Endocrine Abstracts

JOINT3396

Background: Thyroid nodules evaluated through fine-needle aspiration (FNA) cytology yield indeterminate results (Bethesda III or IV) in approximately 15% of cases, with a malignancy risk ranging from 15% to 50%. These uncertainties often result in unnecessary surgical interventions. To address this issue, advanced molecular tests, including the Afirma genomic classifier, were developed. In 2023, Clalit Health Services integrated Afirma testing into its insured services, providing it at no cost to patients to reduce unnecessary surgeries. This study assesses the utilization and impact of Afirma testing within this healthcare framework.

Methods: Data on demographics, laboratory findings, imaging results, and Afirma test outcomes were retrieved from Clalit Health Services records. Ethical approval for the study was obtained from the organizational ethics committee.

Results: Between January 1, 2023 and September 30, 2024, 298 Afirma tests were performed. The mean age was 56.2±16.6 years, and the mean TSH level prior to testing was 2.1±1.5. During this period, patients underwent an average of 4±3.5 neck ultrasounds and 2.9±1.6 FNAs. Among the cohort, 26 patients (8.7%) were Arabs, 16 (5.4%) were Orthodox Jews, and 96 (33%) had a low socioeconomic score. Fifty-two percent of the tests (156 patients) yielded benign Results Among the suspicious findings, NRAS mutations were identified in 13 cases (10%), BRAF V600E in 8 cases (6%), and HRAS in 6 cases (5%). Within the study period, 38 patients underwent thyroidectomy following Afirma testing.

Conclusion: Afirma testing prevented surgery in 52% of patients. The inclusion of Afirma testing in Clalit Health Services facilitated access to advanced diagnostics for patients with lower socioeconomic status, who represented 33% of the cohort, thus reducing healthcare disparities in Israel.