I had a lobectomy sep. 30th. Can someone give me their take on my fna results? My Afirma results came back suspicious. 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. If all nonsurgical GSC benign cases were truly benign, the chance a suspicious nodule was truly a thyroid cancer was 60% and a benign nodule was benign was 100%. The Afirma GSC is a next-generation genomic test that relies on RNA sequencing and advanced machine learning methodology to categorize tissue from cytologically indeterminate FNA biopsy as either benign or suspicious.2 Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. Which if they used the YTD income they could clearly see that I qualified for a reduced billing. How "suspicious" is that nodule? Review of "suspicious" Afirma gene Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. Please enable it to take advantage of the complete set of features! 4,6 In addition to the benign versus malignant classifier, the Afirma GSC suite includes 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% The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. Should I be treating this as a Hurthle Cell Lesion, or should I just relax. 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. Thanks for chiming in. I find out my biopsy results next week. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. 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.". Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. It was found incidentally in an MRI I had for cervical spine pain. It's really upsetting to suddenly be thrust into this with no symptoms, etc. I have multiple nodules. Papillary Thyroid Cancer: the most common type of thyroid cancer. detect variants in greater than 50 genes. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? 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 was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. Thyroid Cancer - Afirma& Genomic Sequencing Classifier - Veracyte The Afirma Genomic Sequencing Classifier (GSC) provides physicians with a comprehensive solution for a complex landscape in thyroid cancer diagnosis and individualization of care. Is is the Benign that is a false negative ? A. 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? My journey through TT and a suspicious for cancer diagnosis, part one. 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. Thyroid. Her only information about this comes from me, as she lives across the country and can't go to doctor's visits with me. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. So we decided to remove the right lobe a week after the afirma results. Epub 2017 Feb 2. This is about 25% of all thyroid cancers currently. It took about 8 days to get back results. Each wait has been tough, but the wait after the biopsy was excruciating. Some people say I should have had my thyroid out years ago. 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. 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. And it keeps growing. 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. 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. 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 (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.) The doc mentioned the thyroid and upon a physical exam felt the nodule, leading to the rest of the testing. And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. They were incredibly supportive and also concerned. No parathyroid tissue identified. 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. http://www.glandsurgery.org/article/view/1002/1193, http://biotechstrategyblog.com/2012/06/veracyte-, Papillary and follicular thyroid cancer (differentiated), Multiple endocrine neoplasia type 2 (MEN2), Mental challenges of living with thyroid cancer, ThyCa fundraising and thyroid cancer research grants. Afirma; FNA; cytology; thyroid nodules. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . http://www.glandsurgery.org/article/view/1002/1193 Biotech Strategy Blog in this post by Pieter Droppert June 28,2012 Also mentions 48% of nodules falsely called "suspicious" for cancer and can cause many people to have unnecessary thyroid surgery when they don't have cancerous thyroid cells! The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. 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. 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! Several thyroid nodules. 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. It seems like with every ultrasound, some new suspicious characteristic pops up. suspicious - ~50% risk of cancer. All my blood tests and tsh levels are in the normal range. I am hesitant to go to surgery with the 30% cancer chance without more information. I'm afraid I feel ok now then all of a sudden will begin feeling horrible. A woman on the excellent health site Medhelp told me she had a 3cm. Thanks. One such test is the Afirma gene test. 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. PollAfirma GSC Biospy Result - Thyroid cancer - Inspire 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 don't think the reclassification was mentioned specifically in the WSJ article. PDF Afirma Thyroid Cancer Classifier Tests - evicore.com SUMMARY OF THE STUDIES Thyroseq The Afirma Genomic Sequencing Classifier (GSC) is used to rule out malignancy and reclassify cytologically indeterminate (Bethesda III or IV) nodules to molecularly benign or suspicious ( 5 ). Thyroid 29:11151124. These results do not change the risk of malignancy of the (ROM) of the Afirma GSC suspicious result." Epub 2012 Oct 18. 2020 Sep;8(9):e1288. I heard about the Afirma analysis , spent $5000 on the test and the results are even more confusing !! I had my surgery in NYC, it took 2 hours, and I went home the same day. Bookshelf 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. 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. The results of the GEC are either read as suspicious for cancer or benign. 5) What are your thoughts on these results? My Afirma results also came back as "suspicious." Others understand my need for more information. Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). 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. For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. I asked her if I have permission to email and post these articles and she said yes,they are for the public. 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. But in my case, it was a risk well worth taking. Multiple nodules. 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. The Afirma MTC may not be billed separately using an additional unit or procedure code. At least 1 genomic alteration was identified by the expanded Afirma XA panel in 70% of medullary thyroid carcinoma classifier-positive FNAs, 44% of Bethesda III or IV Afirma GSC suspicious FNAs, 64% of Bethesda V FNAs, and 87% of Bethesda VI FNAs. I am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. Finally, the cells were sent to Afirma, Now I was growing concerned. 3) What do I need to know? Hello, 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! My expensive, unsolicited, Afirma test results came back as negativegood thing I had already had my TT before I received the results; I have stage III pap/follicular thyca. With each step, I'd expected to hear, "yeah, you are a lumpy person, but no cancer." But all of these suspicious ultrasound results have me wondering if I might have gotten a false negative on the Afirma. 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. :-). 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 . Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. microRNA: a short RNA molecule that has specific actions within a cell to affect the expression of certain genes. 1). Have lots of decisions to make and just trying to do some homework. He recently called me back and said that my criticism of the test is valid. 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. The authors concluded that a GEC suspicious test result may include noninvasive follicular variant papillary thyroid cancer as well as classical papillary thyroid cancer. Please let me know what you think. Patients usually return home or to work after the biopsy without any ill effects. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas BACKGROUND Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. How Does the Afirma Genomic Test Perform in the Real World? 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. I'm a 57 year old male who took a full body scan 6 1/2 years ago and among other things a small 1 cm nodule was found on the right lobe of my thyroid. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) - Partial was recommended at first, though we are leaning total now with the remainder of tests now complete. More than one doctor has told me I should just have surgery, at least half the thyroid, maybe the whole thing. Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. Genes: a molecular unit of heredity of a living organism. PDF Summary of Veracyte Recommendations - CMS Mine did, and that can also be a sign of cancer. It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. He recently emailed me back and said,as we discusssed on the phone,he agrees with many of my concerns about the Afirma test. eCollection 2021 Nov 1. Our offering enables physicians to answer multiple clinical questions for their thyroid patients using a single, minimally invasive fine needle aspiration (FNA) sample. 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. 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. I had another biopsy which came back showing "Atypical cells". We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. After some research of my own, I decided to leave it. I have never really loved my endo, and have always felt like she was pressuring me into surgery. 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. The Afirma MTC may not be billed separately using an additional unit or procedure code. o The Afirma MTC testing must be billed as part of the Afirma GSC. They did not address that issue in their letter, just my income. sharing sensitive information, make sure youre on a federal A month ago I had the Afirma test and it came back positive - suspicious for cancer which increased my chance from 5% to 50%. 42 year old female. Bethesda, MD 20894, Web Policies 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!) Thyroid nodule molecular profiling: The clinical utility of Afirma Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing. 2. 6. SUMMARY OF THE STUDY On May 8th endocrinologist Dr.Steven P.Hadak who with Dr. David S. Rosenthal co-authored one of these studies for The American Thyroid Association's Clinical Affairs Committee called,Information For Clinician's:Commercially Available Molecular Diagnosis Testing In The Evaluation Of Thyroid Nodule Fine-Needle Aspiration Specimens called me back and was very nice,he even had a patient waiting! 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. Competition Heats Up With Latest Tests for Thyroid Nodules And the 3rd test was Afirma which came back "suspicious". Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. Good luck and happy thoughts! 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. My AFIRMA is also 40% risk. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. Clipboard, Search History, and several other advanced features are temporarily unavailable. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. Genes: a molecular unit of heredity of a living organism. 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. While most thyroid nodules are non-cancerous (Benign), ~5-10% are cancerous. I'm determined to eek out the positive in this. 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. See Somatic Mutation Testing - Solid Tumors guideline for criteria. 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. Lastly I do 25mcg of levothyroxine once a day for Hypothyroidism, it was prescribed based on lab results, not on how I was feeling. Mild lymphocytic thyroiditis ( nonspecific) While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. and transmitted securely. -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular Did your Afirma results show calcification? Suspicious Nodule Surgery the Only Option? 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. I welcome your thoughts on my case. I was told that my thyroid needs to be removed (at least half, possibly all). Which means I would still be paying this amount to the hospital if I didn't pay it to Affirma. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. A publication of the American Thyroid Association, Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. 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.
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