Evidence map›Paper›PMID 36995878›Full record

Trial reportThe Journal of clinical endocrinology and metabolism2023

Bethesda III and IV Thyroid Nodules Managed Nonoperatively After Molecular Testing With Afirma GSC or Thyroseq v3.

Na Eun Kim, Rajam S Raghunathan, Elena G Hughes, Xochitl R Longstaff, Chi-Hong Tseng, Shanpeng Li, Dianne S Cheung, Yaroslav A Gofnung, Pouyan Famini, James X Wu and 2 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The Journal of clinical endocrinology and metabolism, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Article
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  7. The actual and future role of molecular tests in thyroid pathology.Virchows Archiv : an international journal of pathology · 2026
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  15. No Bones About It: Sex Is Binary.Archives of sexual behavior · 2024
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  20. Association of Gene Expression Alterations with Aggressive Features in Papillary Thyroid Carcinomas Harboring Low Allele Frequency BRAF V600E Mutations.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Na Eun KimDepartment of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.ORCID 0000-0002-7896-9458
Rajam S RaghunathanDepartment of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.ORCID 0000-0003-3734-1688
Elena G HughesDepartment of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.ORCID 0000-0002-7803-1240
Xochitl R LongstaffDepartment of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.ORCID 0000-0003-2561-2639
Chi-Hong TsengDivision of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA 90095, USA.
Shanpeng LiDepartment of Biostatistics, University of California, Los Angeles, CA 90095, USA.ORCID 0000-0002-0724-4564
Dianne S CheungDivision of Endocrinology, Diabetes and Metabolism, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
Yaroslav A GofnungDivision of Endocrinology, Diabetes and Metabolism, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.ORCID 0000-0003-4308-3638
Pouyan FaminiDivision of Endocrinology, Diabetes and Metabolism, UCLA David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.ORCID 0000-0003-3686-7186
James X WuDepartment of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.ORCID 0000-0001-5090-7573
Michael W YehDepartment of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.ORCID 0000-0001-7907-4245
Masha J LivhitsDepartment of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.ORCID 0000-0002-8436-392X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

contextMolecular testing has improved risk stratification and increased nonoperative management for patients with indeterminate thyroid nodules, but data on the long-term outcomes of current molecular tests Afirma Gene Sequencing Classifier (GSC) and Thyroseq v3 are limited.

objectiveTo determine the rate of delayed operation and the false negative rate of the Afirma GSC and Thyroseq v3 in Bethesda III and IV thyroid nodules.

methodsProspective follow-up of a single center, randomized, clinical trial comparing the performance of Afirma GSC and Thyroseq v3 in the diagnosis of indeterminate thyroid nodules at the University of California, Los Angeles (UCLA). Consecutive participants who underwent thyroid biopsy in the UCLA health system with Bethesda III and IV cytology from August 2017 to November 2019. The main outcome measure was false negative rate of molecular testing.

resultsOf 176 indeterminate nodules with negative or benign molecular test results, 14 (8%) nodules underwent immediate resection, with no malignancies found on surgical pathology. Nonoperative management with active surveillance was pursued for 162 (92%) nodules with benign or negative test results. The median surveillance was 34 months (range 12-60 months), and 44 patients were lost to follow-up. Of 15 nodules resected during surveillance, 1 malignancy was found (overall false negative rate of 0.6%). This was a 2.7 cm minimally invasive Hurthle cell carcinoma that initially tested negative with Thyroseq v3 and underwent delayed resection due to sonographic growth during surveillance.

conclusionsThe majority of Bethesda III/IV thyroid nodules with negative or benign molecular test results are stable over 3 years of follow-up. These findings support the high sensitivity of current molecular tests and their role in ruling out malignancy in indeterminate thyroid nodules.

Indexed as

AdenocarcinomaThyroid NeoplasmsThyroid NoduleBiopsyCytodiagnosisHumansProspective StudiesRetrospective Studiesindeterminate nodulesmolecular testingnonoperativesurveillancethyroidthyroid cancer

Identifiers

PMID36995878
PMCPMC10438873

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.