Roychoudhury Sudarshana, Klein Melissa, Souza Fabiola, Gimenez Cecilia, Laser Alice, Shaheen Cocker Rubina, Chau Karen, Das Kasturi
Department of Pathology, Northwell Health, Lake Success, New York.
Department of Pathology, Greenwich Hospital, Greenwich, Connecticut.
Diagn Cytopathol. 2017 Apr;45(4):308-311. doi: 10.1002/dc.23680. Epub 2017 Feb 11.
The Afirma gene expression classifier (GEC) is being increasingly utilized to confirm the benign nature of indeterminate FNA cytology results thus avoiding unnecessary surgical procedures. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population.
The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. All thyroid nodules with a "suspicious" Afirma GEC result were investigated. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up.
Afirma result was suspicious in 69 cases. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). The remaining 18% were malignant.
The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). False positive rate of Afirma was 56% (32/57). We conclude that cytology interpretation has a higher rate of predicting malignancy, in nodules interpreted as SN, when compared with the Afirma test, by almost twofold Diagn. Cytopathol. 2017;45:308-311. © 2016 Wiley Periodicals, Inc.
Afirma基因表达分类器（GEC）越来越多地用于确认不确定的细针穿刺活检（FNA）细胞学结果的良性性质，从而避免不必要的手术。然而，Afirma GEC的“可疑”结果在确定适当的治疗方案时并未对这些不确定的结节进行进一步分类。本研究调查了在高危人群中被Afirma GEC判定为“可疑”的甲状腺结节的转归。
检索2013 - 2015年三年期间所有有Afirma检测结果的甲状腺结节的病理数据库。对所有Afirma GEC结果为“可疑”的甲状腺结节进行调查。回顾性查阅患者病历，了解临床病史、FNA结果、影像学检查结果、治疗及随访情况。
69例Afirma结果为可疑。细胞学评估时，3.0%的病例为非诊断性（ND），9%为良性，62%为意义不明确的非典型病变（AUS），26%为可疑肿瘤（SN）。13%的病例未进行随访，87%的病例接受了手术切除（50%为甲状腺叶切除术，50%为全甲状腺切除术）。手术切除后，82%为良性，其中45%为滤泡性腺瘤（FA）, 37%为结节性甲状腺肿（NG）,其余18%为恶性。
Afirma可疑结节的恶性率为18.3%（11/60）。细胞学解释为可疑肿瘤（SN）结节中的恶性率为31.2%（5/16）。Afirma假阳性率为56%（32/57）我们得出结论：与Afirma检测相比，在解释为SN的结节中，细胞学解释预测恶性肿瘤发生率的比率几乎高出两倍。诊断细胞病理学2017;45:308 - 311。©2016威利期刊公司
