title: How "suspicious" is that nodule? Review of "suspicious" Afirma gene expression classifier in high risk thyroid nodules.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Northwell Health, Lake Success, New York.
authors.forename: Sudarshana
authors.identifier: http://orcid.org/0000-0002-4339-2097
authors.initials: S
authors.lastname: Roychoudhury
authors.affiliation: Department of Pathology, Northwell Health, Lake Success, New York.
authors.forename: Melissa
authors.initials: M
authors.lastname: Klein
authors.affiliation: Department of Pathology, Greenwich Hospital, Greenwich, Connecticut.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Souza
authors.affiliation: Department of Pathology, Hofstra Northwell Health School of Medicine, Lake Success, New York.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Gimenez
authors.affiliation: Department of Pathology, Hofstra Northwell Health School of Medicine, Lake Success, New York.
authors.forename: Alice
authors.initials: A
authors.lastname: Laser
authors.affiliation: Department of Pathology, Hofstra Northwell Health School of Medicine, Lake Success, New York.
authors.forename: Rubina
authors.initials: R
authors.lastname: Shaheen Cocker
authors.affiliation: Department of Pathology, Northwell Health, Lake Success, New York.
authors.forename: Karen
authors.initials: K
authors.lastname: Chau
authors.affiliation: Department of Pathology, Hofstra Northwell Health School of Medicine, Lake Success, New York.
authors.forename: Kasturi
authors.initials: K
authors.lastname: Das
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis*; D018249:Adenoma, Oxyphilic / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis*; D055815:Young Adult
keywords: Afirma; FNA; cytology; thyroid nodules