In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive results. I am very athletic , very healthy and happy ,don't want to give up any of that !!! https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/afirma-thyroid-analysis/. 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. Indeterminate thyroid nodules in the era of molecular genomics. Results: My thyroid nodule (1.5 cm) was discovered by mistake; the technician was only supposed to do an ultrasound on my gallbladder and ovaries, but for some reason did my thyroid as well. Then she tells me she's just had a "bad feeling" about my case from the beginning, and she wants me to have a TT soon. doi: 10.1210/jendso/bvab148. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. I am very resistant to the thought of having a gland removed that is functioning perfectly fine, if it isn't cancer. PDF Afirma Thyroid Cancer Classifier Tests - evicore.com The surgeon was great. They did not address that issue in their letter, just my income. The remaining 18% were malignant. Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. I'm not sure what the exact terminology is going to be. In early September, at a well-woman visit, my primary care doctor found a lump in my neck and sent me for a sonogram that found three nodules -- one estimated at 3.5 cm, one at 1.5 cm and the third much smaller. I am still holding off on surgery for now. I've enjoyed good health for my whole life. B. Well, this last spring my endo said she didn't like my latest ultrasound results. Have lots of decisions to make and just trying to do some homework. I found many people including more than a few on the Inspire site in their ThyCa forum who have unfortunately gotten false suspicious results from this test and as a result had totally unnecessary thyroid surgery,including this poor woman on thyroidboards.com who is the worst case I found so far,the Afirma test told her she had an 80% highly suspicious result and because of this her endocrinologist told her to expect cancer and that she had an 80% likelihood that her solid hypoechoic 1- 1 1/2 cm mildly suspicious as follicular neoplasm nodule was cancer,so she had totally unnecessary thyroid surgery for a benign nodule and was scared to death for nothing! This test is performed by the company Veracyte Inc. BACKGROUND Thyroid nodules are very common, occurring in 30-50 % of patients. How could it be Benign on one side and Suspicious on the other ? Everyone's story and experience seemed to be totally different. So frustrating!! Like she was just trying to tie up loose ends, and I happened to be one of those loose ends. 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. Thyroid. Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular 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. See Somatic Mutation Testing - Solid Tumors guideline for criteria. The results of the GEC are either read as suspicious for cancer or benign. Follicular and hurthle cells are normal cells found in the thyroid. SUMMARY OF THE STUDY And he said he doesn't think the Afirma test is as accurate as they say. Hi, Any Insights? How they found it was my complaint of feeling tired all the time. Finally, the cells were sent to Afirma, Now I was growing concerned. Her only information about this comes from me, as she lives across the country and can't go to doctor's visits with me. He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. Awaiting pathology. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. The https:// ensures that you are connecting to the I agree that you should have been consulted for the genetic test!! For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. Bugs me. Follicular Neoplasm. Clinician should therefore exercise caution in using this result for treatment decisions. For some reason, my long time best friend is one of the least supportive in all of this. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. If you have benign results they always wonder. Third, I have no history of thyroid cancer (or any cancer) in my family. and transmitted securely. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. However, the results are not conclusive. PDF Lab Management Guidelines V1.0.2020 Afirma Thyroid Cancer - eviCore In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. Cancer Cytopathol. Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. Methods: Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. 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! Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. But in my case, it was a risk well worth taking. Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). 4. Cancer cells frequently have mutations in these genes. 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. At this point, I was exasperated by all of the running around, but fine. Afirma Practice Resources I'm a lumpy person, I told my husband. Accessibility (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.) Lastly I do 25mcg of levothyroxine once a day for Hypothyroidism, it was prescribed based on lab results, not on how I was feeling. The Afirma Genomic Sequencing Classifier (GSC) classifies cytologically indeterminate thyroid nodules as molecularly benign or suspicious. BTW, I'm about to turn 50 and I have no thyroid issues other than this. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. It came back 99% that its cancer. 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. So we decided to remove the right lobe a week after the afirma results. 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. Meanwhile I read a recent WSJ article about patients with ACTUAL thyroid cancer being offered a wait and see approach as there are so many issues after surgery--not just discomfort issues like fatigue, weight gain and so forth but also secondary cancers. 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. First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") Largest is 2.3(previously 1.8cm in 2014) different test center though. 2020 May;162(5):634-640. doi: 10.1177/0194599820911718. I have found this community very informative, thank you. He also said that what the Afirma pathologist and representatives told me that I have a 40% suspicious chance of thyroid cancer isn't true.He said it's about 25% still. I have 1.6 cm nodule on my right lobe. However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. 1). I have met with multiple surgeons, and am meeting with the one I am selecting on Friday and wanted some info on what to do, and how to proceed. 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. I hope this helps calm some fears for others who may be going through the same thing. She admitted once she thinks cancer is unlikely. Hello, new here and confused, anxious and a bit worried. This nodule is solid, hypoechoic, increased central vascularity and now possible microcalcification. Of course I could have gotten very lucky and caught a cancer in it's early stages, but as well, I do not want to remove a healthy organ . t=5283[/url]. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 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. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. Are you sure you want to block this member? PollAfirma GSC Biospy Result - Thyroid cancer - Inspire 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. Frontiers | Analytical and Clinical Validation of Expressed Variants False positive rate of Afirma was 56% (32/57). -Male - Slightly Hypothyroid which began over the past year or so Please let me know what you think. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. Afirma was suspicious. The pathology report on the removed nodule said: In May 2013 I spoke to Barbara Rath Smith the executive director of The American Thyroid Association and she said she was going to email articles as files to download and she did. Many endocrinologists have written articles in The American Thyroid Association's journal criticizing the inaccuracies and unrelabilities of this recent Afirma test, the strongest criticism and concern is by endocrinologist of (*50* years!) After reading many stories, I didn't know what to expect. 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. How do Afirma GSC & Xpression Atlas tests work? What do they mean The aim of this study was to determine the clinical performance of the GSC as compared with the GEC at one academic medical center. Is is the Benign that is a false negative ? 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. THE FULL ARTICLE TITLE: 5. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. Rationale: Crosswalk to 81545 ($3,600) 81545 describes the original Afirma classifier; when . I had a biopsy for 4 nodules 2 mos ago. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? Abigail. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. I'm afraid I feel ok now then all of a sudden will begin feeling horrible. For the past year I've been seeing functional medicine doctors to see if I could shrink my nodules with diet and nutrition but when I got the positive Afirma test and the biggest nodule 3cm kept growing I finally decided to have surgery, which I had last Thursday. Each of my pre-surgical tests are pointing more and more in the wrong direction. Now can anyone shed some light on any negative effects of RAI on your body in the long-run? A woman on the excellent health site Medhelp told me she had a 3cm. My Afirma results came back suspicious. undefined will no longer be visible to you including posts, replies, and photos. http://www.thyroidboards.com/showthread.php? On May 8th endocrinologist Dr.Steven P.Hadak who with Dr. David S. Rosenthal co-authored one of these studies for The American Thyroid Association's Clinical Affairs Committee called,Information For Clinician's:Commercially Available Molecular Diagnosis Testing In The Evaluation Of Thyroid Nodule Fine-Needle Aspiration Specimens called me back and was very nice,he even had a patient waiting! Performance of Afirma Gene Sequencing Classifier versus - ScienceDirect Thank you so much! 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. Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. -38yrs old A. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. It just really annoys me that doctors can order tests that cost us money without our consent. Follicular and hurthle cells are normal cells found in the thyroid. I'm looking for any and all help and/information you can share with me. Suspicious for neoplasm - Veracyte genomic testing? - MedHelp 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. So the probabilities of malignancy for the various Bethesda risk categories are going to change. Did your Afirma results show calcification? Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance This all new to me and I have a lot to learn. for my adopted daughter as she's already lost her bio-parents and thus my husband and I became her new parents.I've stayed like zombie while awaited my total neck ultrasound results and they came back CLEAR any cancer spreading to lymph nodes..yey! While most thyroid nodules are non-cancerous (Benign), ~5-10% are cancerous. Since that time, the pain has all subsided -- I think the biopsy just roughed things up, but when they calmed down, I felt no pain whatsoever, again. 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. It's really upsetting to suddenly be thrust into this with no symptoms, etc. May 7 endocrinologist Dr.Bryan Mclver,one of the authors of the article from September 2012 in The American Thyroid Association's Journal called,An Independent Study Of A Gene Expression Classifier (Afirma) In The Evaluation Of Cytologically Indeterminate Thyroid Nodules Initial Report and he used to work at The Mayo Clinic,(he now works at The Moffit Cancer Center called me back. Otolaryngol Head Neck Surg. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. Thyroid. Unauthorized use of these marks is strictly prohibited. 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. What should I know? Like I said I'm doing ok and compared to what I see about the aftermath of having my thyroid removed, I sometimes just want to leave it alone and keep an eye on it instead. they misclassify benign nodules as suspicious! Our new findings show that the real-world experience supports this data, further demonstrating that the likelihood of malignancy in Afirma GSC-suspicious nodules is even greater than what was . PDF AFIRMA REQ: Sample Patient Report Epub 2020 Aug 6. 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. I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! 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. Thyroid bloodwork normal. Mild lymphocytic thyroiditis ( nonspecific) Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. I was told the only way to find out for sure is to have half my thyroid removed. It's barely even hoarse. I don't understand the results , I thought that if the result is Benign it means you have no cancer genes and it is 95% sure you won't get cancer . On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). 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." A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. The Xpression Atlas reports 905 genomic variants and 235 fusion pairs on GSC Suspicious, Suspicious for Malignancy (SFM), and Malignant FNA samples at the time of diagnosis. suspicious - ~50% risk of cancer. 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. -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 I'm shocked that my voice is still completely in tact. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. HHS Vulnerability Disclosure, Help How "suspicious" is that nodule? Review of "suspicious" Afirma gene I did not get to go under the knife for my TT til this past March. My surgeon and endocrinologist said no further treatment is needed but to continue observation. Local surgical pathology diagnoses were available for 11 of these nodules. 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. 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. o The Afirma MTC testing must be billed as part of the Afirma GSC. 42 year old female. I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines.

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