EP58 – Is A “Suspicious” Afirma Really Suspicious? – Experience at a Community Thyroid Center

      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.   References:
    1. Roychoudhury S, Klein M, Souza F, Gimenez C, Laser A, Shaheen Cocker R, Chau K, Das K. How “suspicious” is that nodule? Review of “suspicious” Afirma gene expression classifier in high risk thyroid nodules. Diagn Cytopathol. 2017 Feb 11. doi: 10.1002/dc.23680
    2. Kloos RT. Molecular Profiling of Thyroid Nodules: Current Role for the Afirma Gene Expression Classifier on Clinical Decision Making. Mol Imaging Radionucl Ther. 2016 Jan 5;26 (Suppl 1):36-49. doi: 10.4274/2017. 26.suppl.05.
    3. McIver B et al. An independent study of a gene expression classifier (Afirma™) in the evaluation of cytologically indeterminate thyroid nodules. J Clin Endocrinol Metab. 2014 Nov;99(11):4069-77. doi: 10.1210/jc.2013-3584


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