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The authors concluded that a GEC suspicious test result may include noninvasive follicular variant papillary thyroid cancer as well as classical papillary thyroid cancer. If benign = no surgery, IF suspicious or malignant = surgery. Everyone's story and experience seemed to be totally different. The Afirma test results came back Benign on left side and Suspicious 40% on the right side . detect variants in greater than 50 genes. Partially Encapsulated Follicular Variant of Papillary Carcinoma. So, what do I not know? I had a lobectomy sep. 30th. He recently emailed me back and said,as we discusssed on the phone,he agrees with many of my concerns about the Afirma test. PMC Then she tells me she's just had a "bad feeling" about my case from the beginning, and she wants me to have a TT soon. She didn't seem overly concerned based on all my previous records. The remaining 18% were malignant. 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. National Library of Medicine I agree that you should have been consulted for the genetic test!! I think my biggest problem is what I read on the internet as far as all the problems afterwards. My blood tests came back totally normal and I am totally asymptomatic. Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). One > 2cm, undetermined twice and "suspicious for follicular neoplasm" the most recent FNA I immediately started crying, knowing that a phone call wasn't "the good news." The two types that are set to be reclassified are the non invasive encapsulated type and the non invasive unencapsulated type. I called and almost everyone has that risk if it is suspicious. Each of my pre-surgical tests are pointing more and more in the wrong direction. I'm now 3 days post op and other than some difficulty swallowing and talking loud, I'm feeling great. What have been your experinces with AFIRMA? 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! 2.) I'm shocked that my voice is still completely in tact. The aim of this study was to determine the clinical performance of the GSC as compared with the GEC at one academic medical center. The Afirma GSC is a cancer rule-out test with a high negative predictive value so that cytologically indeterminate (Bethesda III/IV)2thyroid nodules with an Afirma GSC benign result can be considered for clinical observation in lieu of diagnostic surgical resection (Fig. At least as accurate as FNA, or that was my understanding. 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. 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. I was told that my thyroid needs to be removed (at least half, possibly all). But, I am concerned about the report I just received. So the probabilities of malignancy for the various Bethesda risk categories are going to change. 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. One such test is the Afirma gene test. 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? Like she was just trying to tie up loose ends, and I happened to be one of those loose ends. I know how frustrating, scary and expensive this whole process is.I am sorry that you are going through it!! Arma XA is not performed on GSC Benign nodules.7 IIIIV Atypia of Undetermined Signicance Indeterminate thyroid nodules in the era of molecular genomics. I wish you luck in whatever you decide. 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 . 1. The Afirma GEC is a microarray-based molecular test that uses a machine learning-derived classification algorithm to further classify indeterminate thyroid nodules into benign and suspicious categories. The .gov means its official. Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). Thank you so much! 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. 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 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 The surgeon was great. The third biopsy was sent for genetic testing which came back as suspicious. http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. Thyroid 29:11151124. Mol Genet Genomic Med. something nodule with a majority of Hurthle cells with normal thyroid blood tests and the Afirma test came back 40% suspicious,it grew even bigger in two years and was hypoechoic and vascular on the ultrasound like mine and she said this concerned her and the radiologist,she said (she said my nodule sounds a lot like hers except hers was bigger) so she had half her thyroid out and this nodule was benign! Afirma; FNA; cytology; thyroid nodules. Federal government websites often end in .gov or .mil. There are risks and benefits to any decision - and humans are very bad at assessing both. It came back 99% that its cancer. The Afirma Genomic Sequencing Classifier (GSC) is used to rule out malignancy and reclassify cytologically indeterminate (Bethesda III or IV) nodules to molecularly benign or suspicious ( 5 ). Unable to load your collection due to an error, Unable to load your delegates due to an error. The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. Two have been tested by FNA multiple times over 5 years 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. This all new to me and I have a lot to learn. It took about 8 days to get back results. This did not surprise me since I had researched "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. 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% 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. 2021 Apr;10(2):168-173. doi: 10.1159/000509037. The Afirma MTC may not be billed separately using an additional unit or procedure code. Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. Papillary thyroid cancer is the most common type of thyroid cancer. I have multiple nodules. I called my husband before I even received the callback, and couldn't stop crying. Epub 2017 Feb 2. Nevertheless, I am reluctant to just proceed particularly for the following reasons: How could it be Benign on one side and Suspicious on the other ? 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. The range of confirmed cancer (post surgery) from different studies was as low as 17% to as high as close to 50%. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. One of the hardest things about all of this is the adjustment. Anyone have AUS nodule with suspicious Afirma results end up cancerous? Follicular Neoplasm. It just really annoys me that doctors can order tests that cost us money without our consent. The Afirma Genomic Sequencing Classifier (GSC) classifies cytologically indeterminate thyroid nodules as molecularly benign or suspicious. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. My Endo thinks I should see a thyroid surgeon and my other doctor wants to repeat ultrasounds in 4 months, adopting a wait and see approach. I don't trust this new Afirma thyroid test for very good reasons. I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! Third, I have no history of thyroid cancer (or any cancer) in my family. It's really upsetting to suddenly be thrust into this with no symptoms, etc. I have slightly high blood pressure and slightly high cholesterol that are well controlled with meds. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. 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%. I'm not sure what the exact terminology is going to be. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. Complex nodule. Wong KS et al. I knew it was not good news. Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. MeSH Don't want to gain weight or feel less optimal then I am now. But in my case, it was a risk well worth taking. Bookshelf 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! So now I feel I have no choice to take it out (the nodule also grew .5 cm since the Aug test). Please, I am looking for any and all thoughts. Is one easier to recover from ? I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. I wasn't one to resist. GEC's SE and SP among studies ranged from 78.0 to 100% and 7.7 to 51.7%, respectively. Genes hold the information to build and maintain an organisms cells and pass genetic traits to offspring. I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. Careers. Our offering enables physicians to answer multiple clinical questions for their thyroid patients using a single, minimally invasive fine needle aspiration (FNA) sample. It was .62cm by then. I had a total thyroidectomy in NYC. I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. 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. They sent me home with 125mcg of Synthroid, calcitrol, and calcium. My surgeon wants to operate right away stating that these kind of results have a 90% truancy for cancer to be present. And is this what that recent October 2015 WSJ article was hinting at.having people with certain types of cancer of the thyroid not undergo surgery at all but just adopt a wait and see posture? Conversely, when evaluating nodules with suspicious molecular testing, surgical rates were 88% and 89%, respectively, for GEC and GSC (P = 0.853) . I heard about the Afirma analysis , spent $5000 on the test and the results are even more confusing !! 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. Among the 25 papers that approached Afirma GEC, four studies enrolled an additional number of 635 TNs from 596 patients to evaluate the Afirma GSC (16, 17, 57, 70).