Independent Academic Medical Center Afirma GSC Experience


Interview with Christian Nasr, M.D., Medical Director, Thyroid Center, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, OH

Dr. Christian Nasr is medical director for the Thyroid Center in the Endocrinology & Metabolism Institute at Cleveland Clinic in Cleveland, Ohio. Dr. Nasr’s practice began using the next-generation Afirma® Genomic Sequencing Classifier (GSC) for its thyroid nodule patients in July 2017, after using the Afirma® Gene Expression Classifier (GEC) since December 2011. Dr. Nasr presented findings from an analysis that compared the real-world performance of the two test versions during a Product Theater at the AACE 2018 Annual Meeting.

Q: Topline, what was the focus of your presentation at the 2018 AACE Annual Meeting?

Dr. Nasr: I shared findings from an analysis our group conducted comparing our initial experience with the Afirma GSC to our prior experience with the Afirma GEC, in patients with indeterminate thyroid nodules.

Q: What were one or two of the key findings from this analysis?

Dr. Nasr: Our analysis showed that the rate of benign calls was markedly higher with the Afirma GSC as compared to the Afirma GEC. Specifically, we saw a 60 percent relative increase in benign results among our patients whose nodules were tested with the next-generation test. This is important because these patients would likely have gone to surgery without the benign result. So the GSC has helped significantly more patients in our practice avoid surgery, which is an important and favorable outcome for them and for us.

Q: You shared an interesting and illustrative case study during your presentation at AACE. Can you talk about how the Afirma GSC impacted care and outcomes for that patient?

Dr. Nasr: This case study focused on a healthy, active 56-year-old woman with a Bethesda III nodule who came to us for a differential diagnosis. I told her that we could perform a diagnostic lobectomy or run the Afirma GSC, and she was very much in favor of running the test. She had heard about the experiences of patients living without a thyroid and didn’t want that for herself. We ran the test and it was benign, providing us both with the reassurance we needed to forego surgery and opt for monitoring. She came in for her six-month re-check recently and the ultrasound findings were clean.

Q: What makes you confident that the Afirma GSC benign calls are accurate?

Dr. Nasr: In my experience, the benign results we get from the Afirma tests are very close to the benign calls we get with cytology. When I get a benign result from either, I feel very confident that the patient can be monitored in lieu of surgery.

Q: What is the next step in your research?

Dr. Nasr: As we acquire more Afirma GSC cases, we will be looking to confirm whether our findings are reproducible with a larger sample size. And for benign-call nodules that need to come out due to size or other factors, we will test them to evaluate that they are truly benign. We look forward to sharing the results from these assessments in the future.