Repeat Biopsy with Afirma GEC for Indeterminate Thyroid Nodules: An Institutional Experience
Interview with Whitney Goldner, M.D., University of Nebraska Medical Center
Dr. Whitney Goldner is an associate professor at the University of Nebraska Medical Center’s Department of Internal Medicine in the Division of Endocrinology, Diabetes and Metabolism. She spoke with us about a new study that evaluated her institution’s experience with the Afirma GEC over a five-year period. The findings were presented at ENDO 2017 by Dr. Padmaja Akkireddy, a fellow in her department.
Q: What was the purpose of this study?
Dr. Goldner: We were early users of the Afirma GEC and because the test was so new at the time, we wanted to evaluate our experience with it and see how it impacted clinical care.
Q: How did you go about doing this?
Dr. Goldner: We did a retrospective chart review of all patients with indeterminate thyroid nodules at our institution from April 2011 to March 2016. We looked at how use of the Afirma GEC impacted surgery rates among these patients. Additionally, our institution required that cytopathology be performed by our own pathologists so after we performed the FNA biopsy, we split the sample. Some was sent to our pathology lab and some was sent to Veracyte for cytopathology by Thyroid Cytopathology Partners as part of Afirma. This enabled us to see if there was any change in clinical course based on where the cytopathology was performed.
Q: What were your key findings?
Dr. Goldner: Among the 284 patients we evaluated, we found that adding Afirma GEC testing to indeterminate thyroid nodules reduced our surgery rate by 32.2 percent. These findings are similar to results that have been reported by others and are important because most patients with indeterminate thyroid nodules – about 70 percent – don’t need surgery because their nodules are benign.
We also found that the local and TCP cytopathology was concordant 50 percent of the time, with local cytopathology having more indeterminate results and the TCP group identifying more benign nodules. I think this speaks to the inherent haziness of the indeterminate category in general. Importantly, we only found one case where there the clinical course would have been different between the two cytopathology groups.
Q: How do your results impact how you manage patients
Dr. Goldner: Physicians never want to perform unnecessary surgery on our patients. In the past, most patients with indeterminate thyroid nodules went to surgery because we didn’t have a better way to know who was benign. Our findings show that Afirma is helping us reduce surgeries as it was intended to do.