In Reply We appreciate all scientific efforts to improve care for patients with indeterminate nodules. The Afirma assay has been an excellent addition to this endeavor, and our study helpful in understanding test characteristics in a unique patient population.
Dr Duh and colleagues expressed concern over the number of patients included in our study.1 Specifically, in eliminating patients who did not undergo surgical excision with benign Afirma results for nodules. Compared with other studies evaluating the classifier, they neglected to mention that our study has the highest percentage of patients with benign Afirma Gene Expression Classifier (GEC) results to undergo surgery (62.1%). This large number of confirmatory true-negative results makes our study less likely to be affected by systematic bias.
Al-Qurayshi Z, Sholl AB, Kandil E. Exclusion of Eligible Indeterminate Thyroid Nodules in Estimates of Negative Predictive Value for the Gene Expression Classifier—Reply. JAMA Otolaryngol Head Neck Surg. 2017;143(7):738–739. doi:10.1001/jamaoto.2017.0230
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