3. They did not address that issue in their letter, just my income. Abigail. I'm ready for my next step. Bookshelf Accessibility Cancer Cytopathol. Epub 2012 Oct 18. Here is what the Affirma test disclaimer said: Benign: Preformance characteristics not defined for nodules less than 1 cm diameter. It was found incidentally in an MRI I had for cervical spine pain. What have been your experinces with AFIRMA? This occurs in 1520% of biopsies and often results in the need for surgery to remove the nodule. :-). I hope this helps calm some fears for others who may be going through the same thing. Thanks so much! I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. I agree that you should have been consulted for the genetic test!! Home Patients Portal Clinical Thyroidology for the Public February 2020 Vol 13 Issue 2 p.13-14, CLINICAL THYROIDOLOGY FOR THE PUBLIC Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. Papillary Thyroid Cancer: the most common type of thyroid cancer. 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. The Afirma GSC is designed to help clinicians manage these patients. 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. Method: Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. If all nonsurgical GEC benign cases were actually benign, when evaluating the cases that had surgery, the chance that a GEC suspicious nodule was actually cancer was 33.3% and the chance that a GEC benign nodule was actually benign at surgery was 98.2%. Papillary thyroid cancer is the most common type of thyroid cancer. 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. I think my biggest problem is what I read on the internet as far as all the problems afterwards. Multiple nodules. Thanks. 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. How should I proceed with these results? 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. Thank you. The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. 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. 2020 Sep;8(9):e1288. I was just feeling so much weight and defeated as a mother of four small children..three biological and one adopted in 2012..could not phantom the idea of not being there for my kids esp. This did not surprise me since I had researched "suspicious." However, I was not informed of this. 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. It came back 99% that its cancer. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. I have made an appointment with another endocrinologist, but just to talk to him. Would you like email updates of new search results? 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. Results: Afirma result was suspicious in 69 cases. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. Right now my neck lymph nodes look good. The Afirma Genomic Sequencing Classifier (GSC) was developed and clinically validated to utilize genomic material obtained during the FNA to accurately identify benign nodules among those deemed cytologically indeterminate so that diagnostic surgery can be avoided. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. 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. 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. I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. This all new to me and I have a lot to learn. 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. 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. the GSC is to further differentiate indeterminate FNA. The mindset of most surgeons is to cut it out - ignoring the risks of that approach. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. He also said that what the Afirma pathologist and representatives told me that I have a 40% suspicious chance of thyroid cancer isn't true.He said it's about 25% still. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. Federal government websites often end in .gov or .mil. 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! And she said her surgeon said that this test is not very reliable and that meanwhile she has a large bill from the company. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines. So, in 2014, Thanksgiving was about telling them there was something going on. Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). 5) What are your thoughts on these results? Molecular markers: genes and microRNAs that are expressed in benign or cancerous cells. The doc mentioned the thyroid and upon a physical exam felt the nodule, leading to the rest of the testing. Variant: Afirma XA: Informs selection of surgical and therapeutic decisions for Afirma GSC Suspicious, Bethesda V, and Bethesda VI nodules 1 Is clinically validated 1 and informed by The Cancer Genome Atlas (TCGA), 2 extensive published literature, and Veracyte R&D discovery using nearly 40,000 samples 3 I'm looking for any and all help and/information you can share with me. Gorshtein A, Slutzky-Shraga I, Robenshtok E, Benbassat C, Hirsch D. Eur Thyroid J. 2) Partial or Total Thyroidectomy? I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! My Afirma results came back suspicious. http://www.glandsurgery.org/article/view/1002/1193. And she's just mostly silent about it. The aim of this study was to determine the clinical performance of the GSC as compared with the GEC at one academic medical center. I am hesitant to go to surgery with the 30% cancer chance without more information. And the 3rd test was Afirma which came back "suspicious". 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. o The Afirma MTC testing must be billed as part of the Afirma GSC. The PPV was 50% among GSC suspicious nodules when a variant or fusions was identified, compared with 44% among GSC suspicious nodules when no variant or fusion was identified (p = 0.77 [2]). 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. Follicular and hurthle cells are normal cells found in the thyroid. The authors reported the following rates of final diagnoses for these specimens: 65% of cases had no cancer (ie. 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. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. I am very resistant to the thought of having a gland removed that is functioning perfectly fine, if it isn't cancer. 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% An official website of the United States government. A test with a better NPV (negative predictive value), would be more usefu than ever in that situation. So far, no problems with calcium. Sometimes you only hear the bad stories and not the good so I wanted to share mine. But that's a personal issue I'll have to work out in time. He wisely advised that I need a thyroid ultrasound which revealed the nodule had grown to 2.2cm. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. GEC's SE and SP among studies ranged from 78.0 to 100% and 7.7 to 51.7%, respectively. Methods: The result of this 2.1 cm Bethesda IV nodule A is Arma GSC Benign, which suggests a low risk of cancer at approximately 4%. They billed my insurance $6684 - my ins negotiatied $3370.40 they have billed me for 883.71, I applied for a reduction but they say I make too much income so I am not eligible for one. Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. 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. This study suggests that more research is needed to determine if the noninvasive follicular variant thyroid cancer can be diagnosed by molecular markers without proceeding to surgery. 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). 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. WHAT ARE THE IMPLICATIONS OF THIS STUDY? (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.) Negative for BRAF, RET/ptc1 and ptc3 Before You started down the rabbit hole by focusing on your thyroid gland for no good reason, since the melanoma is not related to anything regarding your asymptomatic thyroid. A woman on the excellent health site Medhelp told me she had a 3cm. Thyroid 2016;26:911-5. 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! I immediately started crying, knowing that a phone call wasn't "the good news." The surgeon recommended complete removal of my thyroid. What do I do? 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. At this point, I was exasperated by all of the running around, but fine. Please Help! 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! He later called and said he was sending me for a biopsy. The panel includes genes that have been identified This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. (although it is so small, you can see it in my neck). My AFIRMA is also 40% risk. Follicular and hurthle cells are normal cells found in the thyroid. I didn't make a big deal about the cost because I am having surgery and they money I paid was my 20% co-pay and my out of pocket limit is almost met. The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. 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. B. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. 1. 3.) 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. 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. 2021 Apr;10(2):168-173. doi: 10.1159/000509037. -Male - Slightly Hypothyroid which began over the past year or so Wow! Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. More than one doctor has told me I should just have surgery, at least half the thyroid, maybe the whole thing. I had another biopsy which came back showing "Atypical cells". t=5283], http://www.thyroidboards.com/showthread.php? Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. 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. I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! But, she ordered another ultrasound because she wants to see the images herself, rather than just rely on reports from the radiologist. It seems like with every ultrasound, some new suspicious characteristic pops up. Have lots of decisions to make and just trying to do some homework. 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. So we decided to remove the right lobe a week after the afirma results. I know, that is still pricey but seems cheap compared to $6,000. 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. He said this Afirma test is wrong half the time misclassifying benign nodules as suspicious,(I'm sure it's even more than half!) Tumor is partially encapsulated with no capsular invasion or extrathyroidal extension identified. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. Epub 2020 Aug 6. 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. Epub 2017 Feb 2. In May 2013 I spoke to Barbara Rath Smith the executive director of The American Thyroid Association and she said she was going to email articles as files to download and she did. You cannot become a thyroid cancer specialist in 24 hours needless to say. Euphemia I just read your post about classifications changing. 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.
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