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- Title
Features of Cytologically Indeterminate Molecularly Benign Nodules Treated With Surgery.
- Authors
Endo, Mayumi; Porter, Kyle; Long, Clarine; Azaryan, Irina; Phay, John E.; Ringel, Matthew D.; Sipos, Jennifer A.; Nabhan, Fadi; Phay, John E; Ringel, Matthew D; Sipos, Jennifer A
- Abstract
<bold>Background: </bold>Most cytologically indeterminate thyroid nodules (ITNs) with benign molecular testing are not surgically removed. The data on clinical outcomes of these nodules are limited.<bold>Methods: </bold>We retrospectively analyzed all ITNs where molecular testing was performed either with the Afirma gene expression classifier or Afirma gene sequencing classifier between 2011 and 2018 at a single institution.<bold>Results: </bold>Thirty-eight out of 289 molecularly benign ITNs were ultimately resected. The most common reason for surgery was compressive symptoms (39%). In multivariable modeling, patients aged <40 years, nodules ≥3 cm, presence of an Afirma suspicious nodule other than the index nodule, and compressive symptoms were associated with higher surgery rates with hazard ratios for surgery of 3.5 (P < 0.001), 3.2 (P < 0.001), 16.8 (P < 0.001), and 7.31 (P < 0.001), respectively. Of resected nodules, 5 were malignant. False-negative rate (FNR) was 1.7%, presuming all unresected nodules were truly benign and 13.2% restricting analysis to resected cases. The FNR was significantly higher in nodules with a high-risk sonographic appearance for cancer (American Thyroid Association high-risk classification and American College of Radiology Thyroid Imaging Reporting and Data Systems score of 5) compared with nodules with all other sonographic categories (11.8% vs 1.1%; P = 0.03 and 11.1% vs 1.1%; P = 0.02, respectively).<bold>Conclusions: </bold>Younger age, larger nodule size, presence of an Afirma suspicious nodule other than the index nodule, and compressive symptoms were associated with a higher rate of surgery. The FNR of benign Afirma was significantly higher in nodules with high-risk sonographic features.
- Subjects
OLDER patients; GLEASON grading system; MULTIVARIABLE testing; SCIENCE conferences; HEAD &; neck cancer
- Publication
Journal of Clinical Endocrinology & Metabolism, 2020, Vol 105, Issue 11, p1
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa506