On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). My Afirma results also came back as "suspicious." 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 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 Also is anybody here familiar with "Afirma Thyroid Analysis" The . -Male - Slightly Hypothyroid which began over the past year or so I had a biopsy for 4 nodules 2 mos ago. Just had TT yesterday. It is such a major decision that the more info you have in making the decision the better. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). It was .62cm by then. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Afirma result was suspicious in 69 cases. The moment that I've been so nervous about finally came yesterday. I asked her if I have permission to email and post these articles and she said yes,they are for the public. Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. Multiple nodules. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. All my blood tests and tsh levels are in the normal range. Is one easier to recover from ? -No Size changes of Nodule in last 2-3 months (duration of time to get all of these tests) Is is the Benign that is a false negative ? Seeking a second opinion I went to a leading hospital. Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. Hello. I am so new to all this that I don't know what this means. She admitted once she thinks cancer is unlikely. 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. 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 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 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. 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. I'm fearful this is a Hurthle Cell Lesion, and I do not like what I have read. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. Some people say I should have had my thyroid out years ago. Hello, So, what do I not know? I'm determined to eek out the positive in this. Thoughts or experiences?? Since then, I've had yearly scans (ultrasounds) and two biopsies, both came back negative. 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. 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 . National Library of Medicine Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. I am very athletic , very healthy and happy ,don't want to give up any of that !!! A publication of the American Thyroid Association, Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. Paratracheal nodule (inclduing B1FS): Thyroid Parenchyma, negative for tumor. I've swallowed the I-131 pill, what are negative effects in the long run? 3.) 2.) It was found incidentally in an MRI I had for cervical spine pain. Everyone's story and experience seemed to be totally different. The site is secure. I was told that my thyroid needs to be removed (at least half, possibly all). - Partial was recommended at first, though we are leaning total now with the remainder of tests now complete. The benign call rate for GSC was 76.2%. I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. Thyroid Fine Needle Aspiration Biopsy (FNAB): a simple procedure that is done in the doctors office to determine if a thyroid nodule is benign (non-cancerous) or cancer. Have lots of decisions to make and just trying to do some homework. Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. Awaiting pathology. For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). Here is what the Affirma test disclaimer said: Benign: Preformance characteristics not defined for nodules less than 1 cm diameter. The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). suspicious - ~50% risk of cancer. This did not surprise me since I had researched "suspicious." Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. Any help really will be appreciated. detect variants in greater than 50 genes. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. 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. Follicular and hurthle cells are normal cells found in the thyroid. Negative for BRAF, RET/ptc1 and ptc3 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. Others understand my need for more information. My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. Thanks so much! Will find out results in about a week. 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. 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. After reading many stories, I didn't know what to expect. 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. The GSC correctly identified 41 of 45 malignant samples as suspicious, yielding a sensitivity of 91.1%, and 99 of 145 . Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. BACKGROUND Sometimes you only hear the bad stories and not the good so I wanted to share mine. A 36% Increase in Specificity With Afirma GSC Versus Older Test . 3. SUMMARY OF THE STUDIES Thyroseq I didn't want to live with the risk, especially already being hypo and having nodules on the other side slowly growing. The Afirma Genomic Sequencing Classifier (GSC) result was "Suspicious," but the usual orange color (representing ~50% risk of malignancy) of this result is replaced with gray, foreshadowing that . Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). Would you like email updates of new search results? So far, no problems with calcium. It just really annoys me that doctors can order tests that cost us money without our consent. Any Insights? I wasn't one to resist. 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) . Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. 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]). 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 . I have never really loved my endo, and have always felt like she was pressuring me into surgery. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. 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 feel good for 55 and slid through menopause easily. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . I had that one sent to Afirma, and it came back indeterminate on cytopathology again, benign on GEC. He tried to console me but he was also upset. WHAT ARE THE IMPLICATIONS OF THIS STUDY? -38yrs old Additionally, there is an increase in the benign call rate with GSC, which in this study decreased surgical interventions by 68%. We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. Dr.Jerome Hershman. 4,6 In addition to the benign versus malignant classifier, the Afirma GSC suite includes One > 4cm, but has tested benign by FNA 4 times Comparison of Afirma GEC and GSC to Nodules Without Molecular Testing in Cytologically Indeterminate Thyroid Nodules. Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. 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. MeSH And he said he doesn't think the Afirma test is as accurate as they say. I had another biopsy which came back showing "Atypical cells". GEC's SE and SP among studies ranged from 78.0 to 100% and 7.7 to 51.7%, respectively. Afirma; FNA; cytology; thyroid nodules. So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? 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. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. Wong KS et al. 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. microRNA: a short RNA molecule that has specific actions within a cell to affect the expression of certain genes. The Afirma GSC is a cancer rule-out test with a high negative predictive value so that cytologically indeterminate (Bethesda III/IV)2thyroid nodules with an Afirma GSC benign result can be considered for clinical observation in lieu of diagnostic surgical resection (Fig. Incidental papillary thyroid carcinoma, .2 cm on Left lobe and Thyroid right lobe: 1.2 cm nodule-Papillary thyroid carcinoma, conventional and follicular variant, histologically infiltrating into adherent skeletal muscle: .2 cm and the right lobe: 1.4 cm, both 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! Epub 2018 Apr 10. [url=http://www.thyroidboards.com/showthread.php? I understand that Afirma tends to have a lot of false positives, but it's supposed to be fairly accurate for negative results. government site. 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. The authors concluded that a GEC suspicious test result may include noninvasive follicular variant papillary thyroid cancer as well as classical papillary thyroid cancer. 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. 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. 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. It mentions possible microcalcification, which has never come up before. Which means I would still be paying this amount to the hospital if I didn't pay it to Affirma. 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. Now can anyone shed some light on any negative effects of RAI on your body in the long-run? I don't trust this new Afirma thyroid test for very good reasons. Thus, 54 NIFTP cases were established, all with a suspicious Afirma GEC result. 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. So, I found a new endo, whom I absolutely loved at my first appointment. doi: 10.1002/mgg3.1288. the GSC is to further differentiate indeterminate FNA. 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. The surgeon recommended complete removal of my thyroid. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. Nevertheless, I am reluctant to just proceed particularly for the following reasons: 2017;45:308-311. The mindset of medical doctors is to analyze the information at hand and see if anything changes that warrants getting more data or doing surgery.". SUMMARY OF THE STUDY A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. 1. I'm not sure what the exact terminology is going to be. The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. So frustrating!! It came back 99% that its cancer. 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? 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. (Afirma GSC suspicious, suspicious for malignancy, or malignant cytopathology) ,2,4,8 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 result of this 2.1 cm Bethesda IV nodule A is Arma GSC Benign, which suggests a low risk of cancer at approximately 4%. 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. Please Help! I really hope that a much better,much more accurate reliable test like this will be created! There are four types of FVPTV: encapsulated with invasion, encapsulated without invasion, unencapsulated non-invasive and unencapsulated and invasive into the surrounding parenchyma of the gland. I also read on this Inspire site in their Thyroid Cancer Survivors Association forum,a woman had a 2cm indetrminate nodule that everyone was concerned about and her Afirma test came out suspicious or still indeterminate,and she had her thyroid removed,it turns out that the 2cm nodule was benign but they found tiny papillary cancers all under 5mm that weren't even seen on the ultrasound! Careers. The mindset of most surgeons is to cut it out - ignoring the risks of that approach. Epub 2021 Jun 22. Anyone here have a false NEGATIVE Afirma GEC result? Should I be treating this as a Hurthle Cell Lesion, or should I just relax. 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 office had already explained that benign results would be sent in a letter, but suspicious or confirmed cancer results would warrant a phone call.) I'm afraid I feel ok now then all of a sudden will begin feeling horrible. Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. This test is performed by the company Veracyte Inc. BACKGROUND Thyroid nodules are very common, occurring in 30-50 % of patients. I am hesitant to go to surgery with the 30% cancer chance without more information. Mild lymphocytic thyroiditis ( nonspecific)
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