Afirma Xpression Atlas Alteration Status Is Associated with Malignancy Risk in Indeterminate Thyroid Nodules
Authors' conclusion
Alteration detection by Afirma XA offers incremental malignancy risk stratification beyond GSC-suspicious classification alone in indeterminate thyroid nodules.
Study context
- Population
- Patients with Bethesda III/IV thyroid nodules, Genomic Sequencing Classifier (GSC)-suspicious with subsequent Xpression Atlas (XA) testing, who underwent surgical resection; single institution, 3/2020 to 9/2025; 77.6% female, median age 51 years200 nodules
- Participants
- 192 patients
- Exposure
- XA alteration-positive vs alteration-negative GSC-suspicious nodules
- Outcome
- Association between XA alteration detection and histopathology outcomes (malignancy)
Methodological detailssingle institution, consecutive patients
- Single institution
- Consecutive patients
Main finding
As reported in the abstract
Malignancy rate
P < 0.001
Observational data: associations, not effects.
Further findings
Alteration-positive nodules
- Alteration-positive nodules
- 94 nodules (47.0%)
Nodule size
- Nodule size did not differ between alteration-positive and alteration-negative groups
Aggressive histopathologic features (extrathyroidal extension, lymphatic invasion, angioinvasion)
- Alteration-positive nodules did not show more aggressive features than alteration-negative nodules
2025 American Thyroid Association (ATA) risk of recurrence category
- No alteration subgroups or clinical covariates were independent predictors on multivariable linear regression
Original publication
Afirma Xpression Atlas Alteration Status Is Associated with Malignancy Risk in Indeterminate Thyroid Nodules. Thyroid. Published 28 August 2026. doi:10.
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