American Thyroid Association Sonographic Risk and Afirma Gene Expression Classifier Alone and in Combination for the Diagnosis of Thyroid Nodules with Bethesda Category III Cytology

Arosemena, Marilyn; Thekkumkattil, Anu; Valderrama, Maria Linares; Kuker, Russ; Castillo, Rosa; Sidani, Charif; Gonzalez, Manuel Lora; Casula, Sabina; Kargi, Atil Y.

doi:10.1089/thy.2019.0673

Cited by 11 publications

(12 citation statements)

References 27 publications

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“…Conversely, we found MTC and poorly differentiated thyroid cancer (PDTC) in seven cases each. Sixteen studies revealed 144 NIFTP cases after histological evaluation ( 14 , 17 , 23 , 40 , 49 , 51 , 56 – 59 , 61 , 62 , 65 , 67 , 72 , 73 , 75 ).…”

Section: Resultsmentioning

confidence: 99%

“…Following surgery and histological evaluation, 895 of 2,365 nodules were malignant, with a malignancy rate among resected nodules of 37.8%. Ten studies performed histological evaluation to highlight the number of NIFTP lesions ( 17 , 40 , 49 , 51 , 56 , 58 , 61 , 68 , 72 , 80 ). Thus, 54 NIFTP cases were established, all with a suspicious Afirma GEC result.…”

Section: Resultsmentioning

confidence: 99%

“…We determined a high risk of bias for the “Patient selection” domain in the pooled studies due to lack of consecutive or random enrollment or inappropriate exclusion in several articles ( 8 , 11 , 14 , 16 , 17 , 21 , 49 – 52 , 60 , 62 – 65 , 67 – 69 , 71 , 73 , 76 , 77 ). Almost all records scored an unclear risk of bias for the “Index test” domain as they did not report whether the molecular panel was interpreted without knowledge of the histopathological diagnosis ( 17 , 20 , 30 , 32 , 35 , 38 , 41 – 44 , 46 – 50 , 53 – 57 , 59 – 61 , 103 ).…”

Section: Resultsmentioning

confidence: 99%

“…Looking specifically at the Bethesda III category TNs, the eleven studies included showed a slightly decreased overall SE (0.94, 95% CI: 0.88 to 0.97) and an increased overall SP (0.23, 95% CI: 0.14 to 0.35) of Afirma GEC (8,17,49,51,53,54,56,64,66,70,77). Moreover, the heterogeneity between studies was dampened to 33% (95% CI: 0 to 81) in the case of SE (Supplementary Figure 17).…”

Section: Impact Of Bethesda Categories Repeated Fna and Conflict Of Interests On Afirma Gec Diagnostic Performancementioning

confidence: 99%

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Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis

et al. 2021

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BackgroundMolecular tests are being used increasingly as an auxiliary diagnostic tool so as to avoid a diagnostic surgery approach for cytologically indeterminate thyroid nodules (ITNs). Previous test versions, Thyroseq v2 and Afirma Gene Expression Classifier (GEC), have proven shortcomings in malignancy detection performance.ObjectiveThis study aimed to evaluate the diagnostic performance of the established Thyroseq v3, Afirma Gene Sequencing Classifier (GSC), and microRNA-based assays versus prior iterations in ITNs, in light of “rule-in” and “rule-out” concepts. It further analyzed the impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification and Bethesda cytological subtypes on the performance of molecular tests.MethodsPubmed, Scopus, and Web of Science were the databases used for the present research, a process that lasted until September 2020. A random-effects bivariate model was used to estimate the summary sensitivity, specificity, positive (PLR) and negative likelihood ratios (NLR), and area under the curve (AUC) for each panel. The conducted sensitivity analyses addressed different Bethesda categories and NIFTP thresholds.ResultsA total of 40 eligible studies were included with 7,831 ITNs from 7,565 patients. Thyroseq v3 showed the best overall performance (AUC 0.95; 95% confidence interval: 0.93–0.97), followed by Afirma GSC (AUC 0.90; 0.87–0.92) and Thyroseq v2 (AUC 0.88; 0.85–0.90). In terms of “rule-out” abilities Thyroseq v3 (NLR 0.02; 95%CI: 0.0–2.69) surpassed Afirma GEC (NLR 0.18; 95%CI: 0.10–0.33). Thyroseq v2 (PLR 3.5; 95%CI: 2.2–5.5) and Thyroseq v3 (PLR 2.8; 95%CI: 1.2–6.3) achieved superior “rule-in” properties compared to Afirma GSC (PLR 1.9; 95%CI: 1.3–2.8). Evidence for Thyroseq v3 seems to have higher quality, notwithstanding the paucity of studies. Both Afirma GEC and Thyroseq v2 performance have been affected by NIFTP reclassification. ThyGenNEXT/ThyraMIR and RosettaGX show prominent preliminary results.ConclusionThe newly emerged tests, Thyroseq v3 and Afirma GSC, designed for a “rule-in” purpose, have been proved to outperform in abilities to rule out malignancy, thus surpassing previous tests no longer available, Thyroseq 2 and Afirma GEC. However, Thyroseq v2 still ranks as the best rule-in molecular test.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO, identifier CRD42020212531.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Impact Of Bethesda Categories Repeated Fna and Conflict Of Interests On Afirma Gec Diagnostic Performancementioning

confidence: 99%

See 2 more Smart Citations

Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis

et al. 2021

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“…Recently, several molecular tests have been utilized to further risk stratify ITNs and guide management, but their use is limited by cost and availability. A study by our group has recently evaluated the association between ASR and Afirma gene expression classifier (GEC) and determined individual and combined diagnostic performances [5].…”

Section: Introductionmentioning

confidence: 99%

Inter-Reader Agreement of ATA Sonographic Risk in Thyroid Nodules with Bethesda Category III Indeterminate Cytology

et al. 2021

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Background: Substantial inter-observer variation has been documented in the recognition and description of specific sonographic features as well as for ATA sonographic risk (ASR). This raises the question if the risk stratification proposed by the ATA guidelines is reproducible and applicable for nodules with indeterminate cytology. The aim of the study was to determine the inter-reader agreement (IRR) among radiologists using the 2015 ASR stratification in indeterminate thyroid nodules. Methods: Three board certified radiologists who were blinded to clinical data and to each other, interpreted the ultrasound findings of 179 nodules that had Bethesda III cytology. The nodules were classified into high suspicion (HS), intermediate (IS), low (LS), very low (VLS). Echogenicity, composition, shape taller than wide, vascularity, type of margins, presence and type of calcifications were also described. Results: The majority consensus revealed that 28%, 27%, 39% and 5% were described as high, intermediate, low and very low ASR, respectively. The inter-reader agreement was near perfect (k 0.82 CI 95% (0.77–0.87)). Nodules were paired into a higher risk (HS + IS) and lower risk (LS + VLS) categories with substantial agreement (k 0.7) in both categories. Conclusion: A near perfect agreement among readers was observed when stratifying indeterminate cytology nodules for ASR.

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Utility of Six Ultrasound-Based Risk Stratification Systems in the Diagnosis of AUS/FLUS Thyroid Nodules

Yang

et al. 2024

Academic Radiology

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American Thyroid Association Sonographic Risk and Afirma Gene Expression Classifier Alone and in Combination for the Diagnosis of Thyroid Nodules with Bethesda Category III Cytology

Cited by 11 publications

References 27 publications

Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis

Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis

Inter-Reader Agreement of ATA Sonographic Risk in Thyroid Nodules with Bethesda Category III Indeterminate Cytology

Utility of Six Ultrasound-Based Risk Stratification Systems in the Diagnosis of AUS/FLUS Thyroid Nodules

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