The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. It's pretty difficult being the patient trying to sort this all out. Finally, the cells were sent to Afirma, Now I was growing concerned. Nevertheless, I am reluctant to just proceed particularly for the following reasons: Unauthorized use of these marks is strictly prohibited. 42 year old female. I knew it was not good news. I immediately started crying, knowing that a phone call wasn't "the good news." I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines. Thyroid 2016;26:911-5. Each of my pre-surgical tests are pointing more and more in the wrong direction. Epub 2017 Feb 2. My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. Which if they used the YTD income they could clearly see that I qualified for a reduced billing. My radiologist determined that the smallest one had follicular cancer cells in her description but called it indetermined. Until now, Afirma has been available as two tests: Afirma GSC and Afirma Xpression Atlas (XA). New Data Show Strong Performance of Veracyte's Afirma GSC in Real-World However, that information will still be included in details such as numbers of replies. The GSC incorporates nuclear and mitochondrial RNA transcriptome gene expression, RNA sequencing, and genomic copy number analysis. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). I wish you luck in whatever you decide. Afirma GSC(NOT GEC) 50% Suspicious - Thyroid cancer - Inspire It mentions possible microcalcification, which has never come up before. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? Awaiting pathology. 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. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). I know, that is still pricey but seems cheap compared to $6,000. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. THE FULL ARTICLE TITLE: I had my surgery in NYC, it took 2 hours, and I went home the same day. Molecular markers: genes and microRNAs that are expressed in benign or cancerous cells. Finally, at the endocrinologist's visit, he told me the results came back as suspicious for papillary cancer on both sides, and that I'd need to have a TT. Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. PDF Lab Management Guidelines V1.0.2020 Afirma Thyroid Cancer - eviCore The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). I've read a lot about this test (both good and bad). Competition Heats Up With Latest Tests for Thyroid Nodules PDF Summary of Veracyte Recommendations - CMS 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. 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. Hi, It's really upsetting to suddenly be thrust into this with no symptoms, etc. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). 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? Personally, I think getting the AFIRMA test done is a good thing. Afirma Suspicious results - Thyroid cancer - Inspire The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC) BACKGROUND Thyroid nodules are very common, occurring in up to 50% of individuals. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. They did not address that issue in their letter, just my income. It came back 99% that its cancer. It seems like with every ultrasound, some new suspicious characteristic pops up. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. Results came back 50% Suspicious for FN(Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) But, I'm also tired of living with the uncertainty and semi-annual nerve sessions after each ultrasound. Can someone give me their take on my fna results? t=5283], http://www.thyroidboards.com/showthread.php? SUMMARY OF THE STUDY 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. In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive results. She has other small nodules on her other thyroid lobe. Thanks. On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). 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. Afirma GSC is a pre-operative genomic test for thyroid tumor biopsies that have . I had that one sent to Afirma, and it came back indeterminate on cytopathology again, benign on GEC. Federal government websites often end in .gov or .mil. The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC). 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! Follicular and hurthle cells are normal cells found in the thyroid. Recommended surgery for suspicious cancer cells. government site. 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. That didn't sit well with me. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. How they found it was my complaint of feeling tired all the time. result (eg, benign or suspicious) Public Comment. The https:// ensures that you are connecting to the 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. And she's just mostly silent about it. Here are some results/Info: Careers. Thyroid 29:11151124. It is such a major decision that the more info you have in making the decision the better. The results were suspicious of papillary cancer, but not conclusive. 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. 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. Fingers crossed they come back negative for cancer! I am very resistant to the thought of having a gland removed that is functioning perfectly fine, if it isn't cancer. - Partial was recommended at first, though we are leaning total now with the remainder of tests now complete. 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. 2) Partial or Total Thyroidectomy? 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. However, the results are not conclusive. My AFIRMA is also 40% risk. Epub 2020 Mar 17. Advice needed please. The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. t=5283[/url]. 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. It just really annoys me that doctors can order tests that cost us money without our consent. Is one easier to recover from ? . 5. My Afirma results also came back as "suspicious." What do I do? 5) What are your thoughts on these results? However, researchers found that when the Afirma GSC identified a thyroid nodule with a TSHR mutation as suspicious, the risk of malignancy was 15.3%, a level of risk for which most physicians. Therefore, a new version of the Afirma test was created called a gene sequencing classifier (GSC) to better predict thyroid cancers in indeterminate nodule while still being able to rule out cancer in benign nodules. I regard this as a substantial cost for it's possible contribution to avoiding diagnostic surgery,in part because it also misclassifies lesions as suspicious about half the time. The aim of this study was to determine the clinical performance of the GSC as compared with the GEC at one academic medical center. Of course I could have gotten very lucky and caught a cancer in it's early stages, but as well, I do not want to remove a healthy organ . This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. Surgical margins: negative for tumor (tumor is < 0.1cm from margin) 4) How do I make sure I get the best care? Hello. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. I wasn't one to resist. I've swallowed the I-131 pill, what are negative effects in the long run? Mol Genet Genomic Med. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. Cancer Cytopathol. 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. Results: Afirma result was suspicious in 69 cases. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. 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 heard about the Afirma analysis , spent $5000 on the test and the results are even more confusing !! 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. 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. Thank you so much! http://www.glandsurgery.org/article/view/1002/1193. This occurs in 15-20% of biopsies and often results in the need for surgery to remove the nodule. And it keeps growing. 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. -5.5cm x 3.9cm x 3.9cm Left Thyroid Nodule: Large mixed/mostly solid, isoechoic, ill-defined margins, macrocalcifications, taller-than-wide: TI-RADS 5 This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. Complex nodule. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Paratracheal nodule (inclduing B1FS): Thyroid Parenchyma, negative for tumor. 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. doi: 10.1002/mgg3.1288. The Afirma MTC may not be billed separately using an additional unit or procedure code. Patients usually return home or to work after the biopsy without any ill effects. National Library of Medicine I was told the only way to find out for sure is to have half my thyroid removed. So I gather if I am reading what you reported correctly, your case is another false NEGATIVE for the Afirma test? ThyCa: Thyroid Cancer Survivors' Association, Inc. 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. Afirma Genomic Sequencing Classifier and Xpression Atlas - PubMed 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. Did your Afirma results show calcification? eCollection 2021. http://biotechstrategyblog.com/2012/06/veracyte- afirma-gene-expression-classifier-thyroid-cancer- diagnostic-test.html/ I'm sure that over the years as more people have this Afirma test done,there will be even more people posting on thyroid and general health boards about getting false "suspicious" results from it! A. they misclassify benign nodules as suspicious! So the probabilities of malignancy for the various Bethesda risk categories are going to change. Since then, I've had yearly scans (ultrasounds) and two biopsies, both came back negative. Cancer Cytopathol. I am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. (And myself.) 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. 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? 1). I am very athletic , very healthy and happy ,don't want to give up any of that !!! Well her Afirma test result was benign,but not long after she had her thyroid removed and found she had papillary cancer that had spread into her central lymph node and she said that her surgeon told her that the Afirma test is not very reliable! Please Help! Sometimes you only hear the bad stories and not the good so I wanted to share mine. Of the 343 nodules that underwent the GEC test, 178 cases (51.9%) were considered suspicious for cancer. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 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. No parathyroid tissue identified. Epub 2020 Aug 6. An evaluation of the molecular marker tests for thyroid cancer The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. It's barely even hoarse. Mine did, and that can also be a sign of cancer. 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. 6. Good luck and happy thoughts! On this topic from this forum member bmcm2girls said she too had a false suspicious result from the Afirma test and her nodule was benign when removed. 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. Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. the GSC is to further differentiate indeterminate FNA. Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance -38yrs old Papillary Thyroid Cancer: the most common type of thyroid cancer. I've enjoyed good health for my whole life. Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. SUMMARY OF THE STUDIES Thyroseq Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. I can learn to live healthier, and to appreciate each day, and to love and support more readily. A group of expert pathologists have recently identified a subgroup of papillary thyroid cancer called noninvasive follicular variant papillary thyroid cancer that has a very low risk of relapsing after surgical removal. I had another biopsy which came back showing "Atypical cells". 1. I'm also anxiously waiting my pathology results! Some people say I should have had my thyroid out years ago. 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. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. Maternal side history of goiter in females, no known thyroid cancer, but late breast cancer and colon cancer It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. So frustrating!! Choosing to have the surgery was the most difficult decision ever, since I wasn't sure if my nodule was cancerous or not, and of course I didn't want to go through the surgery all for nothing. Two have been tested by FNA multiple times over 5 years However, I was not informed of this. Like I said I'm doing ok and compared to what I see about the aftermath of having my thyroid removed, I sometimes just want to leave it alone and keep an eye on it instead. There are 3 variants of papillary thyroid cancer: classic, follicular and tall-cell. Thus, 54 NIFTP cases were established, all with a suspicious Afirma GEC result. Local surgical pathology diagnoses were available for 11 of these nodules. After some research of my own, I decided to leave it. I asked her if I have permission to email and post these articles and she said yes,they are for the public. 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. 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. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. Home Patients Portal Clinical Thyroidology for the Public October 2016 Vol 9 Issue 10 p.11-12, CLINICAL THYROIDOLOGY FOR THE PUBLIC Any help really will be appreciated. The site is secure. She admitted once she thinks cancer is unlikely. So the jump from that mentality to that of, "oh, I can get cancer, too" has big a huge one for me. 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 hope this helps calm some fears for others who may be going through the same thing. I had a biopsy for 4 nodules 2 mos ago. Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular My Afirma test came back May 6 with what the company calls 40% "suspicious". 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. I'm a 39 years old male. What was your experience? Patients usually return home or to work after the biopsy without any ill effects. Accessibility Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. Well, this last spring my endo said she didn't like my latest ultrasound results. WHAT ARE THE IMPLICATIONS OF THIS STUDY? o The Afirma MTC testing must be billed as part of the Afirma GSC. The results of the GEC are either read as suspicious for cancer or benign. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. The rest were called benign by the GEC. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. Epub 2021 Jun 22. Please let me know what you think. A month ago I had the Afirma test and it came back positive - suspicious for cancer which increased my chance from 5% to 50%. Multiple nodules. With each step, I'd expected to hear, "yeah, you are a lumpy person, but no cancer." 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. One such test is the Afirma gene test. The . We conclude that cytology interpretation has a higher rate of predicting malignancy, in nodules interpreted as SN, when compared with the Afirma test, by almost twofold Diagn. 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). He recently called me back and said that my criticism of the test is valid. The remaining 18% were malignant. SUMMARY OF THE STUDY Wong KS, Angell TE, Strickland KC, Alexander EK, Cibas ES, Krane JF, Barletta JA. Used for FNA indeterminate nodules (bethesda III-IV). Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. 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. Afirma result was suspicious in 69 cases. Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. The cells need to be "fresh." I don't understand the results , I thought that if the result is Benign it means you have no cancer genes and it is 95% sure you won't get cancer .