Five Year Experience with Afirma Gene Expression Classifier (GEC) at a Southern California Teaching Hospital

Saturday, September 24
9:45 AM MT  

Interview with Matthew J. Levine, M.D., F.A.C.E., Scripps Clinic/Scripps Green Hospital, Division of Diabetes/Endocrinology

Dr. Matthew Levine is the Endocrinology fellowship director at Scripps Clinic/Scripps Green Hospital. His center was involved in the multicenter, prospective validation study for the Afirma GEC and was one of the first sites in the United States to use the test when it became commercially available. Here he speaks with us about a poster reporting on Scripps’ experience with the genomic test, which senior fellow Dr. Lauren Clarine will present at the ATA conference.

Q: What prompted you to do this study?

Dr. Levine: Now that we have been using the Afirma GEC for a number of years, and more of our physicians have experience with this tool, we wanted to evaluate our center’s experience with it.

Q: How did you go about doing this?

Dr. Levine: We did a retrospective chart review that looked at all thyroid FNAs we did over a 60-month period. We isolated 55 cases where the patient had an indeterminate FNA and the samples were sent to Thyroid Cytopathology Partners for cytopathology and, when those results were indeterminate, then the Afirma GEC was performed. We looked at the 29 patients who went on to have Afirma GEC testing and we evaluated their outcomes and the test’s impact on surgery rates.

Q: What was the impact on surgery rates?

Dr. Levine: Overall, we found that with use of the Afirma GEC, our recommendations for surgeries for indeterminate nodules went down by a significant amount – 23.6 percent. Specifically, we found that, of the 29 patients who had Afirma GEC testing, 13 were classified as benign and, of these, none underwent surgery as of at least eight months afterwards.

Q: What do these results mean for patients?

Dr. Levine: By reducing surgery referrals, we can cut down on patient anxiety and, although we didn’t specifically measure it, theoretically reduce costs.

Historically in our practice, before we used the Afirma GEC, surgical resection was recommended for all patients with indeterminate thyroid nodules. Now, when a patient has a benign genomic test result, we can put their minds at ease, which we couldn’t do before.

There are also numerous other benefits of avoiding surgery. Fewer surgeries means there are fewer complications, including those like hypothyroidism, which can be lifelong. You remove the risk of potential complications and have fewer patients that need to be counseled. Patients can also avoid scars.

Q: What else should your endocrinology peers know?

Dr. Levine: Institutions should know that they can use their own in-house pathology group and just send the indeterminate samples for genomic testing. We’ve used this “enabled” approach where we collect the sample for GEC testing and only send it to Veracyte if the nodule is indeterminate. This makes things easy for the patient because it means they only need one FNA procedure.