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. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Tumor is partially encapsulated with no capsular invasion or extrathyroidal extension identified. A 36% Increase in Specificity With Afirma GSC Versus Older Test . I had another biopsy which came back showing "Atypical cells". I've read a lot about this test (both good and bad). Careers. 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 pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. My radiologist determined that the smallest one had follicular cancer cells in her description but called it indetermined. 2. 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. This all new to me and I have a lot to learn. Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) The doctor uses a very thin needle to withdraw cells from the thyroid nodule. Surgical margins: negative for tumor (tumor is < 0.1cm from margin) 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. I am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. I am so glad to find this as reading everyone's story helps me feel not so aloneTHANK YOU! 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. Some people say I should have had my thyroid out years ago. Most probably, a lot more lobectomies are going to be performed for indeterminate nodules since the level of certainty is going to drop. 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. I had a lobectomy sep. 30th. 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! Personally, I think getting the AFIRMA test done is a good thing. 5. ThyCa: Thyroid Cancer Survivors' Association, Inc. 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! Rationale: Crosswalk to 81545 ($3,600) 81545 describes the original Afirma classifier; when . This occurs in 1520% of biopsies and often results in the need for surgery to remove the nodule. It's really upsetting to suddenly be thrust into this with no symptoms, etc. Christmas got in the way, so January 22 is my date. 3) What do I need to know? THE FULL ARTICLE TITLE: Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. One > 2cm, undetermined twice and "suspicious for follicular neoplasm" the most recent FNA 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). 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. suspicious - ~50% risk of cancer. t=5283[/url]. One has tested benign on several FNAs, is cystic, and has remained consistent in size. government site. Before While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. A. 4. For those of you that had a thyroidectomy, how long did it take for you to realize that the medicine was or was not enough for you? I don't think the reclassification was mentioned specifically in the WSJ article. However, FVPTC is currently classified as a type of "papillary" carcinoma, so the rate of diagnosis is also going to fall pretty substantially. How they found it was my complaint of feeling tired all the time. It just really annoys me that doctors can order tests that cost us money without our consent. With each step, I'd expected to hear, "yeah, you are a lumpy person, but no cancer." The rest were called benign by the GEC. Negative for BRAF, RET/ptc1 and ptc3 Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. -Male - Slightly Hypothyroid which began over the past year or so Molecular markers: genes and microRNAs that are expressed in benign or cancerous cells. 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. Follicular Neoplasm. I have made an appointment with another endocrinologist, but just to talk to him. 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 . I didn't take the nodule too seriously, but did see a specialist and also got the FNA. I am so new to all this that I don't know what this means. 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 Only when I had a follow up visit with a cardiologist in JAn.of 2016 he noticed the results after requesting the previous scan results. I have 1.6 cm nodule on my right lobe. 2020 May;162(5):634-640. doi: 10.1177/0194599820911718. Sometimes, thyroid biopsy specimens are indeterminate, meaning that thyroid cancer cannot be definitively ruled in or out. Have lots of decisions to make and just trying to do some homework. He recently emailed me back and said,as we discusssed on the phone,he agrees with many of my concerns about the Afirma test. First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") -Lymph Node US: Mostly clear in neck, 1 ovoid focus in submandibular region that may be enlarged LN or Submandibular Lesion I opted for a total after much thought because I had three un biopsied nodules on the other side and was already hypo with my entire thyroid to begin with. 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. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. This site needs JavaScript to work properly. However, I was not informed of this. detect variants in greater than 50 genes. 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. I was told the only way to find out for sure is to have half my thyroid removed. Is one easier to recover from ? I am hesitant to go to surgery with the 30% cancer chance without more information. the GSC is to further differentiate indeterminate FNA. 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. Second, this nodule has been stable and has not grown from the first day it was discovered. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. Conclusion: I'm so happy because I just thought I would be struggling a lot more. I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. 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. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. The final Diagnosis from Mayo Clinic: I'm looking for any and all help and/information you can share with me. 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. 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.". 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 am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . 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. FOIA I have multiple nodules. Accessibility 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. Suspicious Nodule Surgery the Only Option? The GSC incorporates nuclear and mitochondrial RNA transcriptome gene expression, RNA sequencing, and genomic copy number analysis. I find out my biopsy results next week. SUMMARY OF THE STUDY Endo M et al 2019 Afirma Gene Sequencing Classifier compared with Gene Expression Classifier in indeterminate thyroid nodules. I'd done enough research to know that Thyroid cancer is generally treatable, and was sure to tell them about that. 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 This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. An important limitation of this study is that the authors did not examine the rate of noninvasive follicular variant papillary thyroid cancer in specimens that were not reported as suspicious by the GEC test. Multiple nodules. Fingers crossed they come back negative for cancer! False Positives. Is is the Benign that is a false negative ? Afirma result was suspicious in 69 cases. The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC). Largest is 2.3(previously 1.8cm in 2014) different test center though. Disclaimer. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. She didn't seem overly concerned based on all my previous records. B. He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. Cancer-Associated Genes: these are genes that are normally expressed in cells. Did your Afirma results show calcification? 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. That didn't sit well with me. See Somatic Mutation Testing - Solid Tumors guideline for criteria. Clinician should therefore exercise caution in using this result for treatment decisions. Bethesda, MD 20894, Web Policies She admitted once she thinks cancer is unlikely. Complex nodule. 1). I don't know if I'm speaking too soon, but the pain isn't as bad as I thought it would be. 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. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) What was your experience? The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. 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). I welcome your thoughts on my case. 1. This was done in hopes of maintaining my own thryoid function which the doctors and I felt better than taking thyroid medicine daily for the rest of my life. My Afirma test came back May 6 with what the company calls 40% "suspicious". He recently called me back and said that my criticism of the test is valid. http://www.glandsurgery.org/article/view/1002/1193. 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. I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. The mindset of most surgeons is to cut it out - ignoring the risks of that approach. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. He tried to console me but he was also upset. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. But all of these suspicious ultrasound results have me wondering if I might have gotten a false negative on the Afirma. Thanks for chiming in. GEC's SE and SP among studies ranged from 78.0 to 100% and 7.7 to 51.7%, respectively. 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. WHAT ARE THE IMPLICATIONS OF THIS STUDY? 2.) For some reason, my long time best friend is one of the least supportive in all of this. BACKGROUND Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer I don't want to jump the gun, and will wait to hear what the new doctor says. 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!
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