Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. 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. I had a biopsy for 4 nodules 2 mos ago. Hi, 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. I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). The Afirma Genomic Sequencing Classifier (GSC) (Veracyte, San Francisco, CA) is a cancer rule-out test that partners whole transcriptome RNA sequencing with machine learning to categorize nodules as benign or suspicious. So, if you were going to go down that route then this will save you from having a second biopsy. Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. 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. Thyroid Cancer - Afirma& Genomic Sequencing Classifier - Veracyte The remaining 18% were malignant. I called back and left them a message that was at home, to call me back. Am I being reasonable? 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. In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive results. But that's a personal issue I'll have to work out in time. 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. 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!) Local surgical pathology diagnoses were available for 11 of these nodules. Hello. I have multiple nodules. detect variants in greater than 50 genes. I asked him if I could get another opinion on my FNA slides and he said yes and I asked him who he could recommend that is very good with thyroid pathology and FNA's and he recommended quite a few Dr.'s so I asked about any at The Mayo Clinic where he used to work and did that Afirma study from,and he recommended three Dr.'s there. It took about 8 days to get back results. Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Nsui BA, Dobrean A, Silaghi H. Front Endocrinol (Lausanne). Good luck and happy thoughts! the nodule was only 1.5 cm and I really had no concerning symptoms. Anyway, if these are to be become non-malignant, the rates of malignancy for the different Bethesda Categories are going to have to be adjusted downward. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. Home Patients Portal Clinical Thyroidology for the Public October 2016 Vol 9 Issue 10 p.11-12, CLINICAL THYROIDOLOGY FOR THE PUBLIC PollAfirma GSC Biospy Result - Thyroid cancer - Inspire And it keeps growing. The .gov means its official. How should I proceed with these results? Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/. So far, no problems with calcium. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. 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. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. 4) How do I make sure I get the best care? 2021 Apr;10(2):168-173. doi: 10.1159/000509037. 2017;45:308-311. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. Epub 2020 May 21. Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. The benign call rate for GSC was 76.2%. 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 . 6. 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. Wong KS et al. Nevertheless, I am reluctant to just proceed particularly for the following reasons: And the 3rd test was Afirma which came back "suspicious". Unable to load your collection due to an error, Unable to load your delegates due to an error. 3) What do I need to know? So, what do I not know? As said I have a lot of great important articles by many different endocrinologists written at different times for The American Thyroid Association's journal criticizing the Afirma test and how 48% (I'm sure it's much higher!) The Afirma Xpression Atlas for thyroid nodules and thyroid cancer While most thyroid nodules are non-cancerous (Benign), ~5-10% are cancerous. 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. But it is saying that actual surgical results show that 40% "suspicion" turns out to send lots of people to surgery and then about 50% of the surgeries done yield results that show that the nodules were not cancerous at all. Here is what the Affirma test disclaimer said: Benign: Preformance characteristics not defined for nodules less than 1 cm diameter. I am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. So frustrating!! Used for FNA indeterminate nodules (bethesda III-IV). 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. The good news is that if your insurance refuses to pay for the test, then you will only have to pay 300.00 out of pocket. Each wait has been tough, but the wait after the biopsy was excruciating. See Somatic Mutation Testing - Solid Tumors guideline for criteria. The cells need to be "fresh." They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. Genes: a molecular unit of heredity of a living organism. I've read a lot about this test (both good and bad). I didn't want to live with the risk, especially already being hypo and having nodules on the other side slowly growing. Methods: 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. 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. The results were suspicious of papillary cancer, but not conclusive. So the jump from that mentality to that of, "oh, I can get cancer, too" has big a huge one for me. Any help really will be appreciated. I think my biggest problem is what I read on the internet as far as all the problems afterwards. Cancer Cytopathol. and I said this is not a good test,and he said I don't think it's a good test either! 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]). How do Afirma GSC & Xpression Atlas tests work? What do they mean Once you go down the hole, there are no good statistics to guide you in making rational decisions in an irrational area of medicine - AND as you know, no decisions in medicine in even cut and dried cases are so simple as to have no opposing point of view. they misclassify benign nodules as suspicious! Cancer Cytopathol. [url=http://www.thyroidboards.com/showthread.php? doi: 10.1002/mgg3.1288. I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! 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). 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. The surgeon recommended complete removal of my thyroid. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. 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. 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! 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." Epub 2020 Aug 6. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. An important limitation of this study is that the authors did not examine the rate of noninvasive follicular variant papillary thyroid cancer in specimens that were not reported as suspicious by the GEC test. -No Size changes of Nodule in last 2-3 months (duration of time to get all of these tests) Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. 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 am very athletic , very healthy and happy ,don't want to give up any of that !!! -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? 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. 4. Afirma Suspicious results - Thyroid cancer - Inspire Follicular and hurthle cells are normal cells found in the thyroid. Please, I am looking for any and all thoughts. I've enjoyed good health for my whole life. Hello, new here and confused, anxious and a bit worried. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer Each of my pre-surgical tests are pointing more and more in the wrong direction. sharing sensitive information, make sure youre on a federal 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. After some research of my own, I decided to leave it. She didn't seem overly concerned based on all my previous records. Conclusion: Thyroid 2016;26:911-5. 3. suspicious - ~50% risk of cancer. Now can anyone shed some light on any negative effects of RAI on your body in the long-run? 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. The Afirma Genomic Sequencing Classifier (GSC) classifies cytologically indeterminate thyroid nodules as molecularly benign or suspicious. Suspicious readings of the Afirma gene-expression classifier include I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines. Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). Before Mild lymphocytic thyroiditis ( nonspecific) Fingers crossed they come back negative for cancer! 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. 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%. At the end of his great article in the journal Clinical Thyroidology August 2012 criticizing the inaccuracies and unreliabilities of the Afirma test, endocrinologist of 50 years Dr.Jerome Hershman says, Currently the Veracyte Affirma GEC method "retails" for 3,350 plus 300 for cytopathology. I have never really loved my endo, and have always felt like she was pressuring me into surgery. Epub 2012 Oct 18. :-). On the day before Thanksgiving, I returned home from work to discover a recorded phone message from the endocrinologist's office. -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 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! That not only had the nodule continued to grow (from 2.0 to 3.2cm over the last 2 years), but it is now showing increased central vascularity. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. Otolaryngol Head Neck Surg. Anyone have AUS nodule with suspicious Afirma results end up cancerous? That was a hard Thanksgiving. Bookshelf Molecular Markers: genes and microRNAs that are expressed in benign or cancerous cells. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies.
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