This all new to me and I have a lot to learn. eCollection 2021. Awaiting pathology. But, I am concerned about the report I just received. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? One has tested benign on several FNAs, is cystic, and has remained consistent in size. I hadn't told my two college-age daughters about the series of more and more concerning doctor's visits, but knew I couldn't get through a long day with them at home without showing my emotions. Glad to have found Inspire to learn more, and support others, and receive support. My Endo thinks I should see a thyroid surgeon and my other doctor wants to repeat ultrasounds in 4 months, adopting a wait and see approach. and I said this is not a good test,and he said I don't think it's a good test either! A Indeterminate Suspicious (ROM ~50%) Negative NRAS:p.Q61R c. 182A>G TSHR:p.M453T c. 1358T>C ISTHMUS A UPPER MIDDLE LOWER RIGHT LEFT See Xpression Atlas results overview page for additional information . Fingers crossed they come back negative for cancer! He recently called me back and said that my criticism of the test is valid. o The Afirma MTC testing must be billed as part of the Afirma GSC. Finally, the cells were sent to Afirma, Now I was growing concerned. Yesterday my surgeon told me that FNA Biopsy and Affirma are not reliable and said he would be surprised if the post op pathology shows the same findings. Partially Encapsulated Follicular Variant of Papillary Carcinoma. So, I found a new endo, whom I absolutely loved at my first appointment. PMC The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. Two have been tested by FNA multiple times over 5 years The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. So, what do I not know? The positive predictive value of the GSC is 47.1%.1 Results Afirma GSC results may help guide surgical decision making in patients with thyroid nodules. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. How could it be Benign on one side and Suspicious on the other ? I agree that you should have been consulted for the genetic test!! I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. Afirma GSC (NOT GEC) 50% Suspicious Fayadosky Oct 30, 2018 10:56 AM (edited Nov 04) Results came back 50% Suspicious for FN (Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) Negative for BRAF, RET/ptc1 and ptc3 Any Insights? But still my labs are all within normal range. WHAT ARE THE IMPLICATIONS OF THIS STUDY? An official website of the United States government. I asked her if I have permission to email and post these articles and she said yes,they are for the public. Which means I would still be paying this amount to the hospital if I didn't pay it to Affirma. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. (The office had already explained that benign results would be sent in a letter, but suspicious or confirmed cancer results would warrant a phone call.) A. The site is secure. Upenn top thyroid pathologists including Dr.Virginia Lavosi report that follicular neoplasms with oncocytic (hurthle cells)often are misclassified as suspicious by the Afirma test! Just had TT yesterday. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. One of the hardest things about all of this is the adjustment. I've read a lot about this test (both good and bad). Thanks for chiming in. Afirma; FNA; cytology; thyroid nodules. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Follicular and hurthle cells are normal cells found in the thyroid. This was done in hopes of maintaining my own thryoid function which the doctors and I felt better than taking thyroid medicine daily for the rest of my life. doi: 10.1210/jendso/bvab148. I don't want to jump the gun, and will wait to hear what the new doctor says. 3.) This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. I had a biopsy for 4 nodules 2 mos ago. I'm now 3 days post op and other than some difficulty swallowing and talking loud, I'm feeling great. So much good info but I wish I had read this before I had agreed with my endo on his prescription for rai:( In fact, i am currently on my fifth day of my 7-10 day rai staycation. Afirma testing is back "Risk of malignancy: Afirma GSC Suspicious ~50%" "Malignancy classifiers: Negative" "MTC and BRAF classifier results were negative and RET/PTC1 and RET/PTC3 were not detected. I called back and left them a message that was at home, to call me back. Bugs me. I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. Choosing to have the surgery was the most difficult decision ever, since I wasn't sure if my nodule was cancerous or not, and of course I didn't want to go through the surgery all for nothing. They billed my insurance $6684 - my ins negotiatied $3370.40 they have billed me for 883.71, I applied for a reduction but they say I make too much income so I am not eligible for one. 85% were benign. I went under a fna biopsy and got the results stating that there's are 2 malignant tumors one on each side of my thyroid, and one is suspicions of papillary adenocarcinoma, the other one is suspicions of malignancy. They sent me home with 125mcg of Synthroid, calcitrol, and calcium. Thyroid 2016;26:911-5. I am hesitant to go to surgery with the 30% cancer chance without more information. The Afirma Genomic Sequencing Classifier (GSC) provides physicians with a comprehensive solution for a complex landscape in thyroid cancer diagnosis and individualization of care. Epub 2021 Jun 22. The Afirma GSC is designed to help clinicians manage these patients. Thanks. Genes: a molecular unit of heredity of a living organism. All I can say is that in reviewing my ultrasounds and the report from the interventional radiologist and the Affirma report, I have noticed that there are inconsistencies in even the reported measurements of the nodules and now that I have read further into studies done on people undergoing thyroid removal after getting "Suspicious"/40% of Cancer Affirma results, there are many more false positives than Afirma would have you understand. Local surgical pathology diagnoses were available for 11 of these nodules. Wong KS et al. Epub 2020 Aug 6. Unauthorized use of these marks is strictly prohibited. Can someone give me their take on my fna results? Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. My expensive, unsolicited, Afirma test results came back as negativegood thing I had already had my TT before I received the results; I have stage III pap/follicular thyca. Mol Genet Genomic Med. I have bumps on my head that come and go and are considered normal, and another cyst on my arm that I've had since I was eleven -- also normal. The original Afirma Xpression Atlas (XA) panel reported on 761 genomic variants and 130 fusion pairs from 511 genes ( 6 ). https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. http://biotechstrategyblog.com/2012/06/veracyte- afirma-gene-expression-classifier-thyroid-cancer- diagnostic-test.html/ I'm sure that over the years as more people have this Afirma test done,there will be even more people posting on thyroid and general health boards about getting false "suspicious" results from it! I knew it was not good news. When the nurse called she couldn't even tell me results over he phone -- she said she didn't know them -- but set up an appointment for end of the following week -- another wait. I refuse to rush as there are long-term consequences either way. 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. She admitted once she thinks cancer is unlikely. Others understand my need for more information. I'm shocked that my voice is still completely in tact. This test is performed by the company Veracyte Inc. BACKGROUND Thyroid nodules are very common, occurring in 30-50 % of patients. Papillary Thyroid Cancer: the most common type of thyroid cancer. Also difficult is the reaction from others. Rationale: Crosswalk to 81545 ($3,600) 81545 describes the original Afirma classifier; when . Recently I change insurance and in doing so, my new doctor ordered a ultrasound which showed the nodule and he felt it was nothing to worry about. 2021 Apr;10(2):168-173. doi: 10.1159/000509037. The doctor uses a very thin needle to withdraw cells from the thyroid nodule. 4. Just underwent Afirma and Asurgen testing on the suspicious one. I don't know if I'm speaking too soon, but the pain isn't as bad as I thought it would be. I'm a 57 year old male who took a full body scan 6 1/2 years ago and among other things a small 1 cm nodule was found on the right lobe of my thyroid. They did not address that issue in their letter, just my income. I have slightly high blood pressure and slightly high cholesterol that are well controlled with meds. Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. Thyroid fine needle aspiration biopsy: a simple procedure that is done in the doctors office to determine if a thyroid nodule is benign (non-cancerous) or cancer. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. Neither will talk to the other. A 36% Increase in Specificity With Afirma GSC Versus Older Test . I have 1.6 cm nodule on my right lobe. I have also read a recent 2015 report that posits that there are built-in subjectivities to begin with at the Ultrasound/Pathology level yielding "Indeterminate" or "Atypical Cells" to begin with that then sets up a natural path to getting a "Suspicious" result from Afirma. I feel good for 55 and slid through menopause easily. Epub 2018 Apr 10. undefined will no longer be visible to you including posts, replies, and photos. Indeterminate Thyroid Biopsy: this happens a few atypical cells are seen but not enough to be abnormal (atypia of unknown significance (AUS) or follicular lesion of unknown significance (FLUS)) or when the diagnosis is a follicular or hurthle cell lesion. 2. My Endo thinks I should see a thyroid surgeon and my other doctor wants to repeat ultrasounds in 4 months, adopting a wait and see approach. WHAT ARE THE IMPLICATIONS OF THIS STUDY? The remaining 18% were malignant. Most probably, a lot more lobectomies are going to be performed for indeterminate nodules since the level of certainty is going to drop. I was told my path report from the local hosp was inconclusive so it had to be sent to Mayo Clinic and after almost three weeks after my surgery, I got the word that it was cancerous. But that's a personal issue I'll have to work out in time. No one was telling me that. She also said that her endo said that all of his colleagues stopped using this test and that in their experience the number of suspicious that came back cancerous is the same as what you find in the general population. However, the results are not conclusive. What should I know? Cancer Cytopathol. The rest were called benign by the GEC. http://www.glandsurgery.org/article/view/1002/1193. However, researchers found that when the Afirma GSC identified a thyroid nodule with a TSHR mutation as suspicious, the risk of malignancy was 15.3%, a level of risk for which most physicians. All my blood tests and tsh levels are in the normal range. The cancer-associated genes important in thyroid cancer are BRAF, RET/PTC and RAS. eCollection 2021 Nov 1. The Afirma test results came back Benign on left side and Suspicious 40% on the right side . In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. There are 3 variants of papillary thyroid cancer: classic, follicular and tall-cell. The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. I didn't make a big deal about the cost because I am having surgery and they money I paid was my 20% co-pay and my out of pocket limit is almost met. Now having dodged a few close bullets, I was like wobble head to my new endo's treatment plan which included 100 mci RAI though after reading my path report that I may be at little higher risk with "variant" than most others. Sometimes you only hear the bad stories and not the good so I wanted to share mine. Afirma Gene Expression Classifier: a test for a group of molecular markers in thyroid biopsy specimens in order to determine the likelihood that a thyroid nodule is benign or cancerous. Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis. suspicious - ~50% risk of cancer. I scheduled the surgery for June 3rd but now I'm apprehensive because I don't want to have surgery if there's a chance of this to be benign. The benign call rate for GSC was 76.2%. I am very resistant to the thought of having a gland removed that is functioning perfectly fine, if it isn't cancer. Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. t=5283], http://www.thyroidboards.com/showthread.php? I also recently found *another* article written by an endocrine surgeon Sam Wiseman from the Department of Surgery ,St.Paul's Hospital University Of British Columbia for the site Gland Surgery where he also points out real concerns that half of patients(as I said I know it's more,from all of the people I have found posting on thyroid boards) with benign nodules wrongly classified as "suspicious" by the Afirma test are getting unnecessary thyroid surgery because this Afirma result influenced a lot of endocrinologists and their patients to have the thyroid surgery! https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. It's pretty difficult being the patient trying to sort this all out. And at that appointment, she told me she was about to go on maternity leave, and wanted me to have surgery before her leave. He recently emailed me back and said,as we discusssed on the phone,he agrees with many of my concerns about the Afirma test. Disclaimer. Several thyroid nodules. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/afirma-thyroid-analysis/. But it is saying that actual surgical results show that 40% "suspicion" turns out to send lots of people to surgery and then about 50% of the surgeries done yield results that show that the nodules were not cancerous at all. Papillary thyroid cancer is the most common type of thyroid cancer. It took about 8 days to get back results. I'm fearful this is a Hurthle Cell Lesion, and I do not like what I have read. The original Afirma GSC validation study showed: 54% of ITNs return a benign Afirma GSC result (GSC-B) When categorized by the Afirma test as GSC-B, the risk of thyroid cancer is < 4% When categorized by the genomic test as suspicious (GSC-S), the risk of thyroid cancer is ~50% It just really annoys me that doctors can order tests that cost us money without our consent. I've swallowed the I-131 pill, what are negative effects in the long run? Dr.Hershman then says, In a world where there are unlimited financial resources,both the oncogene and the GEC methods could be applied to all indeterminate nodules,but this approach is not practical currently. The Afirma Genomic Sequencing Classifier (GSC) classifies cytologically indeterminate thyroid nodules as molecularly benign or suspicious. A publication of the American Thyroid Association, Summaries for the Public from recent articles in Clinical Thyroidology, Table of Contents | PDF File for Saving and Printing, THYROID CANCER Wong KS, Angell TE, Strickland KC, Alexander EK, Cibas ES, Krane JF, Barletta JA. Here are some results/Info: While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. Here is what the Affirma test disclaimer said: Benign: Preformance characteristics not defined for nodules less than 1 cm diameter. After reading many stories, I didn't know what to expect. How should I proceed with these results? Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. Therefore, a new version of the Afirma test was created called a gene sequencing classifier (GSC) to better predict thyroid cancers in indeterminate nodule while still being able to rule out cancer in benign nodules. The Afirma GSC is a next-generation genomic test that relies on RNA sequencing and advanced machine learning methodology to categorize tissue from cytologically indeterminate FNA biopsy as either benign or suspicious.2 result (eg, benign or suspicious) Public Comment. I wanted to share my Thyroidectomy story because like most of you I was super scared and nervous about surgery but my surgery went great and I've had no complications. Dr.Jerome Hershman. Seeking a second opinion I went to a leading hospital. 2021 Oct 7;5(11):bvab148. Our offering enables physicians to answer multiple clinical questions for their thyroid patients using a single, minimally invasive fine needle aspiration (FNA) sample. Thank you so much! A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. This did not surprise me since I had researched "suspicious." 8600 Rockville Pike (And myself.) Genes: a molecular unit of heredity of a living organism. My blood tests came back totally normal and I am totally asymptomatic. At first it sounded like only the encapsulated variety was going to be included in the reclassification, but more recently it seems that non-encapsulated and non-invasive FVPTC is also going to be included. they misclassify benign nodules as suspicious! Now can anyone shed some light on any negative effects of RAI on your body in the long-run? I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. At the end of the day, it is what it is now that I SWALLOWED (no pun intended) the I-131 pill, hopefully it won't work against me. We conclude that cytology interpretation has a higher rate of predicting malignancy, in nodules interpreted as SN, when compared with the Afirma test, by almost twofold Diagn. I was told the only way to find out for sure is to have half my thyroid removed. So, in 2014, Thanksgiving was about telling them there was something going on. But, she ordered another ultrasound because she wants to see the images herself, rather than just rely on reports from the radiologist. I had another biopsy which came back showing "Atypical cells". Patients usually return home or to work after the biopsy without any ill effects. So I thought I was in the clear, and decided to just monitor this nodule for growth, and revisit the surgery idea only if size became an issue. Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. After some research of my own, I decided to leave it. National Library of Medicine sharing sensitive information, make sure youre on a federal I think my biggest problem is what I read on the internet as far as all the problems afterwards. Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. I called and almost everyone has that risk if it is suspicious. Finally, at the endocrinologist's visit, he told me the results came back as suspicious for papillary cancer on both sides, and that I'd need to have a TT. A total of 27 patients with GEC benign nodules had surgery for nodule growth or patient preference and 3 had a papillary thyroid microcarcinoma discovered at final pathology while the rest were benign. These results show an improved accuracy for the GSC as compared with the GEC. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. It was found incidentally in an MRI I had for cervical spine pain. One > 4cm, but has tested benign by FNA 4 times The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). While most thyroid nodules are non-cancerous (Benign), ~5-10% are cancerous. Are you sure you want to block this member? I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. 2020 May;162(5):634-640. doi: 10.1177/0194599820911718. Unable to load your collection due to an error, Unable to load your delegates due to an error. My question is then I guess, is it really that bad afterwards managing levels and the other side effects post TT? They were incredibly supportive and also concerned. She has other small nodules on her other thyroid lobe. If you have benign results they always wonder. The https:// ensures that you are connecting to the benign), 25% of cases had follicular variant papillary thyroid cancer, 2% of cases had classical papillary thyroid cancer and 8% of cases had follicular thyroid cancer. Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance Thanks again, Ok so this is all brand new to me so please bear with me. Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing. Among the 25 papers that approached Afirma GEC, four studies enrolled an additional number of 635 TNs from 596 patients to evaluate the Afirma GSC (16, 17, 57, 70). Should I be treating this as a Hurthle Cell Lesion, or should I just relax. I had numerous FNA biospy's last result "suspicious for follicular neoplasm " , the last ultrasound showed several microcalcifications on left and scattered microcalcification on the right. Afirma result was suspicious in 69 cases. Also is anybody here familiar with "Afirma Thyroid Analysis" As I have learned on this board, just 'taking a pill' for the rest of your life isn't as easy as it sounds. That not only had the nodule continued to grow (from 2.0 to 3.2cm over the last 2 years), but it is now showing increased central vascularity. I'm also anxiously waiting my pathology results! Results: Afirma result was suspicious in 69 cases. There are risks and benefits to any decision - and humans are very bad at assessing both. Recommended surgery for suspicious cancer cells. SUMMARY OF THE STUDY doi: 10.1002/mgg3.1288. A test with a better NPV (negative predictive value), would be more usefu than ever in that situation. The aggressive one wants to cover his ass in the tiny chance you have an aggressive thyroid cancer, and the wait and see one is playing the odds that there is nothing to worry about, and that unneeded surgery has risks that are higher than the benefits in your case. -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 Am I being reasonable? Thus, 54 NIFTP cases were established, all with a suspicious Afirma GEC result. I was told to monitor my nodules every couple years using ultra-sound and if they increased in size, they needed to have FNA done. 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. B. And he said he doesn't think the Afirma test is as accurate as they say. BTW, I'm about to turn 50 and I have no thyroid issues other than this. The Afirma GSC is a cancer rule-out test with a high negative predictive value so that cytologically indeter-minate (Bethesda III/IV)2 thyroid nodules with an Afirma GSC benign result can be considered for clinical observation in lieu of diagnostic surgical resection (Fig.

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