As I have learned on this board, just 'taking a pill' for the rest of your life isn't as easy as it sounds. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. Local surgical pathology diagnoses were available for 11 of these nodules. If benign = no surgery, IF suspicious or malignant = surgery. Bugs me. 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 http://www.glandsurgery.org/article/view/1002/1193. 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% Neither will talk to the other. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. Results: Thirty-eight TP53 variants were present among >13,000 Bethesda III/IV Afirma GSC Suspicious samples. Endo M et al 2019 Afirma Gene Sequencing Classifier compared with Gene Expression Classifier in indeterminate thyroid nodules. But, I'm also tired of living with the uncertainty and semi-annual nerve sessions after each ultrasound. False positive rate of Afirma was 56% (32/57). I have slightly high blood pressure and slightly high cholesterol that are well controlled with meds. He later called and said he was sending me for a biopsy. One has tested benign on several FNAs, is cystic, and has remained consistent in size. -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 Meanwhile I read a recent WSJ article about patients with ACTUAL thyroid cancer being offered a wait and see approach as there are so many issues after surgery--not just discomfort issues like fatigue, weight gain and so forth but also secondary cancers. 2020 May;162(5):634-640. doi: 10.1177/0194599820911718. So, I found a new endo, whom I absolutely loved at my first appointment. Competition Heats Up With Latest Tests for Thyroid Nodules Epub 2020 May 21. Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. No lymphovascular invasion is identified. 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. 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. 1). Accessibility Comparison of Afirma GEC and GSC to Nodules Without Molecular Testing in Cytologically Indeterminate Thyroid Nodules. 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. But that's a personal issue I'll have to work out in time. I didn't take the nodule too seriously, but did see a specialist and also got the FNA. I can learn to live healthier, and to appreciate each day, and to love and support more readily. I was told the only way to find out for sure is to have half my thyroid removed. The other tested indeterminate, follicular atypia, cannot rule out follicular neoplasm. He tried to console me but he was also upset. Cytopathol. 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 . A certain type of thyroid cancer is going to converted to non-malignant or "borderline" status. Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular He recently called me back and said that my criticism of the test is valid. I had that one sent to Afirma, and it came back indeterminate on cytopathology again, benign on GEC. For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. Epub 2020 Aug 6. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. PDF Lab Management Guidelines V1.0.2020 Afirma Thyroid Cancer - eviCore After some research of my own, I decided to leave it. I'm shocked that my voice is still completely in tact. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. . Hello, Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). 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 doctor uses a very thin needle to withdraw cells from the thyroid nodule. 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 ). 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. 85% 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." PDF AFIRMA REQ: Sample Patient Report 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. No parathyroid tissue identified. Afirma GSC(NOT GEC) 50% Suspicious - Thyroid cancer - Inspire I've read a lot about this test (both good and bad). My expensive, unsolicited, Afirma test results came back as negativegood thing I had already had my TT before I received the results; I have stage III pap/follicular thyca. 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. That didn't sit well with me. 2021 Aug;31(8):1253-1263. doi: 10.1089/thy.2020.0969. She didn't seem overly concerned based on all my previous records. So far, no problems with calcium. Follicular Neoplasm. It's really upsetting to suddenly be thrust into this with no symptoms, etc. Afirma Gene Expression Classifier: a test for a group of molecular markers in thyroid biopsy specimens in order to determine the likelihood that a thyroid nodule is benign or cancerous. What have been your experinces with AFIRMA? -No Size changes of Nodule in last 2-3 months (duration of time to get all of these tests) I have made an appointment with another endocrinologist, but just to talk to him. A. But still my labs are all within normal range. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. My Afirma results also came back as "suspicious." There are risks and benefits to any decision - and humans are very bad at assessing both. http://www.glandsurgery.org/article/view/1002/1193. How should I proceed with these results? Surgical margins: negative for tumor (tumor is < 0.1cm from margin) 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). My AFIRMA is also 40% risk. 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. She says very little, and if she does say anything, questions my reactions. All my blood tests and tsh levels are in the normal range. The Afirma GSC is designed to help clinicians manage these patients. She has other small nodules on her other thyroid lobe. 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! Thyroid. I agree that you should have been consulted for the genetic test!! Bethesda, MD 20894, Web Policies Of the 343 nodules that underwent the GEC test, 178 cases (51.9%) were considered suspicious for cancer. I am still holding off on surgery for now. The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. He is very calm and laid back, and prefers to take a more controlled approach to everything, but I'm feeling a more aggressive approach is warranted. Please Help! They did not address that issue in their letter, just my income. Have lots of decisions to make and just trying to do some homework. How do Afirma GSC & Xpression Atlas tests work? What do they mean The rate of malignancy in nodules suspicious by Afirma was 18.3% (11/60). 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. 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. Papillary Thyroid Cancer: the most common type of thyroid cancer. PDF Afirma Thyroid Cancer Classifier Tests - eviCore I am so glad to find this as reading everyone's story helps me feel not so aloneTHANK YOU! 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.