Differentiated thyroid cancer and Hashimoto thyroiditis: Utility of the Afirma gene expression classifier.

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Citation: Journal of Surgical Oncology. 121(7):1053-1057, 2020 Jun.PMID: 32115718Institution: MedStar Washington Hospital CenterDepartment: Medicine/Endocrinology | Pathology | Surgery/Endocrine Surgery | Surgery/General SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Hashimoto Disease/ge [Genetics] | *Thyroid Neoplasms/ge [Genetics] | Adult | Aged | Cohort Studies | Female | Gene Expression Profiling/mt [Methods] | Hashimoto Disease/pa [Pathology] | Hashimoto Disease/su [Surgery] | Humans | Male | Middle Aged | Reproducibility of Results | Retrospective Studies | Thyroid Neoplasms/pa [Pathology] | Thyroid Neoplasms/su [Surgery] | Thyroid Nodule/ge [Genetics] | Thyroid Nodule/pa [Pathology] | Thyroid Nodule/su [Surgery] | ThyroidectomyYear: 2020ISSN:
  • 0022-4790
Name of journal: Journal of surgical oncologyAbstract: BACKGROUND AND OBJECTIVES: The Afirma gene expression classifier (AGEC) has not been tested or validated in a high-risk group, such as patients with Hashimoto's thyroiditis (HT). We hypothesized that AGEC would perform worse in patients with HT.CONCLUSIONS: We observed a lower NPV for AGEC to rule out thyroid cancer in patients with HT, which reduces the utility of the test for this population. Copyright (c) 2020 Wiley Periodicals, Inc.METHODS: A retrospective review of patient charts in a single academic institution who underwent thyroidectomy between 2012 and 2017 was conducted. Patients with HT who underwent AGEC were identified to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).RESULTS: We identified 69 patients with HT and atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) on cytology who underwent AGEC analysis. The mean age of AGEC cohort was 50 years (range, 26-77 years) with 90% female. The median nodule size was 1.9 cm (interquartile range [IQR], 1.2-2.7 cm). Of the 69 patients, 62 showed suspicious AGEC of which 26 showed TC on surgical pathology. Of the seven benign AGEC, two showed TC on surgical pathology. The sensitivity, specificity, PPV, and NPV were 93%, 12%, 42%, and 71%, respectively. Of the entire AGEC cohort, 17 (43%) showed multicentric disease.All authors: Felger EA, Lee W, Papoian V, Rosen JE, Wartofsky LOriginally published: Journal of Surgical Oncology. 121(7):1053-1057, 2020 Jun.Fiscal year: FY2020Digital Object Identifier: ORCID: Date added to catalog: 2020-07-09
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Journal Article MedStar Authors Catalog Article 32115718 Available 32115718

BACKGROUND AND OBJECTIVES: The Afirma gene expression classifier (AGEC) has not been tested or validated in a high-risk group, such as patients with Hashimoto's thyroiditis (HT). We hypothesized that AGEC would perform worse in patients with HT.

CONCLUSIONS: We observed a lower NPV for AGEC to rule out thyroid cancer in patients with HT, which reduces the utility of the test for this population. Copyright (c) 2020 Wiley Periodicals, Inc.

METHODS: A retrospective review of patient charts in a single academic institution who underwent thyroidectomy between 2012 and 2017 was conducted. Patients with HT who underwent AGEC were identified to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS: We identified 69 patients with HT and atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) on cytology who underwent AGEC analysis. The mean age of AGEC cohort was 50 years (range, 26-77 years) with 90% female. The median nodule size was 1.9 cm (interquartile range [IQR], 1.2-2.7 cm). Of the 69 patients, 62 showed suspicious AGEC of which 26 showed TC on surgical pathology. Of the seven benign AGEC, two showed TC on surgical pathology. The sensitivity, specificity, PPV, and NPV were 93%, 12%, 42%, and 71%, respectively. Of the entire AGEC cohort, 17 (43%) showed multicentric disease.

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