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.

6 Comments
  • Ramy October 30, 2018 9:47 am

    I have HRAS c.182A>G (Q61R) Mutation in a 2.3CM solid thyroid nodule. This came in an Afirma 50% Suspicious test result for an indeterminate FNA biopsy. Please note that this is Afirma GSC (not GEC)

    What do you think?

    Thank you,
    Ramy

    • Dr Guttler October 30, 2018 3:53 pm

      What was the cytopathology report?
      Class III or IV?
      It makes a difference.
      Dr.G.

  • MHB January 4, 2019 4:38 pm

    Indeterminate FNA & Afirma GSC suspicious (ROM 50%). Endocrinologist recommending right half thyroid and isthmus to be removed. Nodule is 3.24 x 1.69 x2.88. Clinical history I hypoechoic & intramodular vascularity. Malignancy Classifiers-negative. Xpression Atlas-not detected.
    Cytopathology Diagnosis: Indeterminate – atypia of undetermined significance (AUS – Bethesda Category III)
    Diagnostic Comments: These features are best classified as atypia of undetermined significance.
    Microscopic Description: The cytologic preparations are mildly cellular and show a few clusters of follicular cells in crowded and microfollicular groups with nuclear enlargement, few bland groups of follicular cells and come colloid. Cell block shows scant colloid only.
    I thank you in advance for any insight and direction you can provide. I live in another state so it would not be feasible for me to make an appointment with for a consultation in person.

    • Dr Guttler January 7, 2019 9:09 am

      Hi MHB,
      Get more opinions before you consider surgery.
      Sparse biopsy sample can lead to false conclusions.
      Send me the slides and come for my evaluation.
      Call me at 310-393-8860 ot thyroid.manager @protonmail.com.
      Dr.G.

  • Robyn Licursi February 15, 2019 6:13 am

    Hello. I also had a suspicious afirma result in April last year. Had another sonogram done a week ago and there has been no growth or changes to my nodule in 6 years. Could you evaluate my findings for me? I don’t want a needless surgery. I live out of state but would pay for a consultation over the phone. Thank you!

    • Dr Guttler February 15, 2019 4:40 pm

      Robyn
      I told you you need to travel to see me if you want to prevent an unnecessary surgery.
      No phone.
      Dr.G.

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