The surgeon recommended complete removal of my thyroid. The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. I had a lobectomy sep. 30th. Frontiers | Thyroseq v3, Afirma GSC, and microRNA Panels Versus For those of you that had a thyroidectomy, how long did it take for you to realize that the medicine was or was not enough for you? 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. Seeking a second opinion I went to a leading hospital. Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. The Afirma gene expression classifier (GEC) is being increasingly utilized to confirm the benign nature of indeterminate FNA cytology results thus avoiding unnecessary surgical procedures. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. 3) What do I need to know? Bookshelf They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. They were incredibly supportive and also concerned. On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). Are you sure you want to block this member? Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). No parathyroid tissue identified. Afirma GSC is a pre-operative genomic test for thyroid tumor biopsies that have . 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 surgeon was great. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. 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 Afirma GEC is a microarray-based molecular test that uses a machine learning-derived classification algorithm to further classify indeterminate thyroid nodules into benign and suspicious categories. THE FULL ARTICLE TITLE: 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 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. What should I know? PDF AFIRMA REQ: Sample Patient Report So the probabilities of malignancy for the various Bethesda risk categories are going to change. 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. government site. suspicious - ~50% risk of cancer. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. 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. He recently emailed me back and said,as we discusssed on the phone,he agrees with many of my concerns about the Afirma test. Dr.Jerome Hershman. See Somatic Mutation Testing - Solid Tumors guideline for criteria. 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. Epub 2020 May 21. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. Endo M et al 2019 Afirma Gene Sequencing Classifier compared with Gene Expression Classifier in indeterminate thyroid nodules. Please let me know what you think. 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. This study indicates that the newer Afirma GSC test is superior to the Afirma GEC test by better predicting which indeterminate nodules are more likely to be cancers and should be removed while maintaining the same or better performance of predicting which indeterminate nodules are benign and can be monitored without surgery. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. Wow! 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. Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) I'm a lumpy person, I told my husband. Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. If you have benign results they always wonder. 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. Complex nodule. Method: I think my biggest problem is what I read on the internet as far as all the problems afterwards. HHS Vulnerability Disclosure, Help No lymphovascular invasion is identified. o The Afirma MTC testing must be billed as part of the Afirma GSC. 42 year old female. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . 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. The GSC correctly identified 41 of 45 malignant samples as suspicious, yielding a sensitivity of 91.1%, and 99 of 145 . Afirma Practice Resources -Male - Slightly Hypothyroid which began over the past year or so All my blood tests and tsh levels are in the normal range. Follicular and hurthle cells are normal cells found in the thyroid. Sometimes, thyroid biopsy specimens are indeterminate, meaning that thyroid cancer cannot be definitively ruled in or out. 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. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier. for my adopted daughter as she's already lost her bio-parents and thus my husband and I became her new parents.I've stayed like zombie while awaited my total neck ultrasound results and they came back CLEAR any cancer spreading to lymph nodes..yey! I called and almost everyone has that risk if it is suspicious. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. My Afirma results came back suspicious. These results do not change the risk of malignancy of the (ROM) of the Afirma GSC suspicious result." 6. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. Negative for BRAF, RET/ptc1 and ptc3 I called back and left them a message that was at home, to call me back. The Afirma MTC may not be billed separately using an additional unit or procedure code. Papillary Thyroid Cancer: the most common type of thyroid cancer. 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. Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. 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. I wish you luck in whatever you decide. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. The original Afirma Xpression Atlas (XA) panel reported on 761 genomic variants and 130 fusion pairs from 511 genes ( 6 ). These 3 papers report the performance of these assays in evaluating Bethesda III and IV indeterminate biopsies. 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. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? Genes: a molecular unit of heredity of a living organism. Hello, Follicular and hurthle cells are normal cells found in the thyroid. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. Before -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 http://www.glandsurgery.org/article/view/1002/1193. Abigail. The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. So now I feel I have no choice to take it out (the nodule also grew .5 cm since the Aug test). PDF Afirma Thyroid Cancer Classifier Tests - evicore.com The GSC incorporates nuclear and mitochondrial RNA transcriptome gene expression, RNA sequencing, and genomic copy number analysis. And it keeps growing. Among the 25 papers that approached Afirma GEC, four studies enrolled an additional number of 635 TNs from 596 patients to evaluate the Afirma GSC (16, 17, 57, 70). This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. The cancer-associated genes important in thyroid cancer are BRAF, RET/PTC and RAS. Paratracheal nodule (inclduing B1FS): Thyroid Parenchyma, negative for tumor. BACKGROUND I had a biopsy for 4 nodules 2 mos ago. What have been your experinces with AFIRMA? I find out my biopsy results next week. 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! Gorshtein A, Slutzky-Shraga I, Robenshtok E, Benbassat C, Hirsch D. Eur Thyroid J. And at that appointment, she told me she was about to go on maternity leave, and wanted me to have surgery before her leave. WHAT ARE THE IMPLICATIONS OF THIS STUDY? Nevertheless, I am reluctant to just proceed particularly for the following reasons: 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.". I have slightly high blood pressure and slightly high cholesterol that are well controlled with meds. . Suspicious Nodule Surgery the Only Option? 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 . 5) What are your thoughts on these results? I posted the below post on this forum on several different topics since 2013. The benign call rate for GSC was 76.2%. False Positives. Thyroid bloodwork normal. And she's just mostly silent about it. 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. He said this Afirma test is wrong half the time misclassifying benign nodules as suspicious,(I'm sure it's even more than half!) She says very little, and if she does say anything, questions my reactions. Just had TT yesterday. My journey through TT and a suspicious for cancer diagnosis, part one. However, FVPTC is currently classified as a type of "papillary" carcinoma, so the rate of diagnosis is also going to fall pretty substantially. ThyCa: Thyroid Cancer Survivors' Association, Inc. Thyroid 29:11151124. The Afirma MTC may not be billed separately using an additional unit or procedure code. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). 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. Also difficult is the reaction from others. doi: 10.1210/jendso/bvab148. I didn't take the nodule too seriously, but did see a specialist and also got the FNA. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. I'm afraid I feel ok now then all of a sudden will begin feeling horrible. One of the hardest things about all of this is the adjustment. The rest were called benign by the GEC. I refuse to rush as there are long-term consequences either way. My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. Multiple nodules. This all new to me and I have a lot to learn. I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. 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!) The doctor uses a very thin needle to withdraw cells from the thyroid nodule. Among the 22 with only a TP53 alteration, the first 16 consecutive nodules were included (7 nodules were Bethesda III and 9 nodules were Bethesda IV). Epub 2012 Oct 18. Surgical margins: negative for tumor (tumor is < 0.1cm from margin) 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. Forth, I have absolutely no symptoms and feel fine. After some research of my own, I decided to leave it. I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! 2017;45:308-311. 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. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. How should I proceed with these results? Good luck and happy thoughts! Thyroid nodules are very common, occurring in up to 50% of individuals. Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. I am very athletic , very healthy and happy ,don't want to give up any of that !!! My radiologist determined that the smallest one had follicular cancer cells in her description but called it indetermined. 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. Thyroid nodule molecular profiling: The clinical utility of Afirma 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. :-). 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! http://www.thyroidboards.com/showthread.php? The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. Patients usually return home or to work after the biopsy without any ill effects. Still, I can see my nodule on one side and don't want to risk having cancer in my body, so I was ready to set up the surgery as soon as possible. The panel includes genes that have been identified The Afirma GSC is a cancer rule-out test with a high negative predictive value so that cytologically indeter-minate (Bethesda III/IV)2 thyroid nodules with an Afirma GSC benign result can be considered for clinical observation in lieu of diagnostic surgical resection (Fig. 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. 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]). I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines. Well, this last spring my endo said she didn't like my latest ultrasound results. Afirma Genomic Sequencing Classifier and Xpression Atlas - PubMed A thyroid nodule biopsy can be benign (normal), malignant (cancer) or indeterminate. Thus, 54 NIFTP cases were established, all with a suspicious Afirma GEC result. Here are some results/Info: 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. My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. eCollection 2021. I have 1.6 cm nodule on my right lobe. Others understand my need for more information. My blood tests came back totally normal and I am totally asymptomatic. Molecular Markers: genes and microRNAs that are expressed in benign or cancerous cells. But still my labs are all within normal range. Ultrasound reports unfortunately not very informative other than size. Results: Afirma result was suspicious in 69 cases. Frontiers | Analytical and Clinical Validation of Expressed Variants I had my surgery in NYC, it took 2 hours, and I went home the same day. However, I was not informed of this. Which if they used the YTD income they could clearly see that I qualified for a reduced billing. You cannot become a thyroid cancer specialist in 24 hours needless to say. Euphemia I just read your post about classifications changing. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. I asked her if I have permission to email and post these articles and she said yes,they are for the public. The remaining 18% were malignant. How "suspicious" is that nodule? Review of "suspicious" Afirma gene 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. In early September, at a well-woman visit, my primary care doctor found a lump in my neck and sent me for a sonogram that found three nodules -- one estimated at 3.5 cm, one at 1.5 cm and the third much smaller. I feel good for 55 and slid through menopause easily. 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. He said there was no lymph node involvement but there's no way to tell until final path. Neither will talk to the other. Indeterminate thyroid nodules in the era of molecular genomics. Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. 2) Partial or Total Thyroidectomy? If benign = no surgery, IF suspicious or malignant = surgery. 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? The Afirma test results came back Benign on left side and Suspicious 40% on the right side . The cells need to be "fresh." I don't trust this new Afirma thyroid test for very good reasons. Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. Sorry for such a long post, but as Im sure you remember, those first few days after receiving this type of news, Im full of questions and anxiety. Home Patients Portal Clinical Thyroidology for the Public February 2020 Vol 13 Issue 2 p.13-14, CLINICAL THYROIDOLOGY FOR THE PUBLIC SUMMARY OF THE STUDIES Thyroseq 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. (And myself.) 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. eCollection 2021 Nov 1. I've enjoyed good health for my whole life. 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. 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 . Is one easier to recover from ? Clinician should therefore exercise caution in using this result for treatment decisions. The final Diagnosis from Mayo Clinic: Would you like email updates of new search results? Competition Heats Up With Latest Tests for Thyroid Nodules Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. A test with a better NPV (negative predictive value), would be more usefu than ever in that situation. 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. Right now my neck lymph nodes look good. 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) . 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! The positive predictive value of the GSC is 47.1%.1 Results Afirma GSC results may help guide surgical decision making in patients with thyroid nodules. 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. -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 The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC). Adherence to Active Surveillance and Clinical Outcomes in Patients with Indeterminate Thyroid Nodules Not Referred for Thyroidectomy. [url=http://www.thyroidboards.com/showthread.php? The range of confirmed cancer (post surgery) from different studies was as low as 17% to as high as close to 50%. Rationale: Crosswalk to 81545 ($3,600) 81545 describes the original Afirma classifier; when . Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. Thanks again, Ok so this is all brand new to me so please bear with me. I'm determined to eek out the positive in this. This site needs JavaScript to work properly. 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. It took about 8 days to get back results. Evaluation of the Afirma Gene Expression Classifier to determine 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. PDF Lab Management Guidelines V1.0.2020 Afirma Thyroid Cancer - eviCore How Does the Afirma Genomic Test Perform in the Real World? Cytopathol. 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. It seems like with every ultrasound, some new suspicious characteristic pops up. Thanks for chiming in. 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. Thyroid 2016;26:911-5. Bugs me. He tried to console me but he was also upset. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. The authors reported the following rates of final diagnoses for these specimens: 65% of cases had no cancer (ie. One > 4cm, but has tested benign by FNA 4 times It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. 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?