Medical Oncology

, 33:79 | Cite as

Efficiency versus effectiveness: impact of molecular testing on healthcare costs and clinical outcome of patients with indeterminate thyroid nodules

  • Emmanuel LabourierEmail author
Letter to the Editor

The value of the Afirma gene expression classifier for the differential diagnosis of cytologically indeterminate thyroid nodules has been extensively debated since the publication of the initial clinical data in 2012. In a recent meta-analysis, Santhanam et al. [1] reported a pooled specificity of 30.5 % and a pooled sensitivity of 95.7 %. The statistical analysis was based on clinical data from seven peer-reviewed studies that met widely accepted quality criteria for bias and applicability. This work is important because it provides prevailing estimates of test performance and utility to better inform clinical decision making. The authors concluded that the updated performance of the Afirma test “makes it an excellent tool to rule out malignancy”. I believe this statement is only partially correct; a test with a specificity of 30 % might not be an effective diagnostic procedure, both clinically and economically.

The performance metrics that define the effectiveness of a molecular test...


Thyroid Cancer Thyroid Nodule Molecular Test Benign Nodule Health Economics Study 
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Compliance with ethical standards

Conflict of interest

EL was an employee of Asuragen Inc. from March 2006 to March 2014 and a consultant for PDI Inc. from September 2014 to October 2015. The author does not have any direct or indirect employment for and does not hold any equity interest in companies providing commercial testing services for thyroid nodules.


  1. 1.
    Santhanam P, Khthir R, Gress T, Elkadry A, Olajide O, Yaqub A, et al. Gene expression classifier for the diagnosis of indeterminate thyroid nodules: a meta-analysis. Med Oncol. 2016;33:14.CrossRefPubMedGoogle Scholar
  2. 2.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133.CrossRefPubMedGoogle Scholar
  3. 3.
    Labourier E. Utility and cost-effectiveness of molecular testing in thyroid nodules with indeterminate cytology. Clin Endocrinol. 2016;. doi: 10.1111/cen.13096.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.AustinUSA

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