Outcomes of Bethesda categories III and IV thyroid nodules over 5 years and performance of the Afirma gene expression classifier: A single‐institution study

Abstract

Our 5-year review demonstrated that malignancy rates of B3 and B4 nodules showed year-to-year variability. We suggest that clinicians use a multi-year average of their institution's malignancy rates to optimally manage patients. Follow-up for GEC Benign cases thus far supports their indolent nature.

Method of detection of thyroid nodules: correlation with frequency of fine‐needle aspiration and malignancy rate

“…This is higher than the typically accepted rates reported in the literature of 6‐18% and 10‐40%, respectively . The frequency of indeterminate cytology as well as the malignancy rate for these nodules is known to vary by institution, and similar malignancy rates for nodules interpreted as atypia of undetermined significance/follicular lesion of undetermined significance have been reported . However, the overall higher than expected malignancy rates in nodules with indeterminate cytology in our study may limit the generalizability of our results to institutions where the malignancy rate for these nodules is lower.…”

Extending expressed RNA genomics from surgical decision making for cytologically indeterminate thyroid nodules to targeting therapies for metastatic thyroid cancer

“…Subsequently, 28 real‐world clinical experience studies have cumulatively reported that only 13% of nodules with GEC benign results underwent surgical resection, a marked reduction compared with the historical treatment of patients with cytologically indeterminate thyroid nodules . In 26 of these studies, only 3% of nodules (50 of 1934 nodules) with GEC benign results were found to be malignant . Investigators who assessed GEC test performance only in operated cases with surgical histology systematically underestimated test specificity and NPV by excluding many unoperated GEC benign nodules that were very likely true‐negative results .…”

Long‐Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience

“…In the studies that did report these rates, results were highly variable, with a resection rate ranging from 17% to 100% with a malignancy rate in these nodules of 0% to 100%. 7,8,12,13,17,18,21,25,26,29 Of the 12 initially unresected nodules in our study, 9 (75%) had a repeat biopsy, of which only 1 had a “suspicious” GEC result. Therefore, it is prudent to consider all other clinical elements as well as patient preference when deciding how to manage a nodule with a “no result” reading.…”

“…This number is slightly lower than reported in the initial validation study 3 and at other institutions. 5-30 Our large population of high-risk patients leads to a high pretest probability of malignancy, which may have contributed to our lower negative predictive value. The prevalence of thyroid malignancy in patients with thyroid nodules with indeterminate cytology at our institution during this timeframe was 41%, thus lowering our negative predictive value.…”

“…The rate of surgical resection in “benign” GEC results was 24% at our institution, one of the highest reported in the literature. 5-18,20-22,24-31,33,34 The main reason for surgery in this category was the presence of a concomitant nodule having a “suspicious” GEC result, and thus, there was a high rate of total thyroidectomies in this group. In the cases that underwent surgery for other reasons such as the presence of compressive symptoms, molecular marker testing did not add value to the therapeutic decision making.…”