Follicular and hurthle cells are normal cells found in the thyroid. 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. microRNA: a short RNA molecule that has specific actions within a cell to affect the expression of certain genes. 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. Just underwent Afirma and Asurgen testing on the suspicious one. Competition Heats Up With Latest Tests for Thyroid Nodules I posted the below post on this forum on several different topics since 2013. I called and almost everyone has that risk if it is suspicious. 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. 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. Mine did, and that can also be a sign of cancer. Before (Afirma GSC suspicious, suspicious for malignancy, or malignant cytopathology) ,2,4,8 The final Diagnosis from Mayo Clinic: Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/. t=5283], http://www.thyroidboards.com/showthread.php? Results: Afirma result was suspicious in 69 cases. Have lots of decisions to make and just trying to do some homework. I'm now 3 days post op and other than some difficulty swallowing and talking loud, I'm feeling great. One of the hardest things about all of this is the adjustment. I did not get to go under the knife for my TT til this past March. 1). MON-LB88 Positive Predictive Value of TP53 Variants - Oxford Academic Any help really will be appreciated. I was told that my thyroid needs to be removed (at least half, possibly all). However, I was not informed of this. In this study from Boston, 63 thyroid surgical specimens were reviewed from patients whose thyroid biopsy samples were read as indeterminate and in whom the GEC test was reported as suspicious. It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. He recently called me back and said that my criticism of the test is valid. They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. WHAT ARE THE IMPLICATIONS OF THIS STUDY? They sent me home with 125mcg of Synthroid, calcitrol, and calcium. doi: 10.1210/jendso/bvab148. 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. I've read a lot about this test (both good and bad). detect variants in greater than 50 genes. After reading many stories, I didn't know what to expect. The other tested indeterminate, follicular atypia, cannot rule out follicular neoplasm. Thank God I have good insurance but in the end my medical out of pocket for all of this could cost me up to $4,500. 2017;45:308-311. Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. What should I know? New Data Show Strong Performance of Veracyte's Afirma GSC in Real-World So the probabilities of malignancy for the various Bethesda risk categories are going to change. My Enfo bumped up my Synthroid right away to adjust for the surgery. And it keeps growing. 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. 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." the nodule was only 1.5 cm and I really had no concerning symptoms. 6. eCollection 2021. He recently emailed me back and said,as we discusssed on the phone,he agrees with many of my concerns about the Afirma test. I had that one sent to Afirma, and it came back indeterminate on cytopathology again, benign on GEC. First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") The range of confirmed cancer (post surgery) from different studies was as low as 17% to as high as close to 50%. Abigail. 2016 Wiley Periodicals, Inc. Keywords: But, I am concerned about the report I just received. One such test is the Afirma gene test. I have also read a recent 2015 report that posits that there are built-in subjectivities to begin with at the Ultrasound/Pathology level yielding "Indeterminate" or "Atypical Cells" to begin with that then sets up a natural path to getting a "Suspicious" result from Afirma. Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). 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. 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. Follicular Neoplasm. I was seen by a thryoid surgeon who did a 1st biopsy with w/ " suspicious of FVPTC". Also is anybody here familiar with "Afirma Thyroid Analysis" Thanks so much! PDF Lab Management Guidelines V1.0.2020 Afirma Thyroid Cancer - eviCore My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. I've read a lot about this test (both good and bad). Afirma GSC(NOT GEC) 50% Suspicious - Thyroid cancer - Inspire No lymphovascular invasion is identified. No parathyroid tissue identified. She also said that her surgeon told her he's had five patients that had a suspicious result from the Afirma test,and then when their nodules were removed and tested they too were benign! Indeterminate means the pathologist cannot tell if the nodule is benign or malignant with certainty. BACKGROUND I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. That not only had the nodule continued to grow (from 2.0 to 3.2cm over the last 2 years), but it is now showing increased central vascularity. The mindset of most surgeons is to cut it out - ignoring the risks of that approach. One such molecular marker test is the Afirma gene expression classifier (GEC) test. I've enjoyed good health for my whole life. All my blood tests and tsh levels are in the normal range. NTRK, RET, BRAF, and ALK fusions in thyroid fine-needle aspirates (FNAs). I don't know if I'm speaking too soon, but the pain isn't as bad as I thought it would be. 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. Method: And the 3rd test was Afirma which came back "suspicious". B. the GSC is to further differentiate indeterminate FNA. With these genetic tests, patients and physicians have more information to feel confident about avoiding surgery or pursuing it based on the test results. He said this Afirma test is wrong half the time misclassifying benign nodules as suspicious,(I'm sure it's even more than half!) Federal government websites often end in .gov or .mil. 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. 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. So, I found a new endo, whom I absolutely loved at my first appointment. Indeterminate thyroid nodules in the era of molecular genomics. 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. I heard about the Afirma analysis , spent $5000 on the test and the results are even more confusing !! government site. These results do not change the risk of malignancy of the (ROM) of the Afirma GSC suspicious result." I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. However, FVPTC is currently classified as a type of "papillary" carcinoma, so the rate of diagnosis is also going to fall pretty substantially. Of the 343 nodules that underwent the GEC test, 178 cases (51.9%) were considered suspicious for cancer. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. Recommended surgery for suspicious cancer cells. 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!) Thyroid bloodwork normal. they misclassify benign nodules as suspicious! Christmas got in the way, so January 22 is my date. The Afirma Genomic Sequencing Classifier (GSC) provides physicians with a comprehensive solution for a complex landscape in thyroid cancer diagnosis and individualization of care. I had a lobectomy sep. 30th. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Frontiers | Analytical Verification Performance of Afirma Genomic 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 . Forth, I have absolutely no symptoms and feel fine. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. PDF Pages: Patient Report Client Id: Afirma Req Don't want to gain weight or feel less optimal then I am now. 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. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. 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. What was your experience? One of these women member dacooper12 on Inspire in their ThyCa forum had the opposite result,which the studies show,that the Afirma test misclassifies a much smaller % of cancerous nodules as benign compared to the higher % of benign nodules it misclassifies as "suspicious. My Afirma results also came back as "suspicious." Cytopathol. The panel includes genes that have been identified At this point, I was exasperated by all of the running around, but fine. The .gov means its official. Thyroid Cancer - Afirma& Genomic Sequencing Classifier - Veracyte I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? Cancer Cytopathol. Comparison of Afirma GEC and GSC to Nodules Without Molecular Testing in Cytologically Indeterminate Thyroid Nodules. Sometimes you only hear the bad stories and not the good so I wanted to share mine. I am hesitant to go to surgery with the 30% cancer chance without more information. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. A. 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. 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. doi: 10.1002/mgg3.1288. 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. 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. Polavarapu P, Fingeret A, Yuil-Valdes A, Olson D, Patel A, Shivaswamy V, Matthias TD, Goldner W. J Endocr Soc. The authors concluded that a GEC suspicious test result may include noninvasive follicular variant papillary thyroid cancer as well as classical papillary thyroid cancer. 2020 Sep;8(9):e1288. I find out my biopsy results next week. 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) . I hope this helps calm some fears for others who may be going through the same thing. This did not surprise me since I had researched "suspicious." I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. 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. Here member santef1 says she had a 2cm nodule that came as suspicious from the Afirma test but after surgery that nodule was found to be benign but as with what happened to so many people,they found several micro pap cancers not seen on the ultrasound. How "suspicious" is that nodule? Review of "suspicious" Afirma gene I really hope that a much better,much more accurate reliable test like this will be created! Example of an Afirma patient report of a hypothetical 1.5 cm thyroid
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