I have made an appointment with another endocrinologist, but just to talk to him. 3.) The Afirma Xpression Atlas for thyroid nodules and thyroid cancer Please click on this link below about the woman with a 1-1 and half cm solid hypoechoic nodule who had an inconclusive Fine Needle biopsy which was suspicious as a follicular neoplasm and mine is being called a follicular neoplasm with oncocytic (hurthle cell features) ,this woman had her FNA nodule sample tested by the veractye Afirma Test which is what I had done,the results came back telling her that her that their results on her FNA was highly suspicious and that because of this her endo told her she had an 80% chance of having thyroid cancer and so she had her thyroid out and found out it was benign! Is one easier to recover from ? Sometimes, thyroid biopsy specimens are indeterminate, meaning that thyroid cancer cannot be definitively ruled in or out. The doc mentioned the thyroid and upon a physical exam felt the nodule, leading to the rest of the testing. Cancer Cytopathol. One has tested benign on several FNAs, is cystic, and has remained consistent in size. Is is the Benign that is a false negative ? The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. I did not get to go under the knife for my TT til this past March. 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. Good luck and happy thoughts! This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. 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. I called and almost everyone has that risk if it is suspicious. I am so new to all this that I don't know what this means. 8600 Rockville Pike My AFIRMA is also 40% risk. Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). So, I found a new endo, whom I absolutely loved at my first appointment. 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. 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. So when I say the doctor's says suspicious for cancer with a 75% possibility, I'm not sure how she gets 'unlikely' from that. Here is what the Affirma test disclaimer said: Benign: Preformance characteristics not defined for nodules less than 1 cm diameter. It mentions possible microcalcification, which has never come up before. The cells need to be "fresh." Thanks. Wong KS, Angell TE, Strickland KC, Alexander EK, Cibas ES, Krane JF, Barletta JA. Afirma was suspicious. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) Neither will talk to the other. It took about 8 days to get back results. How do Afirma GSC & Xpression Atlas tests work? What do they mean Mild lymphocytic thyroiditis ( nonspecific) 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. 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%. Dincer N, Balci S, Yazgan A, Guney G, Ersoy R, Cakir B, Guler G. Cytopathology. I'm a lumpy person, I told my husband. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Methods: 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! Hi, 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. Genes: a molecular unit of heredity of a living organism. Hi, I am joining this group because I was recommended surgery.. Follicular Neoplasm. A woman on the excellent health site Medhelp told me she had a 3cm. Incidental papillary thyroid carcinoma, .2 cm on Left lobe and Thyroid right lobe: 1.2 cm nodule-Papillary thyroid carcinoma, conventional and follicular variant, histologically infiltrating into adherent skeletal muscle: .2 cm and the right lobe: 1.4 cm, both New Data Show Strong Performance of Veracyte's Afirma GSC in Real-World I immediately started crying, knowing that a phone call wasn't "the good news." It was .62cm by then. 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. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. How they found it was my complaint of feeling tired all the time. 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 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. Afirma Genomic Sequencing Classifier and Xpression Atlas - PubMed I agree that you should have been consulted for the genetic test!! suspicious - ~50% risk of cancer. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. 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. Hello. It just really annoys me that doctors can order tests that cost us money without our consent. 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 . 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! Results: Afirma result was suspicious in 69 cases. The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. My surgeon and endocrinologist said no further treatment is needed but to continue observation. 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. and I just found out that my Afirma test isn't being paid for by my insurance company on the grounds that its test is considered "experimental.". Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. Ultrasound reports unfortunately not very informative other than size. 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. A. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. The panel includes genes that have been identified However, the results are not conclusive. The Afirma gene sequencing classifier (GSC) performs better in The results were suspicious of papillary cancer, but not conclusive. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. What have been your experinces with AFIRMA? I am still holding off on surgery for now. 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. Anyone have AUS nodule with suspicious Afirma results end up cancerous? So I thought I was in the clear, and decided to just monitor this nodule for growth, and revisit the surgery idea only if size became an issue. But, she ordered another ultrasound because she wants to see the images herself, rather than just rely on reports from the radiologist. The authors concluded that a GEC suspicious test result may include noninvasive follicular variant papillary thyroid cancer as well as classical papillary thyroid cancer. This isn't saying that Afirma's test isn't useful. Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular 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. Largest is 2.3(previously 1.8cm in 2014) different test center though. 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. 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. Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular Did your Afirma results show calcification? Wow! 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. Independent Comparison of the Afirma Genomic Sequencing - PubMed 3. The https:// ensures that you are connecting to the 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. I am so glad to find this as reading everyone's story helps me feel not so aloneTHANK YOU! The two most common molecular marker tests are the Afirma Gene Expression Classifier and Thyroseq, A publication of the American Thyroid Association, Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). And she's just mostly silent about it. 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. All I can say is that in reviewing my ultrasounds and the report from the interventional radiologist and the Affirma report, I have noticed that there are inconsistencies in even the reported measurements of the nodules and now that I have read further into studies done on people undergoing thyroid removal after getting "Suspicious"/40% of Cancer Affirma results, there are many more false positives than Afirma would have you understand. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. I didn't want to live with the risk, especially already being hypo and having nodules on the other side slowly growing. Recently I change insurance and in doing so, my new doctor ordered a ultrasound which showed the nodule and he felt it was nothing to worry about. I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign! One such molecular marker test is the Afirma gene expression classifier (GEC) test. 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. Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing. 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. The doctor is an Endocrine Surgeon that specializes in Thyroid/Parathyroid and Adrenal surgeries. However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). 2016 Jul;26(7):911-5. doi: 10.1089/thy.2015.0644. Patients usually return home or to work after the biopsy without any ill effects. The Afirma test results came back Benign on left side and Suspicious 40% on the right side . This was done in hopes of maintaining my own thryoid function which the doctors and I felt better than taking thyroid medicine daily for the rest of my life. With each step, I'd expected to hear, "yeah, you are a lumpy person, but no cancer." The site is secure. Multiple nodules. All thyroid nodules with a "suspicious" Afirma GEC result were investigated. Frontiers | Thyroseq v3, Afirma GSC, and microRNA Panels Versus The remaining 18% were malignant. So far, no problems with calcium. Comparison of Afirma GEC and GSC to Nodules Without Molecular Testing in Cytologically Indeterminate Thyroid Nodules. I welcome your thoughts on my case. doi: 10.1210/jendso/bvab148. 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. o The Afirma MTC testing must be billed as part of the Afirma GSC. 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). 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 ). They were incredibly supportive and also concerned. The moment that I've been so nervous about finally came yesterday. 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% I'm afraid I feel ok now then all of a sudden will begin feeling horrible. However, I was not informed of this. Lastly I do 25mcg of levothyroxine once a day for Hypothyroidism, it was prescribed based on lab results, not on how I was feeling. Afirma GSC: Better as One Joshua Klopper, MD March 28, 2023 - Afirma Second, this nodule has been stable and has not grown from the first day it was discovered. I'm determined to eek out the positive in this. Everyone's story and experience seemed to be totally different. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. Bookshelf Right now my neck lymph nodes look good. I could feel food getting lodged in my throat, and felt a pinch like a nerve at times, too. I had the ultrasound, and am waiting for my appointment with her to go over the images. 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. For some reason, my long time best friend is one of the least supportive in all of this. The benign call rate for GSC was 76.2%. I also recently found *another* article written by an endocrine surgeon Sam Wiseman from the Department of Surgery ,St.Paul's Hospital University Of British Columbia for the site Gland Surgery where he also points out real concerns that half of patients(as I said I know it's more,from all of the people I have found posting on thyroid boards) with benign nodules wrongly classified as "suspicious" by the Afirma test are getting unnecessary thyroid surgery because this Afirma result influenced a lot of endocrinologists and their patients to have the thyroid surgery! Thyroid Fine Needle Aspiration Biopsy (FNAB): a simple procedure that is done in the doctors office to determine if a thyroid nodule is benign (non-cancerous) or cancer. I wanted to share my Thyroidectomy story because like most of you I was super scared and nervous about surgery but my surgery went great and I've had no complications. Afirma GEC or GSC a gene-expression classifier that identifies biopsies as "benign" or "suspicious," and mir-THYtype an mRNA-based classifier test. I posted the below post on this forum on several different topics since 2013. Federal government websites often end in .gov or .mil. 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 HHS Vulnerability Disclosure, Help 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]). Thanks so much! Thyroid nodule biopsies are used to identify if a nodule is cancerous or determine the risk that a thyroid nodule may be cancerous. 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.