Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. Epub 2021 Jun 22. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. They sent me home with 125mcg of Synthroid, calcitrol, and calcium. She says very little, and if she does say anything, questions my reactions. 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.". These gene patterns are better at ruling out thyroid cancer in an indeterminate nodule than confirming cancer. In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive results. I was seen by a thryoid surgeon who did a 1st biopsy with w/ " suspicious of FVPTC". I called back and left them a message that was at home, to call me back. The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. I had another biopsy which came back showing "Atypical cells". Forth, I have absolutely no symptoms and feel fine. Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. 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. Afirma Gene Sequencing Classifier Compared with Gene - PubMed So the jump from that mentality to that of, "oh, I can get cancer, too" has big a huge one for me. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. 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. This large study demonstrates that almost one-half of Bethesda III/IV Afirma GSC suspicious and most Bethesda V/VI nodules had at least 1 genomic variant or fusion identified, which may optimize personalized treatment decisions. The aim of this study was to determine the clinical performance of the GSC as compared with the GEC at one academic medical center. Afirma GSC is a pre-operative genomic test for thyroid tumor biopsies that have . 2013 Dec;24(6):385-90. doi: 10.1111/cyt.12021. My oldest daughter has a friend who has survived thyroid cancer, and SHE was sure to tell ME about that. SUMMARY OF THE STUDIES Thyroseq 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. Background: The Afirma Gene Expression Classifier (GEC) has been used to further characterize cytologically indeterminate (cyto-I) thyroid nodules into either benign or suspicious categories. Fingers crossed they come back negative for cancer! 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 . BACKGROUND Thyroid. 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 . My Afirma test came back May 6 with what the company calls 40% "suspicious". How "suspicious" is that nodule? Review of "suspicious" Afirma gene 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. 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. Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier. 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. And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. And he said he doesn't think the Afirma test is as accurate as they say. Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Nsui BA, Dobrean A, Silaghi H. Front Endocrinol (Lausanne). 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). Adherence to Active Surveillance and Clinical Outcomes in Patients with Indeterminate Thyroid Nodules Not Referred for Thyroidectomy. (although it is so small, you can see it in my neck). result (eg, benign or suspicious) Public Comment. Endo M et al 2019 Afirma Gene Sequencing Classifier compared with Gene Expression Classifier in indeterminate thyroid nodules. My Enfo bumped up my Synthroid right away to adjust for the surgery. I have made an appointment with another endocrinologist, but just to talk to him. Multiple nodules. Surgical margins: negative for tumor (tumor is < 0.1cm from margin) The Afirma Genomic Sequencing Classifier (GSC) (Veracyte, San Francisco, CA) is a cancer rule-out test that partners whole transcriptome RNA sequencing with machine learning to categorize nodules as benign or suspicious. My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. I was told the only way to find out for sure is to have half my thyroid removed. 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). 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. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. Several thyroid nodules. But, I am concerned about the report I just received. 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. The third biopsy was sent for genetic testing which came back as suspicious. Most probably, a lot more lobectomies are going to be performed for indeterminate nodules since the level of certainty is going to drop. Afirma; FNA; cytology; thyroid nodules. All my blood tests and tsh levels are in the normal range. 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. Third, I have no history of thyroid cancer (or any cancer) in my family. But in my case, it was a risk well worth taking. The GSC correctly identified 41 of 45 malignant samples as suspicious, yielding a sensitivity of 91.1%, and 99 of 145 . What have been your experinces with AFIRMA? 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. False Positives. My AFIRMA is also 40% risk. t=5283[/url]. It was .62cm by then. These results do not change the risk of malignancy of the (ROM) of the Afirma GSC suspicious result." First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") 2021 Oct 7;5(11):bvab148. Just had TT yesterday. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. So we decided to remove the right lobe a week after the afirma results. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). 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. sharing sensitive information, make sure youre on a federal 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. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? 5) What are your thoughts on these results? Afirma GSC (NOT GEC) 50% Suspicious Fayadosky Oct 30, 2018 10:56 AM (edited Nov 04) Results came back 50% Suspicious for FN (Follicular Neoplasm) with positive HRAS c.18HRAS c.182A>G (Q61R) Negative for BRAF, RET/ptc1 and ptc3 Any Insights? 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. Suspicious for neoplasm - Veracyte genomic testing? - MedHelp 1. I had a total thyroidectomy in NYC. Afirma Practice Resources Cancer Cytopathol. I am still holding off on surgery for now. It's really upsetting to suddenly be thrust into this with no symptoms, etc. Thyroid nodule molecular profiling: The clinical utility of Afirma PMC Also is anybody here familiar with "Afirma Thyroid Analysis" 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. They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. She admitted once she thinks cancer is unlikely. Anyone here have a false NEGATIVE Afirma GEC result? for my adopted daughter as she's already lost her bio-parents and thus my husband and I became her new parents.I've stayed like zombie while awaited my total neck ultrasound results and they came back CLEAR any cancer spreading to lymph nodes..yey! 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. Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). Wow! The Afirma Xpression Atlas for thyroid nodules and thyroid cancer Now can anyone shed some light on any negative effects of RAI on your body in the long-run? Can you expand on this? I don't think the reclassification was mentioned specifically in the WSJ article. Papillary thyroid cancer is the most common type of thyroid cancer. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. -Male - Slightly Hypothyroid which began over the past year or so 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. Cancer cells frequently have mutations in these genes. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. [url=http://www.thyroidboards.com/showthread.php? My question is then I guess, is it really that bad afterwards managing levels and the other side effects post TT? Others understand my need for more information. I have found this community very informative, thank you. I called and almost everyone has that risk if it is suspicious. 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 .gov means its official. Advice needed please. 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. The Afirma MTC may not be billed separately using an additional unit or procedure code. 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 . Afirma GSC: Better as One Joshua Klopper, MD March 28, 2023 - Afirma 2016 Wiley Periodicals, Inc. Keywords: -Lymph Node US: Mostly clear in neck, 1 ovoid focus in submandibular region that may be enlarged LN or Submandibular Lesion I agree that you should have been consulted for the genetic test!! The other side is that I had to have a 2nd biopsy done just to collect cells for AFIRMA. Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). Upenn top thyroid pathologists including Dr.Virginia Lavosi report that follicular neoplasms with oncocytic (hurthle cells)often are misclassified as suspicious by the Afirma test! I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. 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 In this discussion of the Afirma test from 2013 on this board several people also had false results from the Afirma test all false suspicious except for the first, reply from member dacooper12 who said that the Afirma test said her nodule was benign but later she had her thyroid removed and found out that it was actually pap cancer that spread into her central lymph node. 85% were benign. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. I had a lobectomy sep. 30th. 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. So, I found a new endo, whom I absolutely loved at my first appointment. 4,6 In addition to the benign versus malignant classifier, the Afirma GSC suite includes . Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. 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. Good luck and happy thoughts! I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! The good news is that if your insurance refuses to pay for the test, then you will only have to pay 300.00 out of pocket. The Afirma Genomic Sequencing Classifier (GSC) classifies cytologically indeterminate thyroid nodules as molecularly benign or suspicious. 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. Local surgical pathology diagnoses were available for 11 of these nodules. 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. Background: Epub 2017 Feb 2. Evaluation of the Afirma Gene Expression Classifier to determine Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). Just underwent Afirma and Asurgen testing on the suspicious one. 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. And at that appointment, she told me she was about to go on maternity leave, and wanted me to have surgery before her leave. Dr.Hershman then says, In a world where there are unlimited financial resources,both the oncogene and the GEC methods could be applied to all indeterminate nodules,but this approach is not practical currently. However, I was not informed of this. So, in 2014, Thanksgiving was about telling them there was something going on. It's barely even hoarse. So the probabilities of malignancy for the various Bethesda risk categories are going to change. PDF Pages: Patient Report Client Id: Afirma Req 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. 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. 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. One such molecular marker test is the Afirma gene expression classifier (GEC) test. What was your experience? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Please enable it to take advantage of the complete set of features! The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. He recently called me back and said that my criticism of the test is valid. 3.) When the nurse called she couldn't even tell me results over he phone -- she said she didn't know them -- but set up an appointment for end of the following week -- another wait. 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!) 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. 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. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. I can learn to live healthier, and to appreciate each day, and to love and support more readily. 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. In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. National Library of Medicine Patients usually return home or to work after the biopsy without any ill effects. Neither will talk to the other. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. 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. 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! 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." Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. The range of confirmed cancer (post surgery) from different studies was as low as 17% to as high as close to 50%. 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. PDF Afirma Thyroid Cancer Classifier Tests - eviCore
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