In the field of indeterminate thyroide nodules are currently available complete and advanced molecular genetic methods. Among these, Afirma, produced by Veracyte, San Francisco (U.S.A.), represents the one able to determine, with higher reliability and before the surgical intervention, if a thy3 indeterminate thyroid nodule is really benign.
Developed in the United States, it spread to other countries (Canada, Israel, United Arab Emirates, Italy). EndocrinologiaOggi is the first center in Italy and perhaps in Europe where it is possible to routinally use Afirma method for the risk stratification of indeterminate thyroid nodules.
Afirma GSC X Atlas has a negative predictive value of 96%. In essence, if a nodule is benign with Afirma it has a probability> 96% to be really benign, and therefore it should not be underdone to surgery but should be considered as a benign nodule of traditional cytology (Thy2).
Afirma is not a simple genetic test but a true test of gene expression as it evaluates the gene expression profiles of a very high number of genes, measuring at the same time the levels of RNA. The diagnostic capacity of Afirma has been further improved over the years with technical implementations that have given rise to: Afirma-GSC (Gene Sequencing Classifier) and Afirma-GSC-XAtlas in which all the genetic alterations found in the sample are listed, with the risk of malignancy associated with them as reported in the scientific literature.
Afirma is undoubtedly the most advanced method currently available worldwide for pre-operative diagnostics of indeterminate thyroid nodules (TIR3). With gene profiling, Afirma is able to biologically stratify the risk of cancer of an indeterminate thyroid nodule and to select patients who are at very low risk (<4%) of having a tumor. It is therefore the most important exclusion test (“rule-out“) currently available. If a nodule is benign by Afirma, malignancy can be practically ruled out and, therefore, the patient can avoid surgery.
To perform Afirma it is necessary to repeat a needle aspiration to obtain new material to be analyzed.


In conclusion, Afirma GSC and its further implementaion (Afirma GSC X Atlas) represent the most advanced method currently available worldwide for the genomic analysis of indeterminate thyroid nodules (Thy 3a, Thy3f, Bethesda III (AUS/FLUS), Bethesda IV).
Afirma, provides two possible results on indeterminate thyroid nodules: benign or suspicious. Afirma GSC, by reclassifying cytologically indeterminate thyroid nodules as benign, avoids unnecessary thyroid surgery and it is useful in management of cytologically indeterminate thyroid nodules.
Afirma was developed in the United States and, from the first studies, now it is widespread to other countries.
The EndocrinologiaOggi Center in Rome (Italy), is the first center in Europe where Afirma is clinically and routinately used for stratification of indeterminate thyroid nodules. European patients that prefer a closer place to perform Afirma instead of San Francisco (United States), can do it in Rome (Italy) at a lower price (2400 €).

For more information about Afirma GEC, click here.
For more information about Afirma GSC X Atlas, click here.
For an appointment for Afirma GSC X Atlas, you can:
– write an email (
– call (0039 0686391386)
– book on line (click here).


Dr. Massimiliano Andrioli
MD, PhD, Endocrinologist

Centro EndocrinologiaOggi, Roma
viale Somalia 33A, Roma
tel/fax 0686391386
cell 3337831426



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