Gene expression classifier (GEC) testing did not significantly affect the decision to perform surgery in an algorithm applied to 273 consecutive patients with thyroid nodules. However, in the few whose treatment was changed because of the test, researchers saw evidence of overtreatment.

The algorithm used classifications from the Bethesda System for Reporting Thyroid Cytopathology, as well as clinical, laboratory, and radiological findings. Investigators noted changes in management based on the effect GEC testing had on the surgical decision-making process.

Among the results:

• The clinical management plan of 23 patients was altered; 16 were found to be over-treated after postoperative histopathology analysis.

• GEC testing was not necessary in 146 patients.

• The positive predictive value of the GEC test for cytologically indeterminate nodules was 42.1%, and the negative predictive value was 83.3%.

• GEC testing did not affect surgical decision-making in 250 patients.

Citation: Noureldine S, Olson M, Agrawal N, Prescott J, Zeigler M, Tufano R. Effect of gene expression classifier molecular testing on the surgical decision-making process for patients with thyroid nodules. [Published online ahead of print November 25, 2015]. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2015.2708.