Journal of the American Society of Cytopathology · 2026
Combining Thyroid Imaging Report and Data System (TIRADS) and Afirma Genomic Sequencing Classifier (GSC) for potential improvement of malignant risk stratification of Bethesda III thyroid nodules.
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Jin Xiaobing, Pandya Amit, Lew Madelyn, Smola Brian, Hao Wei, Geng Yuhan, Jing Xin
Аннотация
INTRODUCTION: This study retrospectively assessed the ultrasound parameters in Bethesda category III thyroid nodules accompanied by a diagnostic Afirma genomic sequencing classifier (GSC) testing result and surgical/clinical follow-up, and investigated whether combining ultrasound and GSC classifications could improve risk stratification of the atypia of undetermined significance (AUS) nodules.
MATERIALS AND METHODS: Data including radiologic Thyroid Imaging Report and Data System (TIRADS) score, concurrent GSC test results, and surgical/clinical follow-up were collected from patients with thyroid nodules meeting the study criteria. The distribution of TIRADS scores was compared between GSC-suspicious versus GSC-benign cohorts, as well as between malignant and benign nodules. The diagnostic performance of the GSC was compared between TIRADS 5 and TIRADS < 5 cohorts.
RESULTS: The study consisted of 322 AUS nodules. Compared to the GSC-benign cohort, the GSC-suspicious cohort had a greater proportion of TIRADS 5 nodules (34% vs. 24%, P = 0.045), a lower proportion of TIRADS 1-3 nodules (20% vs. 30%, P = 0.048), and a higher average TIRADS score (4.12 vs. 3.92, P = 0.03). Compared to the benign cohort (histologically and/or clinically benign), the malignant cohort (histologically malignant) showed a higher proportion of TIRADS 5 nodules (52% vs. 24%, P = 0.004). The mean TIRADS score was also significantly higher in the malignant cohort compared to the benign cohort (4.36 vs. 3.92, P = 0.015). GSC testing demonstrated a significantly higher positive predictive value in the TIRADS 5 AUS nodules than that of TIRADS< 5 nodules (39% vs. 17%, P = 0.016).
CONCLUSIONS: A GSC-suspicious result combined with TIRADS 5 significantly improved the positive predictive value, thereby enhancing risk stratification in AUS thyroid nodules, while other diagnostic parameters remained unchanged.
MATERIALS AND METHODS: Data including radiologic Thyroid Imaging Report and Data System (TIRADS) score, concurrent GSC test results, and surgical/clinical follow-up were collected from patients with thyroid nodules meeting the study criteria. The distribution of TIRADS scores was compared between GSC-suspicious versus GSC-benign cohorts, as well as between malignant and benign nodules. The diagnostic performance of the GSC was compared between TIRADS 5 and TIRADS < 5 cohorts.
RESULTS: The study consisted of 322 AUS nodules. Compared to the GSC-benign cohort, the GSC-suspicious cohort had a greater proportion of TIRADS 5 nodules (34% vs. 24%, P = 0.045), a lower proportion of TIRADS 1-3 nodules (20% vs. 30%, P = 0.048), and a higher average TIRADS score (4.12 vs. 3.92, P = 0.03). Compared to the benign cohort (histologically and/or clinically benign), the malignant cohort (histologically malignant) showed a higher proportion of TIRADS 5 nodules (52% vs. 24%, P = 0.004). The mean TIRADS score was also significantly higher in the malignant cohort compared to the benign cohort (4.36 vs. 3.92, P = 0.015). GSC testing demonstrated a significantly higher positive predictive value in the TIRADS 5 AUS nodules than that of TIRADS< 5 nodules (39% vs. 17%, P = 0.016).
CONCLUSIONS: A GSC-suspicious result combined with TIRADS 5 significantly improved the positive predictive value, thereby enhancing risk stratification in AUS thyroid nodules, while other diagnostic parameters remained unchanged.