Until now, Afirma has been available as two tests: Afirma GSC and Afirma Xpression Atlas (XA). A test with a better NPV (negative predictive value), would be more usefu than ever in that situation. 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). But, she ordered another ultrasound because she wants to see the images herself, rather than just rely on reports from the radiologist. But, I'm also tired of living with the uncertainty and semi-annual nerve sessions after each ultrasound. My AFIRMA is also 40% risk. Here are some results/Info: Background: 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. Have lots of decisions to make and just trying to do some homework. I know, that is still pricey but seems cheap compared to $6,000. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. 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. With these genetic tests, patients and physicians have more information to feel confident about avoiding surgery or pursuing it based on the test results. 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. 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. Historically, most patients with indeterminate thyroid nodule biopsies were referred for surgery though most would ultimately not have thyroid cancer (around 75% or more would have an unnecessary surgery). 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. Am I being reasonable? He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. 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. My radiologist determined that the smallest one had follicular cancer cells in her description but called it indetermined. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. I'm looking for any and all help and/information you can share with me. Patients usually return home or to work after the biopsy without any ill effects. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . 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. 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. The Afirma GSC is a cancer rule-out test with a high negative predictive value so that cytologically indeter-minate (Bethesda III/IV)2 thyroid nodules with an Afirma GSC benign result can be considered for clinical observation in lieu of diagnostic surgical resection (Fig. These results do not change the risk of malignancy of the (ROM) of the Afirma GSC suspicious result." 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. False positive rate of Afirma was 56% (32/57). 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. After hearing this, I felt a huge kick in my gut and also stupid for getting a second opinion for a fine needle biopsy though I'd ended up with an endo, who wrote articles on the subject. Largest is 2.3(previously 1.8cm in 2014) different test center though. 1. Cytopathol. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. WHAT ARE THE IMPLICATIONS OF THIS STUDY? 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 . 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. 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. One of the hardest things about all of this is the adjustment. I had that one sent to Afirma, and it came back indeterminate on cytopathology again, benign on GEC. Otolaryngol Head Neck Surg. The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. Will find out results in about a week. Later that week I received a call telling me it was suspicious and was referred to an ENT which I saw yesterday. . The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). He tried to console me but he was also upset. 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. Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). They sent me home with 125mcg of Synthroid, calcitrol, and calcium. result (eg, benign or suspicious) Public Comment. 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. 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 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. B. Paratracheal nodule (inclduing B1FS): Thyroid Parenchyma, negative for tumor. -Male - Slightly Hypothyroid which began over the past year or so Don't want to gain weight or feel less optimal then I am now. I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines. 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). My Afirma test came back May 6 with what the company calls 40% "suspicious". 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. My Afirma results came back suspicious. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. I'm not sure what the exact terminology is going to be. Thyroid 29:11151124. Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Nsui BA, Dobrean A, Silaghi H. Front Endocrinol (Lausanne). It seems like with every ultrasound, some new suspicious characteristic pops up. For one thing, I had some pain on one side after biopsy. My Afirma results also came back as "suspicious." Methods: 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. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. I wish you luck in whatever you decide. 85% were benign. What was your experience? They call follicular neoplasms with hurthle cells FNOF. Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). 5) What are your thoughts on these results? Thyroid 2016;26:911-5. Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer 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. So we decided to remove the right lobe a week after the afirma results. The results were suspicious of papillary cancer, but not conclusive. And the 3rd test was Afirma which came back "suspicious". 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. Hi, Indeterminate thyroid nodules in the era of molecular genomics. So, I found a new endo, whom I absolutely loved at my first appointment. Complex nodule. 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. 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. The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. I feel good for 55 and slid through menopause easily. Cancer Cytopathol. 6. Thanks for chiming in. 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 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. Can someone give me their take on my fna results? Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. The Afirma Genomic Sequencing Classifier (GSC) provides physicians with a comprehensive solution for a complex landscape in thyroid cancer diagnosis and individualization of care. Thyroid nodules are very common, occurring in up to 50% of individuals. Thus, 54 NIFTP cases were established, all with a suspicious Afirma GEC result. The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). 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. 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 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'm determined to eek out the positive in this. My question is then I guess, is it really that bad afterwards managing levels and the other side effects post TT? I posted the below post on this forum on several different topics since 2013. 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. Dr.Jerome Hershman. The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. And at that appointment, she told me she was about to go on maternity leave, and wanted me to have surgery before her leave. 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. Used for FNA indeterminate nodules (bethesda III-IV). 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." I had a biopsy for 4 nodules 2 mos ago. The https:// ensures that you are connecting to the 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). I am hesitant to go to surgery with the 30% cancer chance without more information. 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. The surgeon recommended complete removal of my thyroid. SUMMARY OF THE STUDY Now can anyone shed some light on any negative effects of RAI on your body in the long-run? The GSC incorporates nuclear and mitochondrial RNA transcriptome gene expression, RNA sequencing, and genomic copy number analysis. Afirma was suspicious. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. The pathology report on the removed nodule said: Polavarapu P, Fingeret A, Yuil-Valdes A, Olson D, Patel A, Shivaswamy V, Matthias TD, Goldner W. J Endocr Soc. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. Epub 2018 Apr 10. 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. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. This did not surprise me since I had researched "suspicious." 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. (Afirma GSC suspicious, suspicious for malignancy, or malignant cytopathology) ,2,4,8 BACKGROUND At this point, I was exasperated by all of the running around, but fine. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. So, what do I not know? If you have benign results they always wonder. 4. After some research of my own, I decided to leave it. 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. 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. Epub 2020 Mar 17. In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. doi: 10.1002/mgg3.1288. (And myself.) :-). Thyroid nodules are commonly found on ultrasound of the neck and the evaluation of a thyroid nodule may include thyroid biopsy. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Thyroid. Unauthorized use of these marks is strictly prohibited. Patients usually return home or to work after the biopsy without any ill effects. Epub 2012 Oct 18. He later called and said he was sending me for a biopsy. 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? How should I proceed with these results? official website and that any information you provide is encrypted 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. Advice needed please. I wasn't one to resist. Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. The Annual International Thyroid Cancer Survivors' Conference and Regional Workshops, Download our free Low-Iodine Cookbook (PDF), Rally for Research and Thyroid Cancer Research Grants.
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