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Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel.

Publication ,  Journal Article
Jug, RC; Datto, MB; Jiang, XS
Published in: Cancer Cytopathol
July 2018

BACKGROUND: The ThyroSeq mutational panel and Afirma gene expression classifier (GEC) are used to risk stratify cytologically indeterminate thyroid nodules. In the current study, the authors evaluated the performance of these tests within the context of ultrasonographic features and with the incorporation of the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) nomenclature. METHODS: The authors reviewed nodules using ThyroSeq or Afirma GEC testing. For nodules that were surgically resected, both tests were studied within the context of ultrasound findings, comparing performance stratified by the 2015 American Thyroid Association guideline (ATA 2015) sonographic patterns and assessing the positive predictive value (PPV) of these tests both including and excluding NIFTP in the malignant category. RESULTS: A total of 304 cases were identified, 119 of which were resected. All cases that met the criteria for NIFTP on excision demonstrated either high-risk mutations on ThyroSeq or a "suspicious" result on Afirma GEC. When NIFTP cases were shifted from the malignant to nonmalignant category, the PPV of "positive" tests for both ThyroSeq and Afirma GEC decreased from 42.9% to 14.3% (an absolute decrease of 28.6%) and 30.1% to 25.3% (an absolute decrease of 4.8%), respectively. No cases of malignancy were found in the ATA 2015 "very low suspicion" group, even with a "suspicious" Afirma GEC result. CONCLUSIONS: Both the ThyroSeq and Afirma GEC tests demonstrated decreases in the PPV when NIFTP was considered nonmalignant. In the era of NIFTP, a "positive" test result for either the Afirma GEC or ThyroSeq should be interpreted in light of clinical factors and should not exclude conservative (ie, lobectomy) surgical management. ATA 2015 "very low suspicion" nodules, even with "suspicious" Afirma GEC results, were not found to demonstrate malignancy in this series. Cancer Cytopathol 2018. © 2018 American Cancer Society.

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Published In

Cancer Cytopathol

DOI

EISSN

1934-6638

Publication Date

July 2018

Volume

126

Issue

7

Start / End Page

471 / 480

Location

United States

Related Subject Headings

  • Young Adult
  • Thyroid Nodule
  • Thyroid Neoplasms
  • Retrospective Studies
  • Prognosis
  • Mutation
  • Middle Aged
  • Male
  • Humans
  • Gene Expression Profiling
 

Citation

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Chicago
ICMJE
MLA
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Jug, R. C., Datto, M. B., & Jiang, X. S. (2018). Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. Cancer Cytopathol, 126(7), 471–480. https://doi.org/10.1002/cncy.21993
Jug, Rachel C., Michael B. Datto, and Xiaoyin Sara Jiang. “Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel.Cancer Cytopathol 126, no. 7 (July 2018): 471–80. https://doi.org/10.1002/cncy.21993.
Jug, Rachel C., et al. “Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel.Cancer Cytopathol, vol. 126, no. 7, July 2018, pp. 471–80. Pubmed, doi:10.1002/cncy.21993.
Journal cover image

Published In

Cancer Cytopathol

DOI

EISSN

1934-6638

Publication Date

July 2018

Volume

126

Issue

7

Start / End Page

471 / 480

Location

United States

Related Subject Headings

  • Young Adult
  • Thyroid Nodule
  • Thyroid Neoplasms
  • Retrospective Studies
  • Prognosis
  • Mutation
  • Middle Aged
  • Male
  • Humans
  • Gene Expression Profiling