Afirma Benign Thyroid Nodules Show Similar Growth to Cytologically Benign Nodules During Follow-Up.
BACKGROUND
The Afirma gene expression classifier (GEC) is a molecular diagnostic test that has a high negative predictive value for ruling out malignancy in thyroid nodules with indeterminate cytology. Many patients with a cytologically indeterminate and GEC benign (Cyto-I/GEC-B) nodule undergo monitoring instead of diagnostic surgery, but few data describe their follow-up.


OBJECTIVE
The objective of the study was to determine the sonographic changes and clinical outcomes for patients with Cyto-I/GEC-B nodules compared with patients with cytologically benign (Cyto-B) nodules.


METHODS
This was a retrospective analysis of consecutive Cyto-I/GEC-B nodules evaluated at Brigham and Women's Hospital compared with Cyto-B nodules.


RESULTS
Nodule growth of 20% or greater in two dimensions or of 50% or greater in volume, change in sonographic features, and rates of repeat fine-needle aspiration, thyroidectomy, and malignancy.


RESULTS
Ninety-five Cyto-I/GEC-B nodules in 90 patients were identified. Five patients underwent primary surgical resection. Of the remaining 90 nodules, 58 (64.4%) had sonographic follow-up available at a median of 13 months (range 4-40 mo). Cyto-I/GEC-B nodules showed similar growth compared with 1224 Cyto-B nodules using either of the following criteria: 20% or greater in two dimensions (8.6% vs 8.3%, P = .80) or 50% or greater in volume (17.2% vs 13.8%, P = .44). Thyroidectomies were more frequent in the Cyto-I/GEC-B group (13.8% vs 0.9%, P < .0001), but cancer was found in only one patient, with no evidence of persistent disease after initial treatment.


CONCLUSIONS
Cyto-I/GEC-B nodules demonstrate similar growth to Cyto-B nodules during follow-up. Although Cyto-I/GEC-B nodules were more frequently resected, only one malignancy was found. These data suggest that reassessment of Cyto-I/GEC-B nodules may be performed similarly to those with benign cytology.
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Trevor E
TE
Angell
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Mary C
MC
Frates
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Marco
M
Medici
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Xiaoyun
X
Liu
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Norra
N
Kwong
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Edmund S
ES
Cibas
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Matthew I
MI
Kim
Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China.
Ellen
E
Marqusee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D001900:Boston; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015972:Gene Expression Regulation, Neoplastic; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000235:genetics / Q000378:metabolism*; D012086:Reoperation; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D016606:Thyroid Nodule / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D047368:Tumor Burden; D014463:Ultrasonography; D055815:Young Adult
D009363:Neoplasm Proteins