Hello, I am hesitant to go to surgery with the 30% cancer chance without more information. sharing sensitive information, make sure youre on a federal I can learn to live healthier, and to appreciate each day, and to love and support more readily. 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. On this topic from this forum member bmcm2girls said she too had a false suspicious result from the Afirma test and her nodule was benign when removed. The authors concluded that a GEC suspicious test result may include noninvasive follicular variant papillary thyroid cancer as well as classical papillary thyroid cancer. The Annual International Thyroid Cancer Survivors' Conference and Regional Workshops, Download our free Low-Iodine Cookbook (PDF), Rally for Research and Thyroid Cancer Research Grants. My blood tests came back totally normal and I am totally asymptomatic. He recently called me back and said that my criticism of the test is valid. The doctor uses a very thin needle to withdraw cells from the thyroid nodule. 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. I wasn't one to resist. But, I'm also tired of living with the uncertainty and semi-annual nerve sessions after each ultrasound. Afirma Practice Resources Now can anyone shed some light on any negative effects of RAI on your body in the long-run? Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. I called back and left them a message that was at home, to call me back. What should I know? 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. I had that one sent to Afirma, and it came back indeterminate on cytopathology again, benign on GEC. Which means I would still be paying this amount to the hospital if I didn't pay it to Affirma. However, I was not informed of this. Cancer-Associated Genes: these are genes that are normally expressed in cells. Unable to load your collection due to an error, Unable to load your delegates due to an error. I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines. The results were suspicious of papillary cancer, but not conclusive. One > 2cm, undetermined twice and "suspicious for follicular neoplasm" the most recent FNA It seems like with every ultrasound, some new suspicious characteristic pops up. The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). So, if you were going to go down that route then this will save you from having a second biopsy. 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. If all nonsurgical GSC benign cases were truly benign, the chance a suspicious nodule was truly a thyroid cancer was 60% and a benign nodule was benign was 100%. She also said that her surgeon told her he's had five patients that had a suspicious result from the Afirma test,and then when their nodules were removed and tested they too were benign! Thyroid Cancer - Afirma& Genomic Sequencing Classifier - Veracyte That was a hard Thanksgiving. The third biopsy was sent for genetic testing which came back as suspicious. -No Size changes of Nodule in last 2-3 months (duration of time to get all of these tests) Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. SUMMARY OF THE STUDY Afirma GSC is a pre-operative genomic test for thyroid tumor biopsies that have . I have slightly high blood pressure and slightly high cholesterol that are well controlled with meds. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . microRNA: a short RNA molecule that has specific actions within a cell to affect the expression of certain genes. Since then, I've had yearly scans (ultrasounds) and two biopsies, both came back negative. 6. Of the 343 nodules that underwent the GEC test, 178 cases (51.9%) were considered suspicious for cancer. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Are you sure you want to block this member? Wow! Dr.Jerome Hershman. I understand that Afirma tends to have a lot of false positives, but it's supposed to be fairly accurate for negative results. After reading many stories, I didn't know what to expect. official website and that any information you provide is encrypted I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! 3. The original Afirma gene test was a gene expression classifier (GEC) that used a technology called a microarray that results in a pattern of gene expression. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. A thyroid nodule biopsy can be benign (normal), malignant (cancer) or indeterminate. 2020 May;162(5):634-640. doi: 10.1177/0194599820911718. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer I posted the below post on this forum on several different topics since 2013. Thank God I have good insurance but in the end my medical out of pocket for all of this could cost me up to $4,500. http://www.glandsurgery.org/article/view/1002/1193. This study suggests that more research is needed to determine if the noninvasive follicular variant thyroid cancer can be diagnosed by molecular markers without proceeding to surgery. Thank you so much! I'm fearful this is a Hurthle Cell Lesion, and I do not like what I have read. And it keeps growing. I tried to avoid it for 10 years I am 52 years old , I have a multinodular goiter with many, many , many nodules,the biggest on the left side 2.2 cm right side 2.6 all TSH test results are good , in fact , my thyroid is fonctioning perfectly well. Partially Encapsulated Follicular Variant of Papillary Carcinoma. My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. 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. Please let me know what you think. 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. t=5283], http://www.thyroidboards.com/showthread.php? PollAfirma GSC Biospy Result - Thyroid cancer - Inspire 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! The other tested indeterminate, follicular atypia, cannot rule out follicular neoplasm. I agree that you should have been consulted for the genetic test!! 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. Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. The . WHAT ARE THE IMPLICATIONS OF THIS STUDY? 42 year old female. In this study from Boston, 63 thyroid surgical specimens were reviewed from patients whose thyroid biopsy samples were read as indeterminate and in whom the GEC test was reported as suspicious. So, I found a new endo, whom I absolutely loved at my first appointment. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. That didn't sit well with me. 3.) An evaluation of the molecular marker tests for thyroid cancer Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. I am so glad to find this as reading everyone's story helps me feel not so aloneTHANK YOU! I was seen by a thryoid surgeon who did a 1st biopsy with w/ " suspicious of FVPTC". and transmitted securely. Forth, I have absolutely no symptoms and feel fine. Please enable it to take advantage of the complete set of features! 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 NODULES Indeterminate means the pathologist cannot tell if the nodule is benign or malignant with certainty. My surgeon and endocrinologist said no further treatment is needed but to continue observation. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. However, FVPTC is currently classified as a type of "papillary" carcinoma, so the rate of diagnosis is also going to fall pretty substantially. But, I am concerned about the report I just received. How should I proceed with these results? Mine did, and that can also be a sign of cancer. Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/. Patients usually return home or to work after the biopsy without any ill effects. Bethesda, MD 20894, Web Policies THE FULL ARTICLE TITLE A month ago I had the Afirma test and it came back positive - suspicious for cancer which increased my chance from 5% to 50%. BTW, I'm about to turn 50 and I have no thyroid issues other than this. All thyroid nodules with a "suspicious" Afirma GEC result were investigated. However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. They were incredibly supportive and also concerned. The doc mentioned the thyroid and upon a physical exam felt the nodule, leading to the rest of the testing. 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. Did your Afirma results show calcification? She didn't seem overly concerned based on all my previous records. At this point, I was exasperated by all of the running around, but fine. Hello. 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. 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. Results: PDF Afirma Thyroid Cancer Classifier Tests - evicore.com 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'm also anxiously waiting my pathology results! Third, I have no history of thyroid cancer (or any cancer) in my family. 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! The https:// ensures that you are connecting to the The aim of this study was to determine the clinical performance of the GSC as compared with the GEC at one academic medical center. She admitted once she thinks cancer is unlikely. Complex nodule. So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Good luck and happy thoughts! Veracyte Announces New Data Suggesting Afirma Testing Can Help Please Help! 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. Some people say I should have had my thyroid out years ago. doi: 10.1002/mgg3.1288. After hearing this, I felt a huge kick in my gut and also stupid for getting a second opinion for a fine needle biopsy though I'd ended up with an endo, who wrote articles on the subject. 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. Comparison of Afirma GEC and GSC to Nodules Without Molecular Testing 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. 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.". Most probably, a lot more lobectomies are going to be performed for indeterminate nodules since the level of certainty is going to drop. 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. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. 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. I knew it was not good news. 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. -38yrs old The remaining 18% were malignant. New Data Show Strong Performance of Veracyte's Afirma GSC in Real-World One of these women member dacooper12 on Inspire in their ThyCa forum had the opposite result,which the studies show,that the Afirma test misclassifies a much smaller % of cancerous nodules as benign compared to the higher % of benign nodules it misclassifies as "suspicious. This all new to me and I have a lot to learn. The authors reported the following rates of final diagnoses for these specimens: 65% of cases had no cancer (ie. Afirma Genomic Sequencing Classifier and Xpression Atlas - PubMed (And myself.) 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 . o The Afirma MTC testing must be billed as part of the Afirma GSC. Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. Epub 2021 Jun 22. I had my surgery in NYC, it took 2 hours, and I went home the same day. See Somatic Mutation Testing - Solid Tumors guideline for criteria. I almost want to cancel the surgery. Without my permission my specimen was sent to Affirma and their results were Benign, so my radiologist amended her results to benign for all 4 nodules. Paratracheal nodule (inclduing B1FS): Thyroid Parenchyma, negative for tumor. I welcome your thoughts on my case. Here is what the Affirma test disclaimer said: Benign: Preformance characteristics not defined for nodules less than 1 cm diameter. I'm a lumpy person, I told my husband. 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. For some reason, my long time best friend is one of the least supportive in all of this. As I have learned on this board, just 'taking a pill' for the rest of your life isn't as easy as it sounds. On the day before Thanksgiving, I returned home from work to discover a recorded phone message from the endocrinologist's office. Thyroid bloodwork normal. 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. SUMMARY OF THE STUDIES Thyroseq 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. 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! 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! Nevertheless, I am reluctant to just proceed particularly for the following reasons: Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. 2. 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. BACKGROUND False Positives. It is such a major decision that the more info you have in making the decision the better. 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. For one thing, I had some pain on one side after biopsy. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. 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. 1. For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. I did not necessarily like that simplistic answer and I told him, you have nothing to compare it to, since he had not seen my past records. 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. I called and almost everyone has that risk if it is suspicious. Wong KS et al. False positive rate of Afirma was 56% (32/57). The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. 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! Variant: Afirma XA: Informs selection of surgical and therapeutic decisions for Afirma GSC Suspicious, Bethesda V, and Bethesda VI nodules 1 Is clinically validated 1 and informed by The Cancer Genome Atlas (TCGA), 2 extensive published literature, and Veracyte R&D discovery using nearly 40,000 samples 3 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. I am very resistant to the thought of having a gland removed that is functioning perfectly fine, if it isn't cancer. 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 . 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%
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