and Follicular Adenoma (FA). Of the 43 (59%) patients with benign pathology, 17 (39.5%) showed HT, 14 (32.5%) showed FA, 8 (19%) showed MNG and 4 (9%) showed Hurthle Cell Adenoma.
Conclusions: We report a thyroid cancer incidence rate of 41% on suspicious Afirma testing, which is in line with that reported in the literature.
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