He tried to console me but he was also upset. 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. Christmas got in the way, so January 22 is my date. I don't trust this new Afirma thyroid test for very good reasons. Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing. The Affirma Xpression Atlas is based on RNA sequencing. Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. I am still holding off on surgery for now. 4. The PPV was 50% among GSC suspicious nodules when a variant or fusions was identified, compared with 44% among GSC suspicious nodules when no variant or fusion was identified (p = 0.77 [2]). After reading many stories, I didn't know what to expect. Unauthorized use of these marks is strictly prohibited. If you have benign results they always wonder. - Partial was recommended at first, though we are leaning total now with the remainder of tests now complete. I really hope that a much better,much more accurate reliable test like this will be created! I opted for a total after much thought because I had three un biopsied nodules on the other side and was already hypo with my entire thyroid to begin with. 2017;45:308-311. So, what do I not know? Which if they used the YTD income they could clearly see that I qualified for a reduced billing. Multiple nodules. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer metastases: Insights to inform clinical decisionmaking from a fineneedle aspiration sample Jeffrey F. Krane, MD, PhD,1 Edmund S. Cibas, MD,2 Mayumi Endo, MD,3 Ellen Marqusee, MD,4 Mimi I. Hu, MD,5 Christian E. Nasr, MD,6 Steven G. Waguespack, MD,5 Lori J. Wirth, MD,7 Follicular Neoplasm. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. I'm a foodie who has always struggled with weight, but I also exercise so I'm always just plump but in otherwise decent health. Just had TT yesterday. I didn't want to live with the risk, especially already being hypo and having nodules on the other side slowly growing. Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas BACKGROUND Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. And is this what that recent October 2015 WSJ article was hinting at.having people with certain types of cancer of the thyroid not undergo surgery at all but just adopt a wait and see posture? http://www.thyroidboards.com/showthread.php? How they found it was my complaint of feeling tired all the time. Here are some results/Info: Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. Without my knowledge 4/5 of my FNA biopsies came out fine but 1/5 had "atypical" cells and they were sent to Afirma without my knowledge. Wong KS, Angell TE, Strickland KC, Alexander EK, Cibas ES, Krane JF, Barletta JA. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. The authors concluded that a GEC suspicious test result may include noninvasive follicular variant papillary thyroid cancer as well as classical papillary thyroid cancer. Thyroid Nodules: http://www.thyroid.org/thyroid-nodules/, Thyroid Cancer: http://www.thyroid.org/thyroid-cancer/, Thyroid Surgery: http://www.thyroid.org/thyroid-surgery/. No lymphovascular invasion is identified. The https:// ensures that you are connecting to the Thanks so much! Have lots of decisions to make and just trying to do some homework. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . Also is anybody here familiar with "Afirma Thyroid Analysis" Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Well, this last spring my endo said she didn't like my latest ultrasound results. This study indicates that the newer Afirma GSC test is superior to the Afirma GEC test by better predicting which indeterminate nodules are more likely to be cancers and should be removed while maintaining the same or better performance of predicting which indeterminate nodules are benign and can be monitored without surgery. I'm a 39 years old male. Cytopathol. result (eg, benign or suspicious) Public Comment. I am very resistant to the thought of having a gland removed that is functioning perfectly fine, if it isn't cancer. -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 Here n this 2014 discussion member Olivia-T who was 69 when she posted this and had hurthle cell neoplasm that tripled in size in 10 months,and got a 40% suspicious from the Afirma test,and did post a follow up that did turn out to have thyroid cancer,says here that her oncologist said that her last two patients who had surgery also because of the 40% suspicious for cancer DNA test turned out to have benign tumors. So, if you were going to go down that route then this will save you from having a second biopsy. An official website of the United States government. But still my labs are all within normal range. 4) How do I make sure I get the best care? Epub 2012 Oct 18. Once you go down the hole, there are no good statistics to guide you in making rational decisions in an irrational area of medicine - AND as you know, no decisions in medicine in even cut and dried cases are so simple as to have no opposing point of view. The Afirma Genomic Sequencing Classifier (GSC) was developed and clinically validated to utilize genomic material obtained during the FNA to accurately identify benign nodules among those deemed cytologically indeterminate so that diagnostic surgery can be avoided. Please click on this link below about the woman with a 1-1 and half cm solid hypoechoic nodule who had an inconclusive Fine Needle biopsy which was suspicious as a follicular neoplasm and mine is being called a follicular neoplasm with oncocytic (hurthle cell features) ,this woman had her FNA nodule sample tested by the veractye Afirma Test which is what I had done,the results came back telling her that her that their results on her FNA was highly suspicious and that because of this her endo told her she had an 80% chance of having thyroid cancer and so she had her thyroid out and found out it was benign! WHAT ARE THE IMPLICATIONS OF THIS STUDY? 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. Before Also difficult is the reaction from others. Used for FNA indeterminate nodules (bethesda III-IV). I had another biopsy which came back showing "Atypical cells". I wasn't one to resist. I'm shocked that my voice is still completely in tact. I'm fearful this is a Hurthle Cell Lesion, and I do not like what I have read. So I was reading about the new kind of fna biopsy called Afirma, and I guess that my question is, is it worth getting it as a second opinion or should I go through with the surgery because of the results not being undetermined. The range of confirmed cancer (post surgery) from different studies was as low as 17% to as high as close to 50%. Among the 22 with only a TP53 alteration, the first 16 consecutive nodules were included (7 nodules were Bethesda III and 9 nodules were Bethesda IV). http://www.glandsurgery.org/article/view/1002/1193, http://biotechstrategyblog.com/2012/06/veracyte-, Papillary and follicular thyroid cancer (differentiated), Multiple endocrine neoplasia type 2 (MEN2), Mental challenges of living with thyroid cancer, ThyCa fundraising and thyroid cancer research grants. 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. 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 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. 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. Results: Afirma result was suspicious in 69 cases. Don't want to gain weight or feel less optimal then I am now. My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. detect variants in greater than 50 genes. Anyway, if these are to be become non-malignant, the rates of malignancy for the different Bethesda Categories are going to have to be adjusted downward. 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. I've read a lot about this test (both good and bad). It is such a major decision that the more info you have in making the decision the better. So, in 2014, Thanksgiving was about telling them there was something going on. I have 1.6 cm nodule on my right lobe. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. I did not get to go under the knife for my TT til this past March. I posted the below post on this forum on several different topics since 2013. Hello, new here and confused, anxious and a bit worried. Lastly I do 25mcg of levothyroxine once a day for Hypothyroidism, it was prescribed based on lab results, not on how I was feeling. I find out my biopsy results next week. ThyCa: Thyroid Cancer Survivors' Association, Inc. The results of the GEC are either read as suspicious for cancer or benign. 3. I knew it was not good news. Forth, I have absolutely no symptoms and feel fine. I was seen by a thryoid surgeon who did a 1st biopsy with w/ " suspicious of FVPTC". He is very calm and laid back, and prefers to take a more controlled approach to everything, but I'm feeling a more aggressive approach is warranted. A 36% Increase in Specificity With Afirma GSC Versus Older Test . They sent me home with 125mcg of Synthroid, calcitrol, and calcium. Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. 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. These results do not change the risk of malignancy of the (ROM) of the Afirma GSC suspicious result." That was a hard Thanksgiving. See Somatic Mutation Testing - Solid Tumors guideline for criteria. I immediately started crying, knowing that a phone call wasn't "the good news." GEC's SE and SP among studies ranged from 78.0 to 100% and 7.7 to 51.7%, respectively. (Afirma GSC suspicious, suspicious for malignancy, or malignant cytopathology) ,2,4,8 I wish you luck in whatever you decide. Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/. Have lots of decisions to make and just trying to do some homework. 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. I had a total thyroidectomy in NYC. Thyroid. Gorshtein A, Slutzky-Shraga I, Robenshtok E, Benbassat C, Hirsch D. Eur Thyroid J. Conclusion: 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. Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier. Wong KS et al. Overall malignancy rates were highest in the GSC group at 39%, compared to 20% and 22% in the no-molecular-testing and GEC groups, respectively (P = 0.0222) . They did not address that issue in their letter, just my income. I asked her if I have permission to email and post these articles and she said yes,they are for the public. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . Indeterminate thyroid nodules in the era of molecular genomics. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. Follicular and hurthle cells are normal cells found in the thyroid. 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. The good news is that if your insurance refuses to pay for the test, then you will only have to pay 300.00 out of pocket. The Afirma gene expression classifier (GEC) is being increasingly utilized to confirm the benign nature of indeterminate FNA cytology results thus avoiding unnecessary surgical procedures. Well her Afirma test result was benign,but not long after she had her thyroid removed and found she had papillary cancer that had spread into her central lymph node and she said that her surgeon told her that the Afirma test is not very reliable! You started down the rabbit hole by focusing on your thyroid gland for no good reason, since the melanoma is not related to anything regarding your asymptomatic thyroid. Here member santef1 says she had a 2cm nodule that came as suspicious from the Afirma test but after surgery that nodule was found to be benign but as with what happened to so many people,they found several micro pap cancers not seen on the ultrasound. The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC) BACKGROUND Thyroid nodules are very common, occurring in up to 50% of individuals. Several thyroid nodules. Thanks for chiming in. Thyroid bloodwork normal. However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. 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? I've swallowed the I-131 pill, what are negative effects in the long run? I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! The other approach to molecular diagnosis of thyroid cancer is the measurement of oncogenes such as BRAF on FNA to make a positive diagnosis of thyroid cancer in cytologically indeterminate FNA biopsies. I had the ultrasound, and am waiting for my appointment with her to go over the images. Afirma; FNA; cytology; thyroid nodules. The moment that I've been so nervous about finally came yesterday. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. The pathology report on the removed nodule said: Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. Thyroid nodules are very common, occurring in up to 50% of individuals. t=5283[/url]. My surgeon and endocrinologist said no further treatment is needed but to continue observation. Anyone here have a false NEGATIVE Afirma GEC result? and transmitted securely. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. Still, I can see my nodule on one side and don't want to risk having cancer in my body, so I was ready to set up the surgery as soon as possible. And at that appointment, she told me she was about to go on maternity leave, and wanted me to have surgery before her leave. No one was telling me that. I have multiple nodules. Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Nsui BA, Dobrean A, Silaghi H. Front Endocrinol (Lausanne). A thyroid nodule biopsy can be benign (normal), malignant (cancer) or indeterminate. I think my biggest problem is what I read on the internet as far as all the problems afterwards. Found an endocrinologist who is willing to work with me on some more testing. Recommended surgery for suspicious cancer cells. I refuse to rush as there are long-term consequences either way. I know, that is still pricey but seems cheap compared to $6,000. The other side is that I had to have a 2nd biopsy done just to collect cells for AFIRMA. 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. doi: 10.1002/mgg3.1288. There are risks and benefits to any decision - and humans are very bad at assessing both. This test is performed by the company Veracyte Inc. BACKGROUND Thyroid nodules are very common, occurring in 30-50 % of patients. I'm now 3 days post op and other than some difficulty swallowing and talking loud, I'm feeling great. Thanks. Afirma result was suspicious in 69 cases. He later called and said he was sending me for a biopsy. She also said that her surgeon also had 5 other patients that had the Afirma test done,and said their nodules were suspicious too and they all were found to benign after they were removed! There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Surgical margins: negative for tumor (tumor is < 0.1cm from margin) What do I do? Unable to load your collection due to an error, Unable to load your delegates due to an error. My Afirma results also came back as "suspicious." I pointed out to them that since the nodule tested was less than 1cm the radiologist should not have sent it and they should not have tested it. Her only information about this comes from me, as she lives across the country and can't go to doctor's visits with me. So when I say the doctor's says suspicious for cancer with a 75% possibility, I'm not sure how she gets 'unlikely' from that. Each of my pre-surgical tests are pointing more and more in the wrong direction. On the day before Thanksgiving, I returned home from work to discover a recorded phone message from the endocrinologist's office. Thank you so much! 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 . Indeterminate means the pathologist cannot tell if the nodule is benign or malignant with certainty. 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. My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. Epub 2020 May 21. Should I be treating this as a Hurthle Cell Lesion, or should I just relax. I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! something nodule with a majority of Hurthle cells with normal thyroid blood tests and the Afirma test came back 40% suspicious,it grew even bigger in two years and was hypoechoic and vascular on the ultrasound like mine and she said this concerned her and the radiologist,she said (she said my nodule sounds a lot like hers except hers was bigger) so she had half her thyroid out and this nodule was benign! SUMMARY OF THE STUDY 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. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). And he said he doesn't think the Afirma test is as accurate as they say. However, the results are not conclusive. 6. 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. Disclaimer. Long story short, after consulting a reputable endo with 25+ years of exp and hearing that I needed a total neck ultrasound to rule out any possible cancer spread to my lymph-nodes, I could not help but ask him if thyroid cancer is the slowest growing of all cancers and why the concern of cancer-spread only after year after diagnosis.here's the bomb I was not ready for or did not expect: my doc's said that he could not rule out the possibility this cancer may have started back in 2002 but remained to be such a small size of 1.4 cm for all these years. A woman on the excellent health site Medhelp told me she had a 3cm. 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. doi: 10.1210/jendso/bvab148. Everyone's story and experience seemed to be totally different. The authors reported the following rates of final diagnoses for these specimens: 65% of cases had no cancer (ie. A. I appreciate any and all responses, and please do respond, I need as much information as I can get and I live by the saying, "you don't know what you don't know." The remaining 18% were malignant. My Afirma test came back May 6 with what the company calls 40% "suspicious". Thank you. A test with a better NPV (negative predictive value), would be more usefu than ever in that situation. One > 2cm, undetermined twice and "suspicious for follicular neoplasm" the most recent FNA 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. No parathyroid tissue identified. I didn't take the nodule too seriously, but did see a specialist and also got the FNA. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. Our offering enables physicians to answer multiple clinical questions for their thyroid patients using a single, minimally invasive fine needle aspiration (FNA) sample. 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. Awaiting pathology. eCollection 2021. The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. Additionally, there is an increase in the benign call rate with GSC, which in this study decreased surgical interventions by 68%. The Afirma GEC is a microarray-based molecular test that uses a machine learning-derived classification algorithm to further classify indeterminate thyroid nodules into benign and suspicious categories. This did not surprise me since I had researched "suspicious." I was doing some research and came across the Afirma Thyroid Analysis by Veracyte and was wondering if anyone in a similar situation had tried this and what there results were. She admitted once she thinks cancer is unlikely. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. 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. Cancer-Associated Genes: these are genes that are normally expressed in cells. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. HHS Vulnerability Disclosure, Help 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. and I just found out that my Afirma test isn't being paid for by my insurance company on the grounds that its test is considered "experimental.". National Library of Medicine Hello. Bookshelf Hi, Thyroid. 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.

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