The Effect of Implementing Gene Expression Classifier on Outcomes of Thyroid Nodules with Indeterminate Cytology.
Thyroid nodules are classified into six cytological categories under the Bethesda classification system. Two of these categories, atypical of undetermined significance (AUS) and suspicious for a follicular neoplasm (SFN), are further labeled as "indeterminate" diagnosis. Starting in June, 2012, Kansas University-Wichita Endocrine clinic implemented Afirma® Gene Expression Classifier (AGEC) to evaluate the need for surgical resection of thyroid nodules in patients with an indeterminate diagnosis. Electronic medical records of patients who underwent thyroid nodule fine-needle aspiration from 2004-2014 were reviewed. The aim of this study was to find whether implementing AGEC was associated with decreased surgical recommendation rate, decreased cost, and increased incidence of thyroid malignancy diagnosed by surgery in patients with indeterminate diagnosis. A total of 299 consecutive patients' charts were screened. Sixty-one (20 %) patients had an indeterminate diagnosis. Out of these, 27 (44 %) patients underwent evaluation before and 34 (56 %) patients underwent evaluation after AGEC implementation, respectively. Surgical recommendation for patients with indeterminate finding decreased from 81.5 to 50 % (p = 0.01) after AGEC implementation. Surgical pathology was read as malignant in 20 and 85.7 % (p < 0.01) of patients before and after AGEC implementation, respectively. Primary cost-benefit estimate showed implementing AGEC has saved $1048/patient in medical evaluation and initial management of patients with indeterminate diagnosis. AGEC implementation has decreased the number of surgical recommendations, has lowered financial burden, and has increased incidence of thyroid malignancy diagnosed by surgical pathology in patients with indeterminate diagnosis of thyroid nodules.
Department of Internal Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA.
Jithma Prasad
JP
Abeykoon
University of Kansas School of Medicine-Wichita Family Medicine Residency at Via Christi, Wichita, KS, 27208, USA.
Luke
L
Mueller
Graduate College of Biomedical Sciences, Western University of Health Science, Pomona, FL, 91766, USA.
Frank
F
Dong
Department of Medical Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Ashish V
AV
Chintakuntlawar
Department of Medical Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
Jonas
J
Paludo
University of Kansas School of Medicine-Wichita Endocrinology, 8533 E. 32nd St. N., Wichita, KS, 67226, USA. ramimortada@outlook.com.
Rami
R
Mortada
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003362:Cost-Benefit Analysis; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods*; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000145:classification* / Q000473:pathology; D013965:Thyroidectomy; D055815:Young Adult