title: Relationship Between Sonographic Characteristics and Afirma Gene Expression Classifier Results in Thyroid Nodules With Indeterminate Fine-Needle Aspiration Cytopathology.
abstract: OBJECTIVE
  The purpose of this article is to investigate whether specific clinical and sonographic characteristics are predictive of a benign Afirma test result.
  
  
  METHODS
  We conducted a retrospective study of Afirma gene expression classifier analysis performed in 44 patients with 45 indeterminate thyroid fine-needle aspiration (FNA) cytologic results between March 2013 and April 2014. Of these, 33 of 45 nodules (73.3%) were repeat atypia of undetermined significance (AUS) and follicular lesions of undetermined significance (FLUS), or follicular neoplasm (FN) and suspicious for a follicular neoplasm (SFN) before Afirma testing.
  
  
  RESULTS
  Of the 45 nodules, 21 (46.7%) were cytologically diagnosed as FLUS, 16 (35.6%) were diagnosed as AUS, and eight (17.8%) were diagnosed as FN or SFN. By Afirma testing, 23 of the 45 nodules (51.1%) were benign, 21 (46.7%) were suspicious, and one (2.2%) had nondiagnostic results. The mean (± SD) nodule size was smaller in the Afirma-benign group than in the Afirma-suspicious group (1.8 ± 0.8 cm [95% CI, 1.4-2.1] vs 2.2 ± 0.8 cm [95% CI, 1.8-2.6]; p < 0.035). No sonographic feature was statistically significantly different between the Afirma-benign and -suspicious groups, including nodule solidity (p = 0.225), echogenicity (p = 0.543), calcification (p = 0.542), and hypervascularity (p = 0.976). All nodules were ovoid shaped and had circumscribed margins in both Afirma groups.
  
  
  CONCLUSIONS
  Smaller nodule size was the only characteristic associated with a benign diagnosis on Afirma testing. Sonographic characteristics are not helpful in cases that had a repeat indeterminate FNA finding before Afirma testing.
authors.affiliation: 1 Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.|2 Department of Radiology, Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit St, Boston, MA 02114.
authors.forename: Qing-Li
authors.initials: QL
authors.lastname: Zhu
authors.affiliation: 3 Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: William C
authors.initials: WC
authors.lastname: Faquin
authors.affiliation: 2 Department of Radiology, Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit St, Boston, MA 02114.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Samir
mesh_terms: D044963:Biopsy, Fine-Needle; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods*; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000473:pathology; D014463:Ultrasonography
keywords: Afirma; fine-needle aspiration; indeterminate; thyroid nodules; ultrasound