What is the role of the Afirma gene expression classifier (GEC) test in the workup of papillary thyroid carcinoma (PTC)?

Updated: Jun 18, 2020
  • Author: Ponnandai S Somasundar, MD, MPH, FACS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

The Afirma gene expression classifier (GEC) test uses thyroid cells obtained at the time of biopsy to screen for molecular markers (genes) that are associated with thyroid cancer. Its manufacturer claims that the test can predict which indeterminate nodules are likely to be benign (with 95% certainty), and therefore do not require surgery, from those that are likely cancerous (with 50% certainty) and need to be referred to surgery. The hope is that this test will prevent unnecessary thyroid surgeries.

In a multicenter study of Afirma GEC testing of cytologically indeterminate nodules in 393 patients, GEC results significantly altered care recommendations, as 4 of 175 GEC benign nodules were recommended for surgery, versus 141 of 149 GEC suspicious nodules. Of 121 cytologically indeterminate/GEC suspicious nodules surgically removed, 53 (44%) proved to be malignant. On clinical follow-up for an average of 8.5 months, one of 71 GEC-benign nodules proved cancerous. [45]


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