More Incidental Thyroid Malignancies Observed in the Lobes with a GEC Suspicious Thyroid Nodule
Friday, September 23 12:00 PM MT
Interview with Ying Hu, M.D., Ph.D., Geisinger Health System, Danville, Pa.
Dr. Ying Hu is an endocrinologist with Geisinger Health System in Danville, Pennsylvania, where her clinical focus areas include thyroid disorders, thyroid nodules and thyroid cancer. Her practice began using the Afirma GEC in 2013 and, as Dr. Hu indicated, the test is now used widely throughout the organization. She spoke with us about a poster describing Geisinger’s experience with the genomic test, which her resident, Dr. Amanda Karasinki, will present at the ATA meeting.
Q: What was the purpose of your study?
Dr. Hu: There were really two reasons. Initially, the Afirma GEC was a new test for us and, as with all new tests that we use, we wanted to keep a close eye on how it performed. Additionally, we had noticed that patients with suspicious Afirma results seemed to have higher rates of microcarcinomas in the thyroid, even when the nodule itself was benign. So, we were curious and decided to look into that further. Retrospectively, we looked at our Afirma data at Geisinger performed between 2013 and 2015.
Q: First, what did you find in terms of the test’s ability to identify patients with benign thyroid nodules when their cytopathology was indeterminate?
Dr. Hu: We reviewed 153 Afirma GEC patient cases (that had indeterminate cytopathology). We found 70 out of 123 cases of AUS/FLUS and 14 out of 28 cases of FN/SFN were benign. For various reasons, mostly due to either compressive symptoms or nodule size, only 14 patients with Afirma GEC-benign results had surgery. All but one of these were confirmed to be benign.
Q: How are these results impacting patient care?
Dr. Hu: When the patient has a benign Afirma GEC result, we are pretty comfortable in recommending a conservative approach rather than surgery. The test can save extra diagnostic steps for patients with benign Afirma nodules, especially those nodules with AUS/FLUS cytology.
Q: And what did you find in terms of the microcarcinomas in the Afirma GEC-suspicious cases?
Dr. Hu We had 44 out of 58 patients with suspicious Afirma results who had completed surgery. Among them, 23 out of 44 cases had malignant pathology. This included 13 cases with a cancerous nodule and 10 cases with incidental microcarcinomas that were unrelated to the nodule. None of these incidental microcarcinomas were discovered in lobes that had a benign Afirma result.
Q: Where do you go from here with these findings?
Dr. Hu: I’ll be interested in hearing if others have made similar observations in their practices. We would like to know if this is something generalizable. Our findings raise interesting questions for me. For example, does a suspicious Afirma result suggest somewhat of a more favorable microenvironment for tumor genesis? Will these Afirma suspicious nodules have a higher chance to develop cancer in the future even if they are benign now? Hopefully, our findings will prompt some interesting discussions.
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