I'm not against surgery if needed, but wondering shouldn't it be followed for a bit before such a drastic measure is taken. 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 rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). 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. 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 . The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC). 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." Two have been tested by FNA multiple times over 5 years So far, no problems with calcium. 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! https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. Methods: Complex nodule. 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%. Cancer-Associated Genes: these are genes that are normally expressed in cells. Personally, I think getting the AFIRMA test done is a good thing. 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. This site needs JavaScript to work properly. This is about 25% of all thyroid cancers currently. How Does the Afirma Genomic Test Perform in the Real World? PDF AFIRMA REQ: Sample Patient Report (Afirma GSC suspicious, suspicious for malignancy, or malignant cytopathology) ,2,4,8 Choosing to have the surgery was the most difficult decision ever, since I wasn't sure if my nodule was cancerous or not, and of course I didn't want to go through the surgery all for nothing. The Afirma test results came back Benign on left side and Suspicious 40% on the right side . How they found it was my complaint of feeling tired all the time. I've read a lot about this test (both good and bad). 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. My Enfo bumped up my Synthroid right away to adjust for the surgery. One > 4cm, but has tested benign by FNA 4 times Without my knowledge 4/5 of my FNA biopsies came out fine but 1/5 had "atypical" cells and they were sent to Afirma without my knowledge. Overall malignancy rates were highest in the GSC group at 39%, compared to 20% and 22% in the no-molecular-testing and GEC groups, respectively (P = 0.0222) . 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. Several thyroid nodules. 85% were benign. Have lots of decisions to make and just trying to do some homework. Just had TT yesterday. Results: Of the 16 cases of follicular variant papillary thyroid cancer, 14 of them were noninvasive follicular variant of papillary thyroid cancer (88%). Everyone's story and experience seemed to be totally different. This study indicates that the newer Afirma GSC test is superior to the Afirma GEC test by better predicting which indeterminate nodules are more likely to be cancers and should be removed while maintaining the same or better performance of predicting which indeterminate nodules are benign and can be monitored without surgery. microRNA: a short RNA molecule that has specific actions within a cell to affect the expression of certain genes. One of these women member dacooper12 on Inspire in their ThyCa forum had the opposite result,which the studies show,that the Afirma test misclassifies a much smaller % of cancerous nodules as benign compared to the higher % of benign nodules it misclassifies as "suspicious. 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. The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. THE FULL ARTICLE TITLE: Since that time, the pain has all subsided -- I think the biopsy just roughed things up, but when they calmed down, I felt no pain whatsoever, again. 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. Of the 164 nodules included in the study with the GSC test, suspicious nodules were found in 39 of the 164 nodules (23.7%). All my blood tests and tsh levels are in the normal range. Thyroid Cancer - Afirma& Genomic Sequencing Classifier - Veracyte How could it be Benign on one side and Suspicious on the other ? 2018 Jul;126(7):471-480. doi: 10.1002/cncy.21993. A test with a better NPV (negative predictive value), would be more usefu than ever in that situation. After reading many stories, I didn't know what to expect. I have never really loved my endo, and have always felt like she was pressuring me into surgery. Thyroid nodule molecular profiling: The clinical utility of Afirma So now I feel I have no choice to take it out (the nodule also grew .5 cm since the Aug test). Veracyte Announces New Data Suggesting Afirma Testing Can Help More than one doctor has told me I should just have surgery, at least half the thyroid, maybe the whole thing. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). 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). 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. Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing. Afirma said NEGATIVE for BRAF and Meduliary but still assigned a classification of "Suspicious" with 40% chance of cancer. I'd done enough research to know that Thyroid cancer is generally treatable, and was sure to tell them about that. In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. Disclaimer. She admitted once she thinks cancer is unlikely. The doctor uses a very thin needle to withdraw cells from the thyroid nodule. And he said he doesn't think the Afirma test is as accurate as they say. 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. Cancer Cytopathol. 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. If all nonsurgical GSC benign cases were truly benign, the chance a suspicious nodule was truly a thyroid cancer was 60% and a benign nodule was benign was 100%. Which means I would still be paying this amount to the hospital if I didn't pay it to Affirma. But in my case, it was a risk well worth taking. 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. I had three biopsies on a completely solid 2.0cm nodule, all which came back indeterminate/AUS. These results show an improved accuracy for the GSC as compared with the GEC. See Somatic Mutation Testing - Solid Tumors guideline for criteria. 2.) On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). 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. They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. 1). Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. 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! NTRK, RET, BRAF, and ALK fusions in thyroid fine-needle aspirates (FNAs). At this point, I was exasperated by all of the running around, but fine. 3) What do I need to know? Thyroid fine needle aspiration biopsy: a simple procedure that is done in the doctors office to determine if a thyroid nodule is benign (non-cancerous) or cancer. False positive rate of Afirma was 56% (32/57). The Afirma gene sequencing classifier (GSC) performs better in The Afirma Xpression Atlas for thyroid nodules and thyroid cancer Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. Nishino M, Mateo R, Kilim H, Feldman A, Elliott A, Shen C, Hasselgren PO, Wang H, Hartzband P, Hennessey JV. The third biopsy was sent for genetic testing which came back as suspicious. 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!
