One > 4cm, but has tested benign by FNA 4 times I was told the only way to find out for sure is to have half my thyroid removed. Cancer Cytopathol. Neither will talk to the other. I welcome your thoughts on my case. I am so new to all this that I don't know what this means. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). So now I feel I have no choice to take it out (the nodule also grew .5 cm since the Aug test). 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. 2017;45:308-311. Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. 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! Finally, the cells were sent to Afirma, Now I was growing concerned. I am still holding off on surgery for now. sharing sensitive information, make sure youre on a federal 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. 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'm also anxiously waiting my pathology results! But, she ordered another ultrasound because she wants to see the images herself, rather than just rely on reports from the radiologist. 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! 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 really hope that a much better,much more accurate reliable test like this will be created! 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. Several thyroid nodules. 2021 Apr;10(2):168-173. doi: 10.1159/000509037. They did not address that issue in their letter, just my income. Molecular Markers: genes and microRNAs that are expressed in benign or cancerous cells. It is such a major decision that the more info you have in making the decision the better. Indeterminate means the pathologist cannot tell if the nodule is benign or malignant with certainty. BACKGROUND 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%. No one was telling me that. Since that time, the pain has all subsided -- I think the biopsy just roughed things up, but when they calmed down, I felt no pain whatsoever, again. 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. PMC 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. (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.) And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. Polavarapu P, Fingeret A, Yuil-Valdes A, Olson D, Patel A, Shivaswamy V, Matthias TD, Goldner W. J Endocr Soc. Please enable it to take advantage of the complete set of features! It just really annoys me that doctors can order tests that cost us money without our consent. Veracyte Announces New Data Suggesting Afirma Testing Can Help If benign = no surgery, IF suspicious or malignant = surgery. One such molecular marker test is the Afirma gene expression classifier (GEC) test. I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. Just had TT yesterday. Afirma Gene Sequencing Classifier Compared with Gene - PubMed Nevertheless, I am reluctant to just proceed particularly for the following reasons: He said there was no lymph node involvement but there's no way to tell until final path. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . 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. Ultrasound reports unfortunately not very informative other than size. Don't want to gain weight or feel less optimal then I am now. Federal government websites often end in .gov or .mil. Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular Thanks so much! Additionally, there is an increase in the benign call rate with GSC, which in this study decreased surgical interventions by 68%. I didn't take the nodule too seriously, but did see a specialist and also got the FNA. Thyroid. Conclusion: 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. PDF Pages: Patient Report Client Id: Afirma Req 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%. He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. 2020 May;162(5):634-640. doi: 10.1177/0194599820911718. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. But, I am concerned about the report I just received. Bugs me. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. Advice needed please. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? Just underwent Afirma and Asurgen testing on the suspicious one. 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. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. Results: It's barely even hoarse. 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 ). How could it be Benign on one side and Suspicious on the other ? I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! Anyone have AUS nodule with suspicious Afirma results end up cancerous? The other tested indeterminate, follicular atypia, cannot rule out follicular neoplasm. A woman on the excellent health site Medhelp told me she had a 3cm. Lastly I do 25mcg of levothyroxine once a day for Hypothyroidism, it was prescribed based on lab results, not on how I was feeling. But all of these suspicious ultrasound results have me wondering if I might have gotten a false negative on the Afirma. This site needs JavaScript to work properly. Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular 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. I am hesitant to go to surgery with the 30% cancer chance without more information. How they found it was my complaint of feeling tired all the time. 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. With these genetic tests, patients and physicians have more information to feel confident about avoiding surgery or pursuing it based on the test results. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/afirma-thyroid-analysis/. Everyone's story and experience seemed to be totally different. Frontiers | Analytical Verification Performance of Afirma Genomic They call follicular neoplasms with hurthle cells FNOF. Thanks again, Ok so this is all brand new to me so please bear with me. I've read a lot about this test (both good and bad). 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'm a 39 years old male. I am so glad to find this as reading everyone's story helps me feel not so aloneTHANK YOU! I have found this community very informative, thank you. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. In May 2013 I spoke to Barbara Rath Smith the executive director of The American Thyroid Association and she said she was going to email articles as files to download and she did. Still, I can see my nodule on one side and don't want to risk having cancer in my body, so I was ready to set up the surgery as soon as possible. I'm so happy because I just thought I would be struggling a lot more. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? 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. These gene patterns are better at ruling out thyroid cancer in an indeterminate nodule than confirming cancer. 5. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The Afirma MTC may not be billed separately using an additional unit or procedure code. and transmitted securely. 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. 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). The aim of this study was to find out how often indeterminate thyroid biopsy specimens which were read as suspicious by the GEC test were ultimately diagnosed as noninvasive follicular variant papillary thyroid cancer after surgery. I don't want to jump the gun, and will wait to hear what the new doctor says. Largest is 2.3(previously 1.8cm in 2014) different test center though. 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. Which if they used the YTD income they could clearly see that I qualified for a reduced billing. It was found incidentally in an MRI I had for cervical spine pain. 2021 Oct 7;5(11):bvab148. It is illegal for auto mechanics to do work on our car without an estimate, or accountants, lawyers etc but doctors and medical facilities can just run us into BK without any regard. I find out my biopsy results next week. I don't trust this new Afirma thyroid test for very good reasons. 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). Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/. So far, no problems with calcium. The surgeon recommended complete removal of my thyroid. (Afirma GSC suspicious, suspicious for malignancy, or malignant cytopathology) ,2,4,8 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 tried to avoid it for 10 years I am 52 years old , I have a multinodular goiter with many, many , many nodules,the biggest on the left side 2.2 cm right side 2.6 all TSH test results are good , in fact , my thyroid is fonctioning perfectly well. The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. More than one doctor has told me I should just have surgery, at least half the thyroid, maybe the whole thing. The panel includes genes that have been identified The original Afirma gene test was a gene expression classifier (GEC) that used a technology called a microarray that results in a pattern of gene expression. doi: 10.1002/mgg3.1288. Indeterminate thyroid nodules in the era of molecular genomics. I don't think the reclassification was mentioned specifically in the WSJ article. I posted the below post on this forum on several different topics since 2013. I'm fearful this is a Hurthle Cell Lesion, and I do not like what I have read. Thanks. She says very little, and if she does say anything, questions my reactions. 3. Then she tells me she's just had a "bad feeling" about my case from the beginning, and she wants me to have a TT soon. Well, this last spring my endo said she didn't like my latest ultrasound results. I had a lobectomy sep. 30th. I appreciate any and all responses, and please do respond, I need as much information as I can get and I live by the saying, "you don't know what you don't know." Have lots of decisions to make and just trying to do some homework. Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. What should I know? Afirma GSC(NOT GEC) 50% Suspicious - Thyroid cancer - Inspire Hello, new here and confused, anxious and a bit worried. Please Help! Thank you. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. Wong KS et al. Thanks for chiming in. Found an endocrinologist who is willing to work with me on some more testing. The mindset of most surgeons is to cut it out - ignoring the risks of that approach. The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. I've read a lot about this test (both good and bad). I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT.
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