Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . Right now my neck lymph nodes look good. Home Patients Portal Clinical Thyroidology for the Public February 2020 Vol 13 Issue 2 p.13-14, CLINICAL THYROIDOLOGY FOR THE PUBLIC 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. She has other small nodules on her other thyroid lobe. The third biopsy was sent for genetic testing which came back as suspicious. Well, this last spring my endo said she didn't like my latest ultrasound results. If benign = no surgery, IF suspicious or malignant = surgery. PDF Afirma Thyroid Cancer Classifier Tests - eviCore 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. Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). Nevertheless, I am reluctant to just proceed particularly for the following reasons: One > 4cm, but has tested benign by FNA 4 times Please, I am looking for any and all thoughts. Hello, 2017;45:308-311. 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. This occurs in 15-20% of biopsies and often results in the need for surgery to remove the nodule. 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. The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. Wow! You cannot become a thyroid cancer specialist in 24 hours needless to say. Euphemia I just read your post about classifications changing. 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. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. This site needs JavaScript to work properly. 2. Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). 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. 42 year old female. 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. The GSC incorporates nuclear and mitochondrial RNA transcriptome gene expression, RNA sequencing, and genomic copy number analysis. [url=http://www.thyroidboards.com/showthread.php? Recently I change insurance and in doing so, my new doctor ordered a ultrasound which showed the nodule and he felt it was nothing to worry about. We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. I asked her if I have permission to email and post these articles and she said yes,they are for the public. All I can say is that in reviewing my ultrasounds and the report from the interventional radiologist and the Affirma report, I have noticed that there are inconsistencies in even the reported measurements of the nodules and now that I have read further into studies done on people undergoing thyroid removal after getting "Suspicious"/40% of Cancer Affirma results, there are many more false positives than Afirma would have you understand. He is very calm and laid back, and prefers to take a more controlled approach to everything, but I'm feeling a more aggressive approach is warranted. Is is the Benign that is a false negative ? 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% A. 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. Bookshelf I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! 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. Is one easier to recover from ? 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? Did your Afirma results show calcification? How should I proceed with these results? 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 . Each of my pre-surgical tests are pointing more and more in the wrong direction. The GSC correctly identified 41 of 45 malignant samples as suspicious, yielding a sensitivity of 91.1%, and 99 of 145 . 3) What do I need to know? The surgeon was great. Just had TT yesterday. Performance of Afirma Gene Sequencing Classifier versus - ScienceDirect doi: 10.1210/jendso/bvab148. The Afirma Genomic Sequencing Classifier (GSC) classifies cytologically indeterminate thyroid nodules as molecularly benign or suspicious. SUMMARY OF THE STUDY How could it be Benign on one side and Suspicious on the other ? Abigail. Hopefully soon afterward, I'll learn about whether or not the cells are cancerous and can begin to plan my next steps toward recovery. So, in 2014, Thanksgiving was about telling them there was something going on. Epub 2020 May 21. 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. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). He recently emailed me back and said,as we discusssed on the phone,he agrees with many of my concerns about the Afirma test. It was .62cm by then. It seems like with every ultrasound, some new suspicious characteristic pops up. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. 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! I had my surgery in NYC, it took 2 hours, and I went home the same day. My Afirma results came back suspicious. She admitted once she thinks cancer is unlikely. So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . 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. 3.) Thyroid Nodules: http://www.thyroid.org/thyroid-nodules/, Thyroid Cancer: http://www.thyroid.org/thyroid-cancer/, Thyroid Surgery: http://www.thyroid.org/thyroid-surgery/. No parathyroid tissue identified. Thyroid nodules are very common, occurring in up to 50% of individuals. Suspicious for neoplasm - Veracyte genomic testing? - MedHelp 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. This test is performed by the company Veracyte Inc. BACKGROUND Thyroid nodules are very common, occurring in 30-50 % of patients. I wanted to share my Thyroidectomy story because like most of you I was super scared and nervous about surgery but my surgery went great and I've had no complications. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. I regard this as a substantial cost for it's possible contribution to avoiding diagnostic surgery,in part because it also misclassifies lesions as suspicious about half the time. The final Diagnosis from Mayo Clinic: What should I know? One such molecular marker test is the Afirma gene expression classifier (GEC) test. No one was telling me that. I am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") 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. Can you expand on this? Afirma; FNA; cytology; thyroid nodules. What have been your experinces with AFIRMA? Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. So the jump from that mentality to that of, "oh, I can get cancer, too" has big a huge one for me. It just really annoys me that doctors can order tests that cost us money without our consent. How do Afirma GSC & Xpression Atlas tests work? What do they mean Local surgical pathology diagnoses were available for 11 of these nodules. So, I found a new endo, whom I absolutely loved at my first appointment. 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. Anyone have AUS nodule with suspicious Afirma results end up cancerous? Anyone here have a false NEGATIVE Afirma GEC result? The Affirma Xpression Atlas is based on RNA sequencing. However, the results are not conclusive. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. I'm also anxiously waiting my pathology results! Tumor is partially encapsulated with no capsular invasion or extrathyroidal extension identified. If you have benign results they always wonder. 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. Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. 2020 Sep;8(9):e1288. MON-LB88 Positive Predictive Value of TP53 Variants - Oxford Academic I refuse to rush as there are long-term consequences either way. 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. So, what do I not know? THE FULL ARTICLE TITLE -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). 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. How "suspicious" is that nodule? Review of "suspicious" Afirma gene 2) Partial or Total Thyroidectomy? May 7 endocrinologist Dr.Bryan Mclver,one of the authors of the article from September 2012 in The American Thyroid Association's Journal called,An Independent Study Of A Gene Expression Classifier (Afirma) In The Evaluation Of Cytologically Indeterminate Thyroid Nodules Initial Report and he used to work at The Mayo Clinic,(he now works at The Moffit Cancer Center called me back. When the nurse called she couldn't even tell me results over he phone -- she said she didn't know them -- but set up an appointment for end of the following week -- another wait. Patients with thyroid nodule biopsies with indeterminate cytology results were chosen for additional genetic testing; the Afirma GEC (during the period February 2, 2011July 11, 2017) or the Afirma GSC (during the period July 11, 2017December 19, 2018). I heard about the Afirma analysis , spent $5000 on the test and the results are even more confusing !! He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. 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. official website and that any information you provide is encrypted 3. 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? 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! microRNA: a short RNA molecule that has specific actions within a cell to affect the expression of certain genes. This did not surprise me since I had researched "suspicious." I wasn't one to resist. Molecular Markers: genes and microRNAs that are expressed in benign or cancerous cells. Treatment like a cytologically benign nodule may be appropriate, including clinical correlation. 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 am so glad to find this as reading everyone's story helps me feel not so aloneTHANK YOU! Negative for BRAF, RET/ptc1 and ptc3 The rest were called benign by the GEC. But, I'm also tired of living with the uncertainty and semi-annual nerve sessions after each ultrasound. Don't want to gain weight or feel less optimal then I am now. I didn't take the nodule too seriously, but did see a specialist and also got the FNA.