afirma gsc suspicious 50

-5.5cm x 3.9cm x 3.9cm Left Thyroid Nodule: Large mixed/mostly solid, isoechoic, ill-defined margins, macrocalcifications, taller-than-wide: TI-RADS 5 Before On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). 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! I am wondering if anybody can comment on whether my case described below is considered to be reclassified according to the recently released guidelines. 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. Cytopathol. But, I am concerned about the report I just received. If you have benign results they always wonder. 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. Should I be treating this as a Hurthle Cell Lesion, or should I just relax. For nodules determined to be GSC Suspicious or with a cytopathology diagnosis of Bethesda V or VI, physicians ordered XA by checking a box. doi: 10.1210/jendso/bvab148. Epub 2018 Apr 10. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. 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. Molecular testing for indeterminate thyroid nodules: Performance of the Afirma gene expression classifier and ThyroSeq panel. They were incredibly supportive and also concerned. Method: Second, this nodule has been stable and has not grown from the first day it was discovered. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. the nodule was only 1.5 cm and I really had no concerning symptoms. A publication of the American Thyroid Association, Summaries for the Public from recent articles in Clinical Thyroidology, Table of Contents | PDF File for Saving and Printing, THYROID CANCER 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. The rate of malignancy in nodules suspicious for neoplasm (SN) on cytology interpretation was 31.2% (5/16). 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. 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 GSC correctly identified 41 of 45 malignant samples as suspicious, yielding a sensitivity of 91.1%, and 99 of 145 . I don't trust this new Afirma thyroid test for very good reasons. -38yrs old There are risks and benefits to any decision - and humans are very bad at assessing both. 1. A. I knew it was not good news. 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. You cannot become a thyroid cancer specialist in 24 hours needless to say. Euphemia I just read your post about classifications changing. 5) What are your thoughts on these results? While most thyroid nodules are non-cancerous (Benign), ~5-10% are cancerous. Which if they used the YTD income they could clearly see that I qualified for a reduced billing. Home Patients Portal Clinical Thyroidology for the Public February 2020 Vol 13 Issue 2 p.13-14, CLINICAL THYROIDOLOGY FOR THE PUBLIC 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. I didn't take the nodule too seriously, but did see a specialist and also got the FNA. Abigail. Awaiting pathology. I had my surgery in NYC, it took 2 hours, and I went home the same day. I immediately started crying, knowing that a phone call wasn't "the good news." Surgical margins: negative for tumor (tumor is < 0.1cm from margin) B. and transmitted securely. 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. 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. Found an endocrinologist who is willing to work with me on some more testing. I am so new to all this that I don't know what this means. 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. The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC). 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. 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! WHAT ARE THE IMPLICATIONS OF THIS STUDY? I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? (although it is so small, you can see it in my neck). Wow! Did your Afirma results show calcification? He said there was no lymph node involvement but there's no way to tell until final path. Thanks. 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! One such molecular marker test is the Afirma gene expression classifier (GEC) test. 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. Is one easier to recover from ? Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell. 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. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. Epub 2017 Feb 2. I regard this as a substantial cost for it's possible contribution to avoiding diagnostic surgery,in part because it also misclassifies lesions as suspicious about half the time. 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. Each of my pre-surgical tests are pointing more and more in the wrong direction. I think my biggest problem is what I read on the internet as far as all the problems afterwards. 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. t=5283[/url]. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. So the jump from that mentality to that of, "oh, I can get cancer, too" has big a huge one for me. 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. MeSH eCollection 2021. Epub 2020 Aug 6. This study investigated the outcome of the thyroid nodules deemed to be "suspicious" by the Afirma GEC in a high risk population. 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. (And myself.) 1). Here are some results/Info: 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. suspicious - ~50% risk of cancer. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. It is such a major decision that the more info you have in making the decision the better. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. 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. I'd done enough research to know that Thyroid cancer is generally treatable, and was sure to tell them about that. What should I know? Of the 343 nodules that underwent the GEC test, 178 cases (51.9%) were considered suspicious for cancer. I find out my biopsy results next week. 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. Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. 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 ). Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). Dr.Jerome Hershman. The Afirma test results came back Benign on left side and Suspicious 40% on the right side . Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. -FNAB Result: Predominantly Hurthle Cells, Abundant Macrophages, Colloid and Bloody Background: Bethesda 3 (FLUS/AUS) On the day before Thanksgiving, I returned home from work to discover a recorded phone message from the endocrinologist's office. The remaining 18% were malignant. National Library of Medicine Finally, at the endocrinologist's visit, he told me the results came back as suspicious for papillary cancer on both sides, and that I'd need to have a TT. 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 . 2. Thoughts or experiences?? I'm looking for any and all help and/information you can share with me. The aim of this study was to find out how often indeterminate thyroid biopsy specimens which were read as suspicious by the GEC test were ultimately diagnosed as noninvasive follicular variant papillary thyroid cancer after surgery. But all of these suspicious ultrasound results have me wondering if I might have gotten a false negative on the Afirma. Recommended surgery for suspicious cancer cells. Hello, There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Epub 2021 Jun 22. Please, I am looking for any and all thoughts. I scheduled the surgery for June 3rd but now I'm apprehensive because I don't want to have surgery if there's a chance of this to be benign. -Afirma Test: "Suspicious for Malignancy" - NEGATIVE for BRAF, MTC, RET/PTC1 and RET/PTC3 I have never really loved my endo, and have always felt like she was pressuring me into surgery. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. So frustrating!! Can you expand on this? The cells need to be "fresh." Also difficult is the reaction from others. This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. I have 1.6 cm nodule on my right lobe. My surgeon and endocrinologist said no further treatment is needed but to continue observation. Thanks again, Ok so this is all brand new to me so please bear with me. Right now my neck lymph nodes look good. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. Thyroid Fine Needle Aspiration Biopsy (FNAB): Change In Thyroid Nodule Volume Calculator, Find an Endocrinology Thyroid Specialist, Clinical Thyroidology for the Public (CTFP). With each step, I'd expected to hear, "yeah, you are a lumpy person, but no cancer." The doctor uses a very thin needle to withdraw cells from the thyroid nodule. They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. Thank you. Lastly I do 25mcg of levothyroxine once a day for Hypothyroidism, it was prescribed based on lab results, not on how I was feeling. 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. 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. The other side is that I had to have a 2nd biopsy done just to collect cells for AFIRMA. A thyroid nodule biopsy can be benign (normal), malignant (cancer) or indeterminate. Background: All thyroid nodules with a "suspicious" Afirma GEC result were investigated. I opted for a total after much thought because I had three un biopsied nodules on the other side and was already hypo with my entire thyroid to begin with. Sometimes you only hear the bad stories and not the good so I wanted to share mine. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. Afirma result was suspicious in 69 cases. 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. I'm a 39 years old male. It took about 8 days to get back results. Hi, No parathyroid tissue identified. My doctor then sent me to an endocrinologist for a biopsy which came back with atypical but inconclusive results. The doctor uses a very thin needle to withdraw cells from the thyroid nodule. Until now, Afirma has been available as two tests: Afirma GSC and Afirma Xpression Atlas (XA). However the "suspicious" result of the Afirma GEC does not classify these indeterminate nodules further in determining appropriate management. Thyroid 2016;26:911-5. The https:// ensures that you are connecting to the SUMMARY OF THE STUDY Of the 164 GSC nodules, 29 (17.6%) underwent thyroid surgery. they misclassify benign nodules as suspicious! The Afirma MTC may not be billed separately using an additional unit or procedure code. I have found this community very informative, thank you. 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) classifies cytologically indeterminate thyroid nodules as molecularly benign or suspicious. Therefore, a new version of the Afirma test was created called a gene sequencing classifier (GSC) to better predict thyroid cancers in indeterminate nodule while still being able to rule out cancer in benign nodules. I had the ultrasound, and am waiting for my appointment with her to go over the images. Can someone give me their take on my fna results? 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. They call follicular neoplasms with hurthle cells FNOF. Afirma was suspicious. Each wait has been tough, but the wait after the biopsy was excruciating. 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. -Lymph Node US: Mostly clear in neck, 1 ovoid focus in submandibular region that may be enlarged LN or Submandibular Lesion This large study demonstrates that almost one-half of Bethesda III/IV Afirma GSC suspicious and most Bethesda V/VI nodules had at least 1 genomic variant or fusion identified, which may optimize personalized treatment decisions. In my opinion, and my surgeons, I think FNA and Affirma are only good tools if you have positive results. Polavarapu P, Fingeret A, Yuil-Valdes A, Olson D, Patel A, Shivaswamy V, Matthias TD, Goldner W. J Endocr Soc. Sometimes, thyroid biopsy specimens are indeterminate, meaning that thyroid cancer cannot be definitively ruled in or out. But still my labs are all within normal range. And the 3rd test was Afirma which came back "suspicious". Don't want to gain weight or feel less optimal then I am now. So, in 2014, Thanksgiving was about telling them there was something going on. 8600 Rockville Pike On surgical resection 82% were benign, with 45% follicular adenoma (FA), and 37% nodular goiter (NG). Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. Please let me know what you think. BACKGROUND The benign call rate for GSC was 76.2%. 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.
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