Thyroid. (although it is so small, you can see it in my neck). It took about 8 days to get back results. 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. Mine did, and that can also be a sign of cancer. Multiple nodules. 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. 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. The GSC correctly identified 41 of 45 malignant samples as suspicious, yielding a sensitivity of 91.1%, and 99 of 145 . The Afirma Genomic Sequencing Classifier (GSC) provides physicians with a comprehensive solution for a complex landscape in thyroid cancer diagnosis and individualization of care. But in my case, it was a risk well worth taking. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. Federal government websites often end in .gov or .mil. Follicular and hurthle cells are normal cells found in the thyroid. Unauthorized use of these marks is strictly prohibited. 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. THE FULL ARTICLE TITLE It just really annoys me that doctors can order tests that cost us money without our consent. Epub 2021 Jun 22. However, the results are not conclusive. Suspicious Nodule Surgery the Only Option? And at that appointment, she told me she was about to go on maternity leave, and wanted me to have surgery before her leave. FOIA A month ago I had the Afirma test and it came back positive - suspicious for cancer which increased my chance from 5% to 50%. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). One > 4cm, but has tested benign by FNA 4 times Mild lymphocytic thyroiditis ( nonspecific) An evaluation of the molecular marker tests for thyroid cancer The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). It's barely even hoarse. Which means I would still be paying this amount to the hospital if I didn't pay it to Affirma. Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer See Somatic Mutation Testing - Solid Tumors guideline for criteria. Later that week I received a call telling me it was suspicious and was referred to an ENT which I saw yesterday. Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). 1). -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Background: 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 . I'm a lumpy person, I told my husband. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier. 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. Please enable it to take advantage of the complete set of features! 8600 Rockville Pike She also said that her surgeon told her he's had five patients that had a suspicious result from the Afirma test,and then when their nodules were removed and tested they too were benign! Just underwent Afirma and Asurgen testing on the suspicious one. Thanks. 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. 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). So, what do I not know? 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. Suspicious readings of the Afirma gene-expression classifier include Will find out results in about a week. The current Afirma Genomic Sequencing Classifier (GSC) demonstrates improved specificity, suggesting more nodules will have a benign result (benign call rate [BCR]), but independent data are needed to confirm this in clinical practice. Thanks again, Ok so this is all brand new to me so please bear with me. 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. 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 numerous FNA biospy's last result "suspicious for follicular neoplasm " , the last ultrasound showed several microcalcifications on left and scattered microcalcification on the right. Since then, I've had yearly scans (ultrasounds) and two biopsies, both came back negative. 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. undefined will no longer be visible to you including posts, replies, and photos. Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. My question is then I guess, is it really that bad afterwards managing levels and the other side effects post TT? 3.) Please, I am looking for any and all thoughts. 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. I called my husband before I even received the callback, and couldn't stop crying. An official website of the United States government. Clipboard, Search History, and several other advanced features are temporarily unavailable. Epub 2020 Mar 17. 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. HHS Vulnerability Disclosure, Help Should I be treating this as a Hurthle Cell Lesion, or should I just relax. 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. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. Tumor is partially encapsulated with no capsular invasion or extrathyroidal extension identified. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. The site is secure. 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. I'm fearful this is a Hurthle Cell Lesion, and I do not like what I have read. 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. One such molecular marker test is the Afirma gene expression classifier (GEC) test. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. It's really upsetting to suddenly be thrust into this with no symptoms, etc. They were incredibly supportive and also concerned. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . This site needs JavaScript to work properly. Epub 2020 May 21. 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%. I have found this community very informative, thank you. Home Patients Portal Clinical Thyroidology for the Public October 2016 Vol 9 Issue 10 p.11-12, CLINICAL THYROIDOLOGY FOR THE PUBLIC These 3 papers report the performance of these assays in evaluating Bethesda III and IV indeterminate biopsies. I almost want to cancel the surgery. Frontiers | Analytical Verification Performance of Afirma Genomic Genes: a molecular unit of heredity of a living organism. Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) 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. Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. So, if you were going to go down that route then this will save you from having a second biopsy. They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. My radiologist determined that the smallest one had follicular cancer cells in her description but called it indetermined. Also is anybody here familiar with "Afirma Thyroid Analysis" Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. Is is the Benign that is a false negative ? A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . Which if they used the YTD income they could clearly see that I qualified for a reduced billing. But still my labs are all within normal range. 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 original Afirma Xpression Atlas (XA) panel reported on 761 genomic variants and 130 fusion pairs from 511 genes ( 6 ). Like she was just trying to tie up loose ends, and I happened to be one of those loose ends. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. 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. Sometimes you only hear the bad stories and not the good so I wanted to share mine. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. 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. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. Follicular Neoplasm. BTW, I'm about to turn 50 and I have no thyroid issues other than this. So we decided to remove the right lobe a week after the afirma results. eCollection 2021 Nov 1. A 36% Increase in Specificity With Afirma GSC Versus Older Test . Additionally, there is an increase in the benign call rate with GSC, which in this study decreased surgical interventions by 68%. They call follicular neoplasms with hurthle cells FNOF. Thyroid 2016;26:911-5. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. t=5283[/url]. After reading many stories, I didn't know what to expect. 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! 3) What do I need to know? 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 . 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 really hope that a much better,much more accurate reliable test like this will be created! 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. Patients usually return home or to work after the biopsy without any ill effects. My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. I hope this helps calm some fears for others who may be going through the same thing. No one was telling me that. A woman on the excellent health site Medhelp told me she had a 3cm. The panel includes genes that have been identified I've swallowed the I-131 pill, what are negative effects in the long run? MON-LB88 Positive Predictive Value of TP53 Variants - Oxford Academic One has tested benign on several FNAs, is cystic, and has remained consistent in size. Bugs me. I had a biopsy for 4 nodules 2 mos ago. (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.) This nodule is solid, hypoechoic, increased central vascularity and now possible microcalcification. Nevertheless, I am reluctant to just proceed particularly for the following reasons: How "suspicious" is that nodule? Review of "suspicious" Afirma gene My blood tests came back totally normal and I am totally asymptomatic. PDF Lab Management Guidelines V1.0.2020 Afirma Thyroid Cancer - eviCore Adherence to Active Surveillance and Clinical Outcomes in Patients with Indeterminate Thyroid Nodules Not Referred for Thyroidectomy. Third, I have no history of thyroid cancer (or any cancer) in my family. The original Afirma GSC validation study showed: 54% of ITNs return a benign Afirma GSC result (GSC-B) When categorized by the Afirma test as GSC-B, the risk of thyroid cancer is < 4% When categorized by the genomic test as suspicious (GSC-S), the risk of thyroid cancer is ~50% 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. (And myself.) Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. My Afirma results also came back as "suspicious." Next-Generation Molecular Tests for Thyroid Nodules: Which to Use 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. -38yrs old PDF Afirma Thyroid Cancer Classifier Tests - evicore.com doi: 10.1210/jendso/bvab148. What have been your experinces with AFIRMA? The oncogene molecular method misses cancers that do not express the oncogenes tested,but has the advantage of having a much lower rate of false positives as compared with the GEC method,assuming that "suspicious" is positive. The Afirma gene sequencing classifier (GSC) performs better in Local surgical pathology diagnoses were available for 11 of these nodules. The other tested indeterminate, follicular atypia, cannot rule out follicular neoplasm. Most probably, a lot more lobectomies are going to be performed for indeterminate nodules since the level of certainty is going to drop. Gorshtein A, Slutzky-Shraga I, Robenshtok E, Benbassat C, Hirsch D. Eur Thyroid J. 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. So the probabilities of malignancy for the various Bethesda risk categories are going to change. 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. Cancer-Associated Genes: these are genes that are normally expressed in cells. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer 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.". 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. Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. Seeking a second opinion I went to a leading hospital. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. Wong KS et al. Cancer Cytopathol. Several thyroid nodules. SUMMARY OF THE STUDY Christmas got in the way, so January 22 is my date. I wasn't one to resist. t=5283], http://www.thyroidboards.com/showthread.php? I am hesitant to go to surgery with the 30% cancer chance without more information. 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. That didn't sit well with me. Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. GEC's SE and SP among studies ranged from 78.0 to 100% and 7.7 to 51.7%, respectively. 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. But, I'm also tired of living with the uncertainty and semi-annual nerve sessions after each ultrasound. Please Help! I am still holding off on surgery for now. And she's just mostly silent about it. However, I was not informed of this. In this discussion of the Afirma test from 2013 on this board several people also had false results from the Afirma test all false suspicious except for the first, reply from member dacooper12 who said that the Afirma test said her nodule was benign but later she had her thyroid removed and found out that it was actually pap cancer that spread into her central lymph node. Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance I don't know if I'm speaking too soon, but the pain isn't as bad as I thought it would be. My Afirma test came back May 6 with what the company calls 40% "suspicious". However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. 1. 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. official website and that any information you provide is encrypted There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). doi: 10.1002/mgg3.1288. Multiple nodules. It's pretty difficult being the patient trying to sort this all out. The aim of this study was to determine the clinical performance of the GSC as compared with the GEC at one academic medical center. All thyroid nodules with a "suspicious" Afirma GEC result were investigated. The authors reported the following rates of final diagnoses for these specimens: 65% of cases had no cancer (ie. I was seen by a thryoid surgeon who did a 1st biopsy with w/ " suspicious of FVPTC". and I just found out that my Afirma test isn't being paid for by my insurance company on the grounds that its test is considered "experimental.". Any help really will be appreciated. A group of expert pathologists have recently identified a subgroup of papillary thyroid cancer called noninvasive follicular variant papillary thyroid cancer that has a very low risk of relapsing after surgical removal. Afirma Practice Resources . Hopefully soon afterward, I'll learn about whether or not the cells are cancerous and can begin to plan my next steps toward recovery.
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