Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). Bookshelf 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 . Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. Are you sure you want to block this member? Two have been tested by FNA multiple times over 5 years Local surgical pathology diagnoses were available for 11 of these nodules. 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. Have lots of decisions to make and just trying to do some homework. Rationale: Crosswalk to 81545 ($3,600) 81545 describes the original Afirma classifier; when . At least 1 genomic alteration was identified by the expanded Afirma XA panel in 70% of medullary thyroid carcinoma classifier-positive FNAs, 44% of Bethesda III or IV Afirma GSC suspicious FNAs, 64% of Bethesda V FNAs, and 87% of Bethesda VI FNAs. That was a hard Thanksgiving. Thyroid Nodules: http://www.thyroid.org/thyroid-nodules/, Thyroid Cancer: http://www.thyroid.org/thyroid-cancer/, Thyroid Surgery: http://www.thyroid.org/thyroid-surgery/. The GSC correctly identified 41 of 45 malignant samples as suspicious, yielding a sensitivity of 91.1%, and 99 of 145 . For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. 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 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. My question is then I guess, is it really that bad afterwards managing levels and the other side effects post TT? result (eg, benign or suspicious) Public Comment. [url=http://www.thyroidboards.com/showthread.php? So the probabilities of malignancy for the various Bethesda risk categories are going to change. Thanks. I'm a 39 years old male. Ultrasound reports unfortunately not very informative other than size. I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! The original Afirma Xpression Atlas (XA) panel reported on 761 genomic variants and 130 fusion pairs from 511 genes ( 6 ). 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'd done enough research to know that Thyroid cancer is generally treatable, and was sure to tell them about that. 85% were benign. She then tells me that at a recent conference, there was a lot of discussion of Afirma, and the general consensus seemed to be that it was good at detecting papillary cancer, but not necessarily follicular. Dr.Jerome Hershman. BACKGROUND 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]). Right now my neck lymph nodes look good. 6. I feel good for 55 and slid through menopause easily. They did not address that issue in their letter, just my income. -Lymph Node US: Mostly clear in neck, 1 ovoid focus in submandibular region that may be enlarged LN or Submandibular Lesion THE FULL ARTICLE TITLE: 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 mindset of medical doctors is to analyze the information at hand and see if anything changes that warrants getting more data or doing surgery.". This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. It's really upsetting to suddenly be thrust into this with no symptoms, etc. After reading many stories, I didn't know what to expect. Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. Multiple nodules. 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). At this point, I was exasperated by all of the running around, but fine. 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. However, the interesting twist was that cancer was not detected on the nodules being monitored, there was a little sucker hidden behind all these years according to my surgeon and this was why the pathologist at my local hosp could not come up with definitive conclusion as he/she was only focused on the biopsied nodules:( government site. Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. An official website of the United States government. One has tested benign on several FNAs, is cystic, and has remained consistent in size. 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! -Male - Slightly Hypothyroid which began over the past year or so The cancer-associated genes important in thyroid cancer are BRAF, RET/PTC and RAS. Thoughts or experiences?? I called and almost everyone has that risk if it is suspicious. With each step, I'd expected to hear, "yeah, you are a lumpy person, but no cancer." Thyroid 29:11151124. Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Nsui BA, Dobrean A, Silaghi H. Front Endocrinol (Lausanne). BTW, I'm about to turn 50 and I have no thyroid issues other than this. o The Afirma MTC testing must be billed as part of the Afirma GSC. Found an endocrinologist who is willing to work with me on some more testing. The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC). 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 doc mentioned the thyroid and upon a physical exam felt the nodule, leading to the rest of the testing. Any Insights? 2.) 3.) Any help really will be appreciated. How could it be Benign on one side and Suspicious on the other ? :-). Thyroid cancer support group and discussion community. eCollection 2021 Nov 1. These gene patterns are better at ruling out thyroid cancer in an indeterminate nodule than confirming cancer. Before I don't know if I'm speaking too soon, but the pain isn't as bad as I thought it would be. I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. Would you like email updates of new search results? I have found this community very informative, thank you. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. Can someone give me their take on my fna results? The third biopsy was sent for genetic testing which came back as suspicious. 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. (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.) Christmas got in the way, so January 22 is my date. Also difficult is the reaction from others. 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. I think my biggest problem is what I read on the internet as far as all the problems afterwards. I can learn to live healthier, and to appreciate each day, and to love and support more readily. So, what do I not know? However, I was not informed of this. Is one easier to recover from ? For some reason, my long time best friend is one of the least supportive in all of this. A. Have lots of decisions to make and just trying to do some homework. I had that one sent to Afirma, and it came back indeterminate on cytopathology again, benign on GEC. Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). So, if you were going to go down that route then this will save you from having a second biopsy. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). One of the hardest things about all of this is the adjustment. However, that information will still be included in details such as numbers of replies. If benign = no surgery, IF suspicious or malignant = surgery. Of the 343 nodules that underwent the GEC test, 178 cases (51.9%) were considered suspicious for cancer. Afirma was suspicious. 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. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . What do I do? And she's just mostly silent about it. 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. 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. Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer 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. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. A woman on the excellent health site Medhelp told me she had a 3cm. Here are some results/Info: 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! Here's what a friend of mine wrote who is a retired neurologist: "They can both be right for different reasons, or from different perspectives. Advice needed please. This is about 25% of all thyroid cancers currently. All my blood tests and tsh levels are in the normal range. This occurs in 15-20% of biopsies and often results in the need for surgery to remove the nodule. 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. Patients usually return home or to work after the biopsy without any ill effects. http://www.glandsurgery.org/article/view/1002/1193. And the 3rd test was Afirma which came back "suspicious". doi: 10.1002/mgg3.1288. The aim of this study was to find out how often indeterminate thyroid biopsy specimens which were read as suspicious by the GEC test were ultimately diagnosed as noninvasive follicular variant papillary thyroid cancer after surgery. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. Epub 2020 Mar 17. 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. 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. And he said he doesn't think the Afirma test is as accurate as they say. Now, I will most probably undergo surgery, I requested only the right side be removed and they will have a pathologist look at it while I am under and then decide if they remove the whole thing. No one was telling me that. So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? I am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. 2021 Oct 7;5(11):bvab148. 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. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. 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 Hi, Hello. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Thanks for chiming in. Please let me know what you think. Otolaryngol Head Neck Surg. The Afirma test results came back Benign on left side and Suspicious 40% on the right side . I have made an appointment with another endocrinologist, but just to talk to him. I regard this as a substantial cost for it's possible contribution to avoiding diagnostic surgery,in part because it also misclassifies lesions as suspicious about half the time. This did not surprise me since I had researched "suspicious." He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. 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. Bethesda, MD 20894, Web Policies My blood tests came back totally normal and I am totally asymptomatic. 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. Epub 2018 Apr 10. A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. Bugs me. Everyone's story and experience seemed to be totally different. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. -38yrs old Did your Afirma results show calcification? The .gov means its official. Unauthorized use of these marks is strictly prohibited. It seems like with every ultrasound, some new suspicious characteristic pops up. Cancer Cytopathol. The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). Papillary Thyroid Cancer: the most common type of thyroid cancer. Don't want to gain weight or feel less optimal then I am now. Papillary thyroid cancer is the most common type of thyroid cancer.

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