Utility of genomic sequencing classifier in managing cytologically indeterminate oncocytic thyroid nodules
Authors' conclusion
Afirma GSC has a high BCR and improved performance over earlier generation molecular tests in oncocytic thyroid nodules, particularly for Bethesda IV. However, the PPV in Bethesda III nodules remains low, especially in the presence of Hashimoto's thyroiditis.
Study context
- Population
- Adults with Bethesda III and IV thyroid nodules with oncocytic predominance who underwent FNA biopsy and Afirma genomic sequencing classifier (GSC) testing, July 2017–December 2023
- Participants
- 359 nodules
- Comparison
- Bethesda III vs Bethesda IV
- Outcome
- Benign call rate (BCR), sensitivity, specificity, PPV and NPV of Afirma GSC
Methodological detailsmulticenter
- Multicenter
Performance
As reported in the abstract
Afirma GSC performance
| Test or model | Benign call rate (BCR) | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|---|
| Bethesda III | 81% | 89% | 86% | 24% | 99% |
| Bethesda IV | 74% | 94% | 87% | 50% | 99% |
Benign call rate (BCR)
Bethesda III81%
Bethesda IV74%
Sensitivity
Bethesda III89%
Bethesda IV94%
Specificity
Bethesda III86%
Bethesda IV87%
PPV
Bethesda III24%
Bethesda IV50%
NPV
Bethesda III99%
Bethesda IV99%
Further findings
Hashimoto's thyroiditis
- Concurrent Hashimoto's thyroiditis significantly reduced specificity and PPV in Bethesda III nodules
TIRADS classification
- TIRADS classification did not affect BCR or PPV in Bethesda III or IV nodules
Original publication
Utility of genomic sequencing classifier in managing cytologically indeterminate oncocytic thyroid nodules. J Clin Endocrinol Metab. Published 6 February 2026. doi:10.
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