Bethesda III and IV Thyroid Nodules Managed Nonoperatively After Molecular Testing With Afirma GSC or Thyroseq v3

Abstract

Context Molecular testing has improved risk stratification and increased non-operative management for patients with indeterminate thyroid nodules, but data on the long-term outcomes of current molecular tests Afirma Gene Sequencing Classifier (GSC) and Thyroseq v3 are limited. Objective To determine the rate of delayed operation and the false-negative rate of the Afirma GSC and Thyroseq v3 in Bethesda III and IV thyroid nodules. Design Prospective follow-up of a single center randomized clinical trial comparing the performance of Afirma GSC and Thyroseq v3 in the diagnosis of indeterminate thyroid nodules. Setting University of California, Los Angeles Participants Consecutive participants who underwent thyroid biopsy in the UCLA health system with Bethesda III and IV cytology from August 2017 to November 2019. Main Outcomes and Measures False negative rate of molecular testing. Results Of 176 indeterminate nodules with negative or benign molecular test results, 14 (8%) nodules underwent immediate resection, with no malignancies found on surgical pathology. Non-operative management with active surveillance was pursued for 162 (92%) nodules with benign or negative test results. The median surveillance was 34 months (range 12-60 months), and 44 patients were lost to follow-up. Of 15 nodules resected during surveillance, one malignancy was found (overall false negative rate of 0.6%). This was a 2.7 cm minimally invasive Hurthle cell carcinoma that initially tested negative with Thyroseq v3 and underwent delayed resection due to sonographic growth during surveillance. Conclusions The majority of Bethesda III/IV thyroid nodules with negative or benign molecular test results are stable over 3 years of follow-up. These findings support the high sensitivity of current molecular tests and their role in ruling out malignancy in indeterminate thyroid nodules.

Diagnostic accuracy of Afirma gene expression classifier, Afirma gene sequencing classifier, ThyroSeq v2 and ThyroSeq v3 for indeterminate (Bethesda III and IV) thyroid nodules: a meta-analysis

“…The included studies had a total of 6490 FNAs with ITN cytology with molecular diagnostics (GEC, GSC, TSv2, and TSv3). The detailed characteristics of the included studies ( 9 , 10 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ) are given in Supplementary Table 3. According to the QUADAS-2 tool ( 24 , 25 ), the methodological quality of the included trials was acceptable ( Fig.…”

Current State of Molecular Cytology in Thyroid Nodules: Platforms and Their Diagnostic and Theranostic Utility

“…A meta-analysis that included 12 validation and real-world experience studies that reported the performance of Thyroseq (530 nodules) and Afirma (471 nodules) also showed comparable results [28]. Other studies comparing both tests have also found very similar performances between the two tests in terms of NPV, PPV, benign call rate, and clinical utility [12,29,34,35].…”

Real-Time Evaluation of Thyroid Cytology Using New Digital Microscopy Allows for Sample Adequacy Assessment, Morphological Classification, and Supports Molecular Analysis

“…Primarily, FCM application may be conceived in nodules with indeterminate cytological features. These in fact represent a growing clinical problem and molecular testing is proposed to improve the diagnostic accuracy of FNA and to reduce the need for diagnostic surgery [23]. To assure the adequacy of the sample, the rapid on site evaluation (ROSE) has been suggested [24]; however, the need for additional human resources limits the routine use of this approach.…”