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%. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. 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. 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 pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. 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? Epub 2020 Mar 17. I asked her if I have permission to email and post these articles and she said yes,they are for the public. 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. Recommended surgery for suspicious cancer cells. doi: 10.1210/jendso/bvab148. Glad to have found Inspire to learn more, and support others, and receive support. 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). Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. 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. See Somatic Mutation Testing - Solid Tumors guideline for criteria. I refuse to rush as there are long-term consequences either way. -Lymph Node US: Mostly clear in neck, 1 ovoid focus in submandibular region that may be enlarged LN or Submandibular Lesion The authors reported the following rates of final diagnoses for these specimens: 65% of cases had no cancer (ie. But in my case, it was a risk well worth taking. I posted the below post on this forum on several different topics since 2013. Hopefully soon afterward, I'll learn about whether or not the cells are cancerous and can begin to plan my next steps toward recovery. I had a biopsy for 4 nodules 2 mos ago. Hi, So, in 2014, Thanksgiving was about telling them there was something going on. I can learn to live healthier, and to appreciate each day, and to love and support more readily. How could it be Benign on one side and Suspicious on the other ? 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. I'm looking for any and all help and/information you can share with me. 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. Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. They sent me home with 125mcg of Synthroid, calcitrol, and calcium. 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% government site. 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). 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 CANCER She admitted once she thinks cancer is unlikely. I have never really loved my endo, and have always felt like she was pressuring me into surgery. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Epub 2020 May 21. The site is secure. BACKGROUND Cancer Cytopathol. It's really upsetting to suddenly be thrust into this with no symptoms, etc. I pointed out to them that since the nodule tested was less than 1cm the radiologist should not have sent it and they should not have tested it. 1). I think my biggest problem is what I read on the internet as far as all the problems afterwards. Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology. The pathology report on the removed nodule said: It took about 8 days to get back results. Please enable it to take advantage of the complete set of features! Federal government websites often end in .gov or .mil. She also said that her surgeon also had 5 other patients that had the Afirma test done,and said their nodules were suspicious too and they all were found to benign after they were removed! Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. How should I proceed with these results? More than one doctor has told me I should just have surgery, at least half the thyroid, maybe the whole thing. I found many people including more than a few on the Inspire site in their ThyCa forum who have unfortunately gotten false suspicious results from this test and as a result had totally unnecessary thyroid surgery,including this poor woman on thyroidboards.com who is the worst case I found so far,the Afirma test told her she had an 80% highly suspicious result and because of this her endocrinologist told her to expect cancer and that she had an 80% likelihood that her solid hypoechoic 1- 1 1/2 cm mildly suspicious as follicular neoplasm nodule was cancer,so she had totally unnecessary thyroid surgery for a benign nodule and was scared to death for nothing! First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") Hello, Afirma testing is back "Risk of malignancy: Afirma GSC Suspicious ~50%" "Malignancy classifiers: Negative" "MTC and BRAF classifier results were negative and RET/PTC1 and RET/PTC3 were not detected. Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. False Positives. Seeking a second opinion I went to a leading hospital. Indeterminate thyroid nodules in the era of molecular genomics. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. 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. It came back 99% that its cancer. Some people say I should have had my thyroid out years ago. I feel good for 55 and slid through menopause easily. 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. 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. It is such a major decision that the more info you have in making the decision the better. Tumor is partially encapsulated with no capsular invasion or extrathyroidal extension identified. 1. I wasn't one to resist. Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. Wow! But, she ordered another ultrasound because she wants to see the images herself, rather than just rely on reports from the radiologist. So we decided to remove the right lobe a week after the afirma results. The aggressive one wants to cover his ass in the tiny chance you have an aggressive thyroid cancer, and the wait and see one is playing the odds that there is nothing to worry about, and that unneeded surgery has risks that are higher than the benefits in your case. Thyroid 29:11151124. 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! detect variants in greater than 50 genes. 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. 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. At the end of the day, it is what it is now that I SWALLOWED (no pun intended) the I-131 pill, hopefully it won't work against me. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. and transmitted securely. I also read on this Inspire site in their Thyroid Cancer Survivors Association forum,a woman had a 2cm indetrminate nodule that everyone was concerned about and her Afirma test came out suspicious or still indeterminate,and she had her thyroid removed,it turns out that the 2cm nodule was benign but they found tiny papillary cancers all under 5mm that weren't even seen on the ultrasound! 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. 4,6 In addition to the benign versus malignant classifier, the Afirma GSC suite includes 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. 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.". The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. 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. So now I feel I have no choice to take it out (the nodule also grew .5 cm since the Aug test). On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). 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. Most probably, a lot more lobectomies are going to be performed for indeterminate nodules since the level of certainty is going to drop. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. Which if they used the YTD income they could clearly see that I qualified for a reduced billing. microRNA: a short RNA molecule that has specific actions within a cell to affect the expression of certain genes. This is about 25% of all thyroid cancers currently. Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. 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. Mol Genet Genomic Med. Yesterday my surgeon told me that FNA Biopsy and Affirma are not reliable and said he would be surprised if the post op pathology shows the same findings. However, the interesting twist was that cancer was not detected on the nodules being monitored, there was a little sucker hidden behind all these years according to my surgeon and this was why the pathologist at my local hosp could not come up with definitive conclusion as he/she was only focused on the biopsied nodules:( The doctor uses a very thin needle to withdraw cells from the thyroid nodule. Epub 2012 Oct 18. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. If you have benign results they always wonder. Afirma; FNA; cytology; thyroid nodules. 4. 2021 Apr;10(2):168-173. doi: 10.1159/000509037. The benign call rate for GSC was 76.2%. Conclusion: 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 . Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. official website and that any information you provide is encrypted Can you expand on this? One > 2cm, undetermined twice and "suspicious for follicular neoplasm" the most recent FNA Each wait has been tough, but the wait after the biopsy was excruciating. My journey through TT and a suspicious for cancer diagnosis, part one. So, I found a new endo, whom I absolutely loved at my first appointment. Clinician should therefore exercise caution in using this result for treatment decisions. The Xpression Atlas reports 905 genomic variants and 235 fusion pairs on GSC Suspicious, Suspicious for Malignancy (SFM), and Malignant FNA samples at the time of diagnosis. Method: Clipboard, Search History, and several other advanced features are temporarily unavailable. Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. Thank you. However, the results are not conclusive. Until now, Afirma has been available as two tests: Afirma GSC and Afirma Xpression Atlas (XA). Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) 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. The .gov means its official. But that's a personal issue I'll have to work out in time. 2.) The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. Neither will talk to the other. But still my labs are all within normal range. sharing sensitive information, make sure youre on a federal 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. 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. 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). The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. 2020 May;162(5):634-640. doi: 10.1177/0194599820911718. With these genetic tests, patients and physicians have more information to feel confident about avoiding surgery or pursuing it based on the test results. National Library of Medicine This nodule is solid, hypoechoic, increased central vascularity and now possible microcalcification. I've read a lot about this test (both good and bad). What do I do? Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer Paratracheal nodule (inclduing B1FS): Thyroid Parenchyma, negative for tumor. o The Afirma MTC testing must be billed as part of the Afirma GSC. For some reason, my long time best friend is one of the least supportive in all of this. 2) Partial or Total Thyroidectomy? Right now my neck lymph nodes look good. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. The final Diagnosis from Mayo Clinic: I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? I'm fearful this is a Hurthle Cell Lesion, and I do not like what I have read. 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 called and almost everyone has that risk if it is suspicious. It seems like with every ultrasound, some new suspicious characteristic pops up. I agree that you should have been consulted for the genetic test!! For one thing, I had some pain on one side after biopsy. He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. 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. So much good info but I wish I had read this before I had agreed with my endo on his prescription for rai:( In fact, i am currently on my fifth day of my 7-10 day rai staycation. What was your experience? Cancer Cytopathol. One > 4cm, but has tested benign by FNA 4 times Here are some results/Info: (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.) I've read a lot about this test (both good and bad). How they found it was my complaint of feeling tired all the time. In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive 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 . 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. 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. See Somatic Mutation Testing - Solid Tumors guideline for criteria. The Afirma GSC is a cancer rule-out test with a high negative predictive value so that cytologically indeterminate (Bethesda III/IV)2thyroid nodules with an Afirma GSC benign result can be considered for clinical observation in lieu of diagnostic surgical resection (Fig. The Afirma MTC may not be billed separately using an additional unit or procedure code. Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). Largest is 2.3(previously 1.8cm in 2014) different test center though. It was found incidentally in an MRI I had for cervical spine pain. The Afirma GSC is designed to help clinicians manage these patients. This test is performed by the company Veracyte Inc. BACKGROUND Thyroid nodules are very common, occurring in 30-50 % of patients. Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. 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. Home Patients Portal Clinical Thyroidology for the Public October 2016 Vol 9 Issue 10 p.11-12, CLINICAL THYROIDOLOGY FOR THE PUBLIC The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). I almost want to cancel the surgery. I hadn't told my two college-age daughters about the series of more and more concerning doctor's visits, but knew I couldn't get through a long day with them at home without showing my emotions. Unable to load your collection due to an error, Unable to load your delegates due to an error. The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. I welcome your thoughts on my case. -No Size changes of Nodule in last 2-3 months (duration of time to get all of these tests) WHAT ARE THE IMPLICATIONS OF THIS STUDY? Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Nsui BA, Dobrean A, Silaghi H. Front Endocrinol (Lausanne). 2020 Sep;8(9):e1288. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. Epub 2017 Feb 2. I hope this helps calm some fears for others who may be going through the same thing. Christmas got in the way, so January 22 is my date. 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! 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. 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. 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. My question is then I guess, is it really that bad afterwards managing levels and the other side effects post TT? Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. I had another biopsy which came back showing "Atypical cells". So the probabilities of malignancy for the various Bethesda risk categories are going to change. 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. I'm also anxiously waiting my pathology results! 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. 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) . On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). 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 ). Anyone have AUS nodule with suspicious Afirma results end up cancerous? 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.