Tumor is partially encapsulated with no capsular invasion or extrathyroidal extension identified. 85% were benign. With each step, I'd expected to hear, "yeah, you are a lumpy person, but no cancer." Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. 2. 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). 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! Next-Generation Molecular Tests for Thyroid Nodules: Which to Use I have met with multiple surgeons, and am meeting with the one I am selecting on Friday and wanted some info on what to do, and how to proceed. For one thing, I had some pain on one side after biopsy. 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. So, I found a new endo, whom I absolutely loved at my first appointment. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. PDF Afirma Thyroid Cancer Classifier Tests - eviCore 1). I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. I know, that is still pricey but seems cheap compared to $6,000. Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. Some people say I should have had my thyroid out years ago. Seeking a second opinion I went to a leading hospital. However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. Frontiers | Analytical and Clinical Validation of Expressed Variants The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. Is one easier to recover from ? The .gov means its official. 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]). At the end of the day, it is what it is now that I SWALLOWED (no pun intended) the I-131 pill, hopefully it won't work against me. something nodule with a majority of Hurthle cells with normal thyroid blood tests and the Afirma test came back 40% suspicious,it grew even bigger in two years and was hypoechoic and vascular on the ultrasound like mine and she said this concerned her and the radiologist,she said (she said my nodule sounds a lot like hers except hers was bigger) so she had half her thyroid out and this nodule was benign! I think my biggest problem is what I read on the internet as far as all the problems afterwards. It is such a major decision that the more info you have in making the decision the better. I am so new to all this that I don't know what this means. Suspicious readings of the Afirma gene-expression classifier include He later called and said he was sending me for a biopsy. How could it be Benign on one side and Suspicious on the other ? I am so glad to find this as reading everyone's story helps me feel not so aloneTHANK YOU! result (eg, benign or suspicious) Public Comment. 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. Follicular and hurthle cells are normal cells found in the thyroid. Afirma was suspicious. It was found incidentally in an MRI I had for cervical spine pain. How they found it was my complaint of feeling tired all the time. Dr.Jerome Hershman. The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. Thus, 54 NIFTP cases were established, all with a suspicious Afirma GEC result. Unable to load your collection due to an error, Unable to load your delegates due to an error. For some reason, my long time best friend is one of the least supportive in all of this. 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 CANCER Incidental papillary thyroid carcinoma, .2 cm on Left lobe and Thyroid right lobe: 1.2 cm nodule-Papillary thyroid carcinoma, conventional and follicular variant, histologically infiltrating into adherent skeletal muscle: .2 cm and the right lobe: 1.4 cm, both Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Nsui BA, Dobrean A, Silaghi H. Front Endocrinol (Lausanne). I'm ready for my next step. Thanks again, Ok so this is all brand new to me so please bear with me. 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. An evaluation of the molecular marker tests for thyroid cancer Sometimes, thyroid biopsy specimens are indeterminate, meaning that thyroid cancer cannot be definitively ruled in or out. 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. I almost want to cancel the surgery. 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!) 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. This isn't saying that Afirma's test isn't useful. The remaining 18% were malignant. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. But still my labs are all within normal range. 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. . undefined will no longer be visible to you including posts, replies, and photos. Hi, I am joining this group because I was recommended surgery.. These results show an improved accuracy for the GSC as compared with the GEC. Would you like email updates of new search results? I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! Partially Encapsulated Follicular Variant of Papillary Carcinoma. It's pretty difficult being the patient trying to sort this all out. The moment that I've been so nervous about finally came yesterday. Molecular markers: genes and microRNAs that are expressed in benign or cancerous cells. 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 . A month ago I had the Afirma test and it came back positive - suspicious for cancer which increased my chance from 5% to 50%. This test is performed by the company Veracyte Inc. BACKGROUND Thyroid nodules are very common, occurring in 30-50 % of patients. And the 3rd test was Afirma which came back "suspicious". PDF Summary of Veracyte Recommendations - CMS I had my surgery in NYC, it took 2 hours, and I went home the same day. Wong KS et al. A 36% Increase in Specificity With Afirma GSC Versus Older Test . 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. Thanks. The range of confirmed cancer (post surgery) from different studies was as low as 17% to as high as close to 50%. 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. So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? I had another biopsy which came back showing "Atypical cells". He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. B. The Afirma GSC is designed to help clinicians manage these patients. Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer 5. (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.) 6. I've enjoyed good health for my whole life. I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive results. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. 8600 Rockville Pike I have multiple nodules. The aggressive one wants to cover his ass in the tiny chance you have an aggressive thyroid cancer, and the wait and see one is playing the odds that there is nothing to worry about, and that unneeded surgery has risks that are higher than the benefits in your case. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. How should I proceed with these results? 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! We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. One > 4cm, but has tested benign by FNA 4 times Epub 2020 Mar 17. In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. But, she ordered another ultrasound because she wants to see the images herself, rather than just rely on reports from the radiologist. Frontiers | Thyroseq v3, Afirma GSC, and microRNA Panels Versus Of course I could have gotten very lucky and caught a cancer in it's early stages, but as well, I do not want to remove a healthy organ . Unauthorized use of these marks is strictly prohibited. doi: 10.1002/mgg3.1288. 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! Wow! It just really annoys me that doctors can order tests that cost us money without our consent. 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. Now having dodged a few close bullets, I was like wobble head to my new endo's treatment plan which included 100 mci RAI though after reading my path report that I may be at little higher risk with "variant" than most others. The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. Any Insights? 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 I wasn't one to resist. The https:// ensures that you are connecting to the She says very little, and if she does say anything, questions my reactions. Thank you so much! Any help really will be appreciated. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). - Partial was recommended at first, though we are leaning total now with the remainder of tests now complete. I did not necessarily like that simplistic answer and I told him, you have nothing to compare it to, since he had not seen my past records. The results were suspicious of papillary cancer, but not conclusive. Papillary thyroid cancer is the most common type of thyroid cancer. THE FULL ARTICLE TITLE: Therefore, a new version of the Afirma test was created called a gene sequencing classifier (GSC) to better predict thyroid cancers in indeterminate nodule while still being able to rule out cancer in benign nodules. Now can anyone shed some light on any negative effects of RAI on your body in the long-run? After some research of my own, I decided to leave it. So, if you were going to go down that route then this will save you from having a second biopsy. 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 didn't want to live with the risk, especially already being hypo and having nodules on the other side slowly growing. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer 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. And at that appointment, she told me she was about to go on maternity leave, and wanted me to have surgery before her leave. eCollection 2021. But, I'm also tired of living with the uncertainty and semi-annual nerve sessions after each ultrasound. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). The final Diagnosis from Mayo Clinic: What do I do? Second, this nodule has been stable and has not grown from the first day it was discovered. 1. They call follicular neoplasms with hurthle cells FNOF. Did your Afirma results show calcification? With these genetic tests, patients and physicians have more information to feel confident about avoiding surgery or pursuing it based on the test results.