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%. The . 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. The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. Example of an Afirma patient report of a hypothetical 1.5 cm thyroid The surgeon recommended complete removal of my thyroid. 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. I was just feeling so much weight and defeated as a mother of four small children..three biological and one adopted in 2012..could not phantom the idea of not being there for my kids esp. So, what do I not know? 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. It was found incidentally in an MRI I had for cervical spine pain. -Male - Slightly Hypothyroid which began over the past year or so Afirma Gene Sequencing Classifier Compared with Gene - PubMed I have multiple nodules. It's barely even hoarse. But in my case, it was a risk well worth taking. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. Bethesda, MD 20894, Web Policies How Does the Afirma Genomic Test Perform in the Real World? I can learn to live healthier, and to appreciate each day, and to love and support more readily. My AFIRMA is also 40% risk. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. Background: Wong KS et al. It came back 99% that its cancer. (although it is so small, you can see it in my neck). Mol Genet Genomic Med. I'm shocked that my voice is still completely in tact. Epub 2021 Jun 22. 4. 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? Also is anybody here familiar with "Afirma Thyroid Analysis" 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. Finally, at the endocrinologist's visit, he told me the results came back as suspicious for papillary cancer on both sides, and that I'd need to have a TT. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 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. Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular Thanks. http://www.glandsurgery.org/article/view/1002/1193. What should I know? Advice needed please. [url=http://www.thyroidboards.com/showthread.php? 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. Thoughts or experiences?? 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. 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. The Afirma Genomic Sequencing Classifier (GSC) is used to rule out malignancy and reclassify cytologically indeterminate (Bethesda III or IV) nodules to molecularly benign or suspicious ( 5 ). I was seen by a thryoid surgeon who did a 1st biopsy with w/ " suspicious of FVPTC". 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. So we decided to remove the right lobe a week after the afirma results. 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 doctor uses a very thin needle to withdraw cells from the thyroid nodule. 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. 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. PDF AFIRMA REQ: Sample Patient Report 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! I had another biopsy which came back showing "Atypical cells". I welcome your thoughts on my case. I have made an appointment with another endocrinologist, but just to talk to him. At least as accurate as FNA, or that was my understanding. suspicious - ~50% risk of cancer. Please let me know what you think. Cancer-Associated Genes: these are genes that are normally expressed in cells. In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive results. Otolaryngol Head Neck Surg. I don't think the reclassification was mentioned specifically in the WSJ article. Good luck and happy thoughts! -38yrs old However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. There are risks and benefits to any decision - and humans are very bad at assessing both. 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. -5.5cm x 3.9cm x 3.9cm Left Thyroid Nodule: Large mixed/mostly solid, isoechoic, ill-defined margins, macrocalcifications, taller-than-wide: TI-RADS 5 I have 1.6 cm nodule on my right lobe. Follicular and hurthle cells are normal cells found in the thyroid. . The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. The GSC incorporates nuclear and mitochondrial RNA transcriptome gene expression, RNA sequencing, and genomic copy number analysis. the GSC is to further differentiate indeterminate FNA. 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. A 36% Increase in Specificity With Afirma GSC Versus Older Test . Genes: a molecular unit of heredity of a living organism. The results of the GEC are either read as suspicious for cancer or benign. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. undefined will no longer be visible to you including posts, replies, and photos. Papillary Thyroid Cancer: the most common type of thyroid cancer. 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. 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 . For some reason, my long time best friend is one of the least supportive in all of this. 1). I didn't want to live with the risk, especially already being hypo and having nodules on the other side slowly growing. 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. Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. SUMMARY OF THE STUDY An evaluation of the molecular marker tests for thyroid cancer A. The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). The .gov means its official. Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). Suspicious for neoplasm - Veracyte genomic testing? - MedHelp Thanks again, Ok so this is all brand new to me so please bear with me. I had a biopsy for 4 nodules 2 mos ago. 2021 Apr;10(2):168-173. doi: 10.1159/000509037. The remaining 18% were malignant. As I have learned on this board, just 'taking a pill' for the rest of your life isn't as easy as it sounds. Thank you. Others understand my need for more information. Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. sharing sensitive information, make sure youre on a federal I called my husband before I even received the callback, and couldn't stop crying. Thyroid 2016;26:911-5. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer However, FVPTC is currently classified as a type of "papillary" carcinoma, so the rate of diagnosis is also going to fall pretty substantially. I asked her if I have permission to email and post these articles and she said yes,they are for the public. Afirma GSC: Better as One Joshua Klopper, MD March 28, 2023 - Afirma 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. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. Her only information about this comes from me, as she lives across the country and can't go to doctor's visits with me. 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. 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. 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! The doctor uses a very thin needle to withdraw cells from the thyroid nodule. I've read a lot about this test (both good and bad). Two have been tested by FNA multiple times over 5 years 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. At this point, I was exasperated by all of the running around, but fine. Yesterday my surgeon told me that FNA Biopsy and Affirma are not reliable and said he would be surprised if the post op pathology shows the same findings. One such test is the Afirma gene test. He said there was no lymph node involvement but there's no way to tell until final path. Indeterminate thyroid nodules in the era of molecular genomics. 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%. But all of these suspicious ultrasound results have me wondering if I might have gotten a false negative on the Afirma. I'd done enough research to know that Thyroid cancer is generally treatable, and was sure to tell them about that. http://www.thyroidboards.com/showthread.php? 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. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. Neither will talk to the other. Multiple nodules. Accessibility No one was telling me that. It was .62cm by then. The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. government site. 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. A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. Fingers crossed they come back negative for cancer! The rest were called benign by the GEC. Hello, I am very athletic , very healthy and happy ,don't want to give up any of that !!! I opted to have the TT and it turned out it was cancerous and had spread to a few lymph nodes, so then I had right and left central neck dissections as well. Dr.Jerome Hershman. 4) How do I make sure I get the best care? Part 3: Afirma genetic testing for thyroid cancer - Running with a No it's actually the opposite.Many studies by different endocrinologists that were published in The American Thyroid Association's Journal in 2012 found that only 4% of the time the Afirma test falsely says cancerous nodules are benign but it falsely calls benign nodules ''suspicious'' at least 48% of the time! An official website of the United States government. Performance of Afirma Gene Sequencing Classifier versus - ScienceDirect Seeking a second opinion I went to a leading hospital. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). Federal government websites often end in .gov or .mil. 2) Partial or Total Thyroidectomy? 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. Anyone have AUS nodule with suspicious Afirma results end up cancerous? The Afirma MTC may not be billed separately using an additional unit or procedure code. What was your experience? I'm looking for any and all help and/information you can share with me. Cytopathol. Evaluation of the Afirma Gene Expression Classifier to determine The two most common molecular marker tests are the Afirma Gene Expression Classifier and Thyroseq, A publication of the American Thyroid Association, Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). The third biopsy was sent for genetic testing which came back as suspicious. Some people say I should have had my thyroid out years ago. (And myself.) 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! I've enjoyed good health for my whole life. And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. Wow! 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. The site is secure. The pathology report on the removed nodule said: There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. 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. My Afirma results also came back as "suspicious." Which means I would still be paying this amount to the hospital if I didn't pay it to Affirma. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. I really hope that a much better,much more accurate reliable test like this will be created! Historically, most patients with indeterminate thyroid nodule biopsies were referred for surgery though most would ultimately not have thyroid cancer (around 75% or more would have an unnecessary surgery). Paratracheal nodule (inclduing B1FS): Thyroid Parenchyma, negative for tumor. This occurs in 15-20% of biopsies and often results in the need for surgery to remove the nodule. Surgical margins: negative for tumor (tumor is < 0.1cm from margin) Each of my pre-surgical tests are pointing more and more in the wrong direction. One of the hardest things about all of this is the adjustment. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. It is illegal for auto mechanics to do work on our car without an estimate, or accountants, lawyers etc but doctors and medical facilities can just run us into BK without any regard. 5. This all new to me and I have a lot to learn. BACKGROUND New Data Show Strong Performance of Veracyte's Afirma GSC in Real-World This large study demonstrates that almost one-half of Bethesda III/IV Afirma GSC suspicious and most Bethesda V/VI nodules had at least 1 genomic variant or fusion identified, which may optimize personalized treatment decisions. PDF Afirma Thyroid Cancer Classifier Tests - eviCore A woman on the excellent health site Medhelp told me she had a 3cm. 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? 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. 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. Hi, I am joining this group because I was recommended surgery.. MON-LB88 Positive Predictive Value of TP53 Variants - Oxford Academic Multiple nodules. Now can anyone shed some light on any negative effects of RAI on your body in the long-run? Later that week I received a call telling me it was suspicious and was referred to an ENT which I saw yesterday. Ultrasound reports unfortunately not very informative other than size. Home Patients Portal Clinical Thyroidology for the Public February 2020 Vol 13 Issue 2 p.13-14, CLINICAL THYROIDOLOGY FOR THE PUBLIC Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. However, the results are not conclusive. 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 Afirma Xpression Atlas for thyroid nodules and thyroid cancer I find out my biopsy results next week. Here is what the Affirma test disclaimer said: Benign: Preformance characteristics not defined for nodules less than 1 cm diameter. Veracyte Announces New Data Suggesting Afirma Testing Can Help Several thyroid nodules. But, I am concerned about the report I just received. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. Personally, I think getting the AFIRMA test done is a good thing. 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! 1). For one thing, I had some pain on one side after biopsy. No lymphovascular invasion is identified. Second, this nodule has been stable and has not grown from the first day it was discovered. 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. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. I'm now 3 days post op and other than some difficulty swallowing and talking loud, I'm feeling great. This did not surprise me since I had researched "suspicious." Hello, new here and confused, anxious and a bit worried. I'm also anxiously waiting my pathology results! Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. On the day before Thanksgiving, I returned home from work to discover a recorded phone message from the endocrinologist's office. 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. 1. Only when I had a follow up visit with a cardiologist in JAn.of 2016 he noticed the results after requesting the previous scan results. 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! 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. National Library of Medicine the nodule was only 1.5 cm and I really had no concerning symptoms. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 3) What do I need to know? I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! I wish you luck in whatever you decide. So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? Each wait has been tough, but the wait after the biopsy was excruciating. I agree that you should have been consulted for the genetic test!! The cancer-associated genes important in thyroid cancer are BRAF, RET/PTC and RAS. The moment that I've been so nervous about finally came yesterday. 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 . False positive rate of Afirma was 56% (32/57). 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. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? I'm not sure what the exact terminology is going to be. 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. He tried to console me but he was also upset. I am hesitant to go to surgery with the 30% cancer chance without more information. I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. I'm a 39 years old male. He later called and said he was sending me for a biopsy. 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.

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