Dr. Aoun: Surgery has traditionally involved removing all or part of the thyroid.
How often do you perform the FNA, and do you perform it yourself?
Dr. Aoun: I do. I look at the ultrasound sonographic features of the nodule, take in-to consideration the patient’s clinical risk factors, such as radiation exposure or family history of thyroid cancer, and decide accordingly on whether to proceed to FNA.
So how often do you do it here yourself? How many have you done so far?
Dr. Aoun: I’ve done several. I can’t give you an exact number, but I can tell you that about half a million nodules or so get biopsied on a yearly basis in the U.S..
From those half a million how often do they come out inconclusive?
Dr. Aoun: If we consider a twenty percent cut-off, that would be about a hundred thousand indeterminate biopsies per year.
So a hundred thousand people are actually going in to surgery not knowing if they need to or not?
Dr. Aoun: On pathology analysis after surgery, about seventy-five percent of those with indeterminate nodules will end up having a benign disease. Only twenty-five percent or so will turn out to have cancer.
So they’re going through this process of surgery. For patients, what is the recovery time, what do they go through, and how does that change their life?
Dr. Aoun: There is a lifelong requirement for thyroid hormone replacement therapy if the whole thyroid is removed. Also, one must factor in the potential risks of surgery.
How invasive is the surgery?
Dr. Aoun: An incision is done in the neck to remove part of or the whole thyroid. Recovery is fairly good. If the patient is stable and there are no complications, they usually go home the next day.
So now we have this test that’s called the Afirma Gene Expression Classifier?
Dr. Aoun: That is correct.
Can you explain what it does?
Dr. Aoun: The Afirma gene expression classifier comes in-to play when a patient has an indeterminate thyroid nodule FNA. Traditionally, those patients were sent to surgery. Now the Afirma gene expression classifier helps sort out whether the nodule appears benign or not. If benign, the patient can avoid surgery and be monitored instead. If, however, the results of the genetic test are suspicious for cancer, we recommend that those patients still proceed to surgery.
How does it work exactly, how does it know?
Dr. Aoun: The genomic test looks at certain gene expression patterns in the indeterminate FNA sample to reclassify the nodule as benign or suspicious for cancer. When I do the biopsy, I take an extra sample to be analyzed in case the initial results are indeterminate. Thus, the Afirma test will be performed without the patient having to come back for another FNA. The overall goal is to help patients whose inconclusive nodules are actually benign to avoid surgery they would otherwise undergo.
For more information, please contact:
Paul Aoun, DO, PhD
Palm Beach Diabetes & Endocrine Specialists