Experience with the Genomic Sequencing Classifier in >100 Cytologically Indeterminate Thyroid Nodules


Interview with Jennifer A. Sipos, M.D., The Ohio State University

Dr. Jennifer Sipos is a professor and endocrinologist at The Ohio State University’s Division of Endocrinology where she sees patients and specializes in research on thyroid nodules and thyroid cancer. Her institution was an early user of the Afirma Genomic Sequencing Classifier (GSC) and, before that, of the Gene Expression Classifier (GEC). Here she spoke with us about new data on her team’s experience with the next-generation Afirma test since they begin using it in August 2017. The data are being presented in a poster at the ATA annual meeting in Washington, DC.

Q: What was your team trying to determine with this evaluation?

Dr. Sipos: We wanted to see how our use of the Afirma GSC is impacting our “benign call” rate of indeterminate thyroid nodules, compared to our experience with the original GEC. And, if the rate is lower with the GSC, we wanted to see if this is translating into a reduced number of surgeries.

Q: So, what did you find?

Dr. Sipos: We found a very nice increase in the performance of the GSC. Specifically, the benign call rate with the next-generation test was significantly higher than with the GEC – 74.1 percent, compared to 48.4 percent. These findings were similar to data we presented on a smaller cohort back at the AACE meeting in May. We also found that the overall surgery rate among all patients who underwent genomic testing decreased by more than half – from 42.2 percent with the GEC to 20.2 percent with the GSC.

Q: How is your use of the Afirma GSC impacting your practice and patient care?

Dr. Sipos: The data show it’s translated into reduced surgeries. I can’t help but believe it’s also helping to reduce healthcare costs. From a patient standpoint, most patients are very grateful for the opportunity to avoid the surgery suite. These patients are typically happy to be followed with sonography to make sure there are no changes to the nodule.

Q: How do you talk to patients about Afirma GSC testing?

Dr. Sipos: I have that conversation with the patient before I do the FNA biopsy. I ask them, if the nodule is inconclusive, will they want to keep their thyroid or go to surgery? I typically explain that, if the former, we can confidently rule out cancer in a significant number of patients and can follow them with sonography. A few patients are going to be up late at night worrying about their thyroid nodule, regardless, and just want it out. These patients are not good candidates for GSC testing. The vast majority of patients, though, want to keep their thyroids and are fine coming back for periodic checks.