Be Aware: A Suspicious Afirma GEC Can Cause You to Have a Needless Total Thyroidcetomy. “The NIFT-P Effect”

Be Aware: A Suspicious Afirma GEC Can Cause You to Have a Needless Total Thyroidcetomy. “The NIFT-P Effect”

Be Aware: A Suspicious Afirma GEC Can Cause You to Have a Needless Total Thyroidcetomy. “The NIFT-P Effect”

Be Aware: A Suspicious Afirma GEC Can Cause You to Have a Needless Total Thyroidcetomy. “The NIFT-P Effect”

 

Comment: The best use of GEC is when the result is benign, not when it is suspicious.This is just another reason to not pay attention to GEC results when they are suspicious.

THE PATIENT AND PRIMARY PHYSICIANS  MUST BE AWARE OF THIS AND QUESTION THE DECISION OF THE SURGEON TO DO A TOTAL THYROIDECTOMY WHEN THEY MAY BE DEALING WITH A BENIGN TIMOR CALLED NIFT-P.  THE RISKS FROM A TOTAL ARE DIRECTLY RELATED TO THE EXPERIENCE OF THE SURGEON. 50% ARE DONE BY SURGEONS DOING ONLY ONE A YEAR WITH VERY HIGH COMPLICATION RATES COMPARED TO HIGH VOLUME SURGEONS.

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Richard Guttler MD,FACE,ECNU

The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features  NIFT-P on the performance of the Afirma gene expression classifier GEC.

Hang JF Cancer. 2017 May 24.

Abstract

BACKGROUND:

What is the impact of NIFT-P on the performance of the Afirma gene expression classifier (GEC).

14cancer-master768

152/ 304 50% fine-needle aspiration specimens diagnosed as atypia of undetermined significance were suspicious on GEC. 50/80 63%cases suspicious for  suspicious for a follicular neoplasm (SFN)  were suspicious on GEC. After reclassifying NIFTP, the positive predictive value of GEC decreased from 42% to 24% in the AUS group and from 23% to 13% (95% CI, 9%-18%) in the SFN group. Total thyroidectomy was performed more frequently than a partial thyroidectomy in patients with AUS with a suspicious GEC.

Reclassification of NIFTP significantly decreases the positive predictive value of GEC in indeterminate thyroid nodules. Nevertheless, the majority of patients with indeterminate thyroid nodules with a suspicious GEC result in the study institution have undergone total thyroidectomy. This finding raises concerns over reliance on a suspicious GEC result by clinicians to justify total thyroidectomy. Cancer Cytopathol 2017. © 2017 American Cancer Society.

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