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). 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. 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. Since then, I've had yearly scans (ultrasounds) and two biopsies, both came back negative. 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. There are risks and benefits to any decision - and humans are very bad at assessing both. What have been your experinces with AFIRMA? I wasn't one to resist. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. 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. 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!) A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. Epub 2021 Jun 22. Thanks. Results: 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. 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. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. 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. 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. 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. Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer The . My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. It mentions possible microcalcification, which has never come up before. and I said this is not a good test,and he said I don't think it's a good test either! Partially Encapsulated Follicular Variant of Papillary Carcinoma. 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. PMC Additionally, there is an increase in the benign call rate with GSC, which in this study decreased surgical interventions by 68%. I just wrote that these are 25% of all thycas, but I have read just recently that the figure might be anywhere between 15-25% because there are varying standards for diagnosing these between different institutions. With these genetic tests, patients and physicians have more information to feel confident about avoiding surgery or pursuing it based on the test results. I posted the below post on this forum on several different topics since 2013. Here n this 2014 discussion member Olivia-T who was 69 when she posted this and had hurthle cell neoplasm that tripled in size in 10 months,and got a 40% suspicious from the Afirma test,and did post a follow up that did turn out to have thyroid cancer,says here that her oncologist said that her last two patients who had surgery also because of the 40% suspicious for cancer DNA test turned out to have benign tumors. Should I be treating this as a Hurthle Cell Lesion, or should I just relax. Later that week I received a call telling me it was suspicious and was referred to an ENT which I saw yesterday. I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. I've enjoyed good health for my whole life. Once you go down the hole, there are no good statistics to guide you in making rational decisions in an irrational area of medicine - AND as you know, no decisions in medicine in even cut and dried cases are so simple as to have no opposing point of view. No parathyroid tissue identified. Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance Without my permission my specimen was sent to Affirma and their results were Benign, so my radiologist amended her results to benign for all 4 nodules. Tumor is partially encapsulated with no capsular invasion or extrathyroidal extension identified. The doc mentioned the thyroid and upon a physical exam felt the nodule, leading to the rest of the testing. Epub 2020 May 21. Results: Afirma result was suspicious in 69 cases. [url=http://www.thyroidboards.com/showthread.php? I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. Well, this last spring my endo said she didn't like my latest ultrasound results. It came back 99% that its cancer. 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!) However, researchers found that when the Afirma GSC identified a thyroid nodule with a TSHR mutation as suspicious, the risk of malignancy was 15.3%, a level of risk for which most physicians. Thyroid. -Male - Slightly Hypothyroid which began over the past year or so and transmitted securely. More than one doctor has told me I should just have surgery, at least half the thyroid, maybe the whole thing. My surgeon wants to operate right away stating that these kind of results have a 90% truancy for cancer to be present. . These results show an improved accuracy for the GSC as compared with the GEC. 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. Mine did, and that can also be a sign of cancer. I heard about the Afirma analysis , spent $5000 on the test and the results are even more confusing !! Hi, I am joining this group because I was recommended surgery.. 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. One has tested benign on several FNAs, is cystic, and has remained consistent in size. This is about 25% of all thyroid cancers currently. Home Patients Portal Clinical Thyroidology for the Public October 2016 Vol 9 Issue 10 p.11-12, CLINICAL THYROIDOLOGY FOR THE PUBLIC Unable to load your collection due to an error, Unable to load your delegates due to an error. undefined will no longer be visible to you including posts, replies, and photos. I've read a lot about this test (both good and bad). The Afirma Xpression Atlas for thyroid nodules and thyroid cancer metastases: Insights to inform clinical decisionmaking from a fineneedle aspiration sample Jeffrey F. Krane, MD, PhD,1 Edmund S. Cibas, MD,2 Mayumi Endo, MD,3 Ellen Marqusee, MD,4 Mimi I. Hu, MD,5 Christian E. Nasr, MD,6 Steven G. Waguespack, MD,5 Lori J. Wirth, MD,7 Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. Then in December 2014 I thought to have it checked again, with the same results although this time I had it send for the Afirma testing which I was told is more accurate test for cancer. 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. First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") 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. National Library of Medicine -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 I had my surgery in NYC, it took 2 hours, and I went home the same day. Also difficult is the reaction from others. I was told that my thyroid needs to be removed (at least half, possibly all). 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. Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. She says very little, and if she does say anything, questions my reactions. Careers. This site needs JavaScript to work properly. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. All thyroid nodules with a "suspicious" Afirma GEC result were investigated. The Affirma Xpression Atlas is based on RNA sequencing. If all nonsurgical GEC benign cases were actually benign, when evaluating the cases that had surgery, the chance that a GEC suspicious nodule was actually cancer was 33.3% and the chance that a GEC benign nodule was actually benign at surgery was 98.2%. 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. -38yrs old I called back and left them a message that was at home, to call me back. They sent me home with 125mcg of Synthroid, calcitrol, and calcium. As I have learned on this board, just 'taking a pill' for the rest of your life isn't as easy as it sounds. Neither will talk to the other. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . I can learn to live healthier, and to appreciate each day, and to love and support more readily. 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. 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 ). I understand that Afirma tends to have a lot of false positives, but it's supposed to be fairly accurate for negative results. He then says, However,another interpretation is that the method can be used only to classify a nodule as benign and the "suspicious" category by GEC should not be used. Now can anyone shed some light on any negative effects of RAI on your body in the long-run? 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. My Afirma test came back May 6 with what the company calls 40% "suspicious". 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. 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. 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. A. Methods: We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. Afirma Gene Expression Classifier: a test for a group of molecular markers in thyroid biopsy specimens in order to determine the likelihood that a thyroid nodule is benign or cancerous. Please, I am looking for any and all thoughts. A 36% Increase in Specificity With Afirma GSC Versus Older Test . Wong KS, Angell TE, Strickland KC, Alexander EK, Cibas ES, Krane JF, Barletta JA. Choosing to have the surgery was the most difficult decision ever, since I wasn't sure if my nodule was cancerous or not, and of course I didn't want to go through the surgery all for nothing. I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. Method: 2021 Apr;10(2):168-173. doi: 10.1159/000509037. 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. 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. eCollection 2021. 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. 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 am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. A thyroid nodule biopsy can be benign (normal), malignant (cancer) or indeterminate. 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. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/afirma-thyroid-analysis/. Molecular Markers: genes and microRNAs that are expressed in benign or cancerous cells. False Positives. Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. Afirma was suspicious. Afirma GSC is a pre-operative genomic test for thyroid tumor biopsies that have . The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). Here are some results/Info: Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. I'm also anxiously waiting my pathology results! Several thyroid nodules. Home Patients Portal Clinical Thyroidology for the Public February 2020 Vol 13 Issue 2 p.13-14, CLINICAL THYROIDOLOGY FOR THE PUBLIC The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. Seeking a second opinion I went to a leading hospital. The Afirma Genomic Sequencing Classifier (GSC) provides physicians with a comprehensive solution for a complex landscape in thyroid cancer diagnosis and individualization of care. So the jump from that mentality to that of, "oh, I can get cancer, too" has big a huge one for me. 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%. 85% were benign. The original Afirma Xpression Atlas (XA) panel reported on 761 genomic variants and 130 fusion pairs from 511 genes ( 6 ). And she's just mostly silent about it. GEC's SE and SP among studies ranged from 78.0 to 100% and 7.7 to 51.7%, respectively. So, I found a new endo, whom I absolutely loved at my first appointment. I'm not sure what the exact terminology is going to be. My Enfo bumped up my Synthroid right away to adjust for the surgery. 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. What do I do? I am hesitant to go to surgery with the 30% cancer chance without more information. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). I had a total thyroidectomy in NYC. I really hope that a much better,much more accurate reliable test like this will be created! Good luck and happy thoughts! 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. I wish you luck in whatever you decide. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. 2) Partial or Total Thyroidectomy? SUMMARY OF THE STUDIES Thyroseq I'm so happy because I just thought I would be struggling a lot more. Federal government websites often end in .gov or .mil. The two most common molecular marker tests are the Afirma Gene Expression Classifier and Thyroseq, A publication of the American Thyroid Association, Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). The Afirma MTC may not be billed separately using an additional unit or procedure code. That was a hard Thanksgiving. One of the hardest things about all of this is the adjustment. Hi, Our offering enables physicians to answer multiple clinical questions for their thyroid patients using a single, minimally invasive fine needle aspiration (FNA) sample. My surgeon and endocrinologist said no further treatment is needed but to continue observation. He also said that what the Afirma pathologist and representatives told me that I have a 40% suspicious chance of thyroid cancer isn't true.He said it's about 25% still. 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. Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) My question is then I guess, is it really that bad afterwards managing levels and the other side effects post TT? 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) . they misclassify benign nodules as suspicious! I have made an appointment with another endocrinologist, but just to talk to him.

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