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Real-World Performance of the Afirma Genomic Sequencing Classifier (GSC)-A Meta-analysis.

Christian E Nasr¹, Massimiliano Andrioli², Mayumi Endo³

¹University of Arizona College of Medicine Phoenix, Phoenix, AZ 85004, USA.

The Journal of Clinical Endocrinology and Metabolism

|December 5, 2022

Summary

Real-world Afirma GSC performance in thyroid nodule risk stratification shows improved specificity and predictive values compared to validation studies. This higher benign call rate may lead to more observation and fewer unnecessary surgeries.

Keywords:

benign call rate genomic sequencing classifier indeterminate thyroid nodule real world risk of malignancy

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Published on: October 5, 2018

Area of Science:

Endocrinology
Oncology
Molecular Diagnostics

Background:

The Afirma Gene Signature Classifier (GSC) is used for risk stratifying indeterminate thyroid nodules.
Previous validation studies (VS) established baseline performance metrics for the GSC.
Numerous independent real-world (RW) studies have since been published, necessitating a performance comparison.

Approach:

This study compared the performance of the Afirma GSC in real-world (RW) studies against its original validation study (VS) metrics.
Specific assumptions were applied for analyzing surgical histology data and handling unoperated patients.
Statistical significance was assessed for performance metrics and benign call rate (BCR).

Key Points:

Real-world Afirma GSC demonstrated higher observed specificity (oSP) of 88% and observed positive predictive value (oPPV) of 65% compared to VS metrics (68% SP, 47% PPV).
Real-world performance also showed a higher conservative specificity (cSP) of 80% and conservative positive predictive value (cPPV) of 49%.
The benign call rate (BCR) was significantly higher in RW studies (67%) versus VS (54%), indicating more nodules were classified as benign.

Conclusions:

Real-world data indicates the Afirma GSC has significantly improved specificity and predictive value performance compared to its validation study.
The increased BCR in real-world settings suggests a greater likelihood of clinical observation for thyroid nodules.
These findings support the Afirma GSC's utility in refining thyroid nodule management, potentially reducing unnecessary surgeries.