The Affirma Xpression Atlas is based on RNA sequencing. 2017 May;125(5):313-322. doi: 10.1002/cncy.21827. Two have been tested by FNA multiple times over 5 years Complex nodule. 2017;45:308-311. 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. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. Rationale: Crosswalk to 81545 ($3,600) 81545 describes the original Afirma classifier; when . https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/afirma-thyroid-analysis/. The Afirma gene sequencing classifier (GSC) performs better in I've enjoyed good health for my whole life. Any Insights? She didn't seem overly concerned based on all my previous records. Don't want to gain weight or feel less optimal then I am now. For one thing, I had some pain on one side after biopsy. 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 Her only information about this comes from me, as she lives across the country and can't go to doctor's visits with me. I am not afraid of the surgery, only would really be disapointed if a vital organ was removed from my body for nothing. My AFIRMA is also 40% risk. Neither will talk to the other. Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. Afirma Genomic Sequencing Classifier and Xpression Atlas Molecular 3. There are risks and benefits to any decision - and humans are very bad at assessing both. They sent me home with 125mcg of Synthroid, calcitrol, and calcium. We had a long talk and discussed more conservative options, like a partial thyroidectomy, but no rush. I've been battling hypothyroidism and suspicious thyroid nodules for 4 years. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. I found many people including more than a few on the Inspire site in their ThyCa forum who have unfortunately gotten false suspicious results from this test and as a result had totally unnecessary thyroid surgery,including this poor woman on thyroidboards.com who is the worst case I found so far,the Afirma test told her she had an 80% highly suspicious result and because of this her endocrinologist told her to expect cancer and that she had an 80% likelihood that her solid hypoechoic 1- 1 1/2 cm mildly suspicious as follicular neoplasm nodule was cancer,so she had totally unnecessary thyroid surgery for a benign nodule and was scared to death for nothing! doi: 10.1210/jendso/bvab148. They were incredibly supportive and also concerned. The main goal was to help decide if my "suspicious for neoplasm" nodule was benign or not. Should I be treating this as a Hurthle Cell Lesion, or should I just relax. More than one doctor has told me I should just have surgery, at least half the thyroid, maybe the whole thing. Thyroid 29:11151124. I really hope that a much better,much more accurate reliable test like this will be created! 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. I'm curious, if you had similar biopsy results and had surgery, was your final path malignant or not? I agree that you should have been consulted for the genetic test!! 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. Epub 2020 Mar 17. (The office had already explained that benign results would be sent in a letter, but suspicious or confirmed cancer results would warrant a phone call.) 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 ). Afirma BRAF V600E o Afirma BRAF testing may be considered for either GSC or FNA suspicious or malignant results. Frontiers | Analytical Verification Performance of Afirma Genomic I have made an appointment with another endocrinologist, but just to talk to him. the nodule was only 1.5 cm and I really had no concerning symptoms. 2.) It was .62cm by then. Afirma Suspicious results - Thyroid cancer - Inspire Wong KS et al. Method: t=5283], http://www.thyroidboards.com/showthread.php? 2021 Oct 7;5(11):bvab148. I was informed in August of 2013 after a FNA that one of my nodules was suspicious and the recommendation was a TT. Surgical margins: negative for tumor (tumor is < 0.1cm from margin) I don't want to jump the gun, and will wait to hear what the new doctor says. The cells need to be "fresh." Our new findings show that the real-world experience supports this data, further demonstrating that the likelihood of malignancy in Afirma GSC-suspicious nodules is even greater than what was . Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. 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% Epub 2018 Apr 10. One has tested benign on several FNAs, is cystic, and has remained consistent in size. The results were suspicious of papillary cancer, but not conclusive. I'm a foodie who has always struggled with weight, but I also exercise so I'm always just plump but in otherwise decent health. At first it sounded like only the encapsulated variety was going to be included in the reclassification, but more recently it seems that non-encapsulated and non-invasive FVPTC is also going to be included. The Afirma Genomic Sequencing Classifier (GSC) provides physicians with a comprehensive solution for a complex landscape in thyroid cancer diagnosis and individualization of care. 4,6 In addition to the benign versus malignant classifier, the Afirma GSC suite includes Home Patients Portal Clinical Thyroidology for the Public October 2016 Vol 9 Issue 10 p.11-12, CLINICAL THYROIDOLOGY FOR THE PUBLIC 1) Cytologist did not classify this as a Hurthle Cell Lesion Is it a Hurthle Cell Lesion due to predominance of Hurthle Cells? PDF Afirma Thyroid Cancer Classifier Tests - evicore.com I called my husband before I even received the callback, and couldn't stop crying. At least 1 genomic alteration was identified by the expanded Afirma XA panel in 70% of medullary thyroid carcinoma classifier-positive FNAs, 44% of Bethesda III or IV Afirma GSC suspicious FNAs, 64% of Bethesda V FNAs, and 87% of Bethesda VI FNAs. National Library of Medicine My Afirma results came back suspicious. Papillary thyroid cancer is the most common type of thyroid cancer. On the day before Thanksgiving, I returned home from work to discover a recorded phone message from the endocrinologist's office. The biopsy (Afirma) was indeterminate with GSC suspicious with a 50% ROM. The range of confirmed cancer (post surgery) from different studies was as low as 17% to as high as close to 50%. So frustrating!! At least as accurate as FNA, or that was my understanding. It came back 99% that its cancer. You cannot become a thyroid cancer specialist in 24 hours needless to say. Euphemia I just read your post about classifications changing. Papillary thyroid carcinoma, Follicular Variant, 2.1 cm in greatest dimension, present in mid to lowe pole, woth prior FNA site changes. 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. Afirma GSC: Better as One Joshua Klopper, MD March 28, 2023 - Afirma 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. Afirma GSC is a pre-operative genomic test for thyroid tumor biopsies that have . 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. I am also concerned about hormone replacement, would like some personnal comments on recovery from Lobectomy versus TT . Thanks so much! The panel includes genes that have been identified My Afirma test came back May 6 with what the company calls 40% "suspicious". Afirma Genomic Sequencing Classifier and Xpression Atlas - PubMed This process has helped me to realize that there is a lot that physicians do not understand--much more than I knew. Qualifiers of atypia in the cytologic diagnosis of thyroid nodules are associated with different Afirma gene expression classifier results and clinical outcomes. But still my labs are all within normal range. Long-Term Outcomes of Thyroid Nodule AFIRMA GEC Testing and Literature Review: An Institutional Experience. Afirma result was suspicious in 69 cases. I don't trust this new Afirma thyroid test for very good reasons. Thyroid. Another problem with Afirma is that pretty soon they are going to have to adjust the test to the reclassification of non-invasive FVPTC. Thanks. In such cases, testing of molecular markers related to thyroid cancer may help determine the risk of cancer. 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. The Afirma GSC is designed to help clinicians manage these patients. Multiple nodules. No parathyroid tissue identified. There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). The mindset of most surgeons is to cut it out - ignoring the risks of that approach. Background: PMC Otolaryngol Head Neck Surg. http://www.glandsurgery.org/article/view/1002/1193 Biotech Strategy Blog in this post by Pieter Droppert June 28,2012 Also mentions 48% of nodules falsely called "suspicious" for cancer and can cause many people to have unnecessary thyroid surgery when they don't have cancerous thyroid cells! Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). However, I was not informed of this. 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. PDF AFIRMA REQ: Sample Patient Report I'm afraid I feel ok now then all of a sudden will begin feeling horrible. Thyroid nodules are very common, occurring in up to 50% of individuals. Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. For the past year I've been seeing functional medicine doctors to see if I could shrink my nodules with diet and nutrition but when I got the positive Afirma test and the biggest nodule 3cm kept growing I finally decided to have surgery, which I had last Thursday. This isn't saying that Afirma's test isn't useful. Just underwent Afirma and Asurgen testing on the suspicious one. Cytopathol. 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. Hi, I am joining this group because I was recommended surgery.. 3.) If benign = no surgery, IF suspicious or malignant = surgery. And he said he doesn't think the Afirma test is as accurate as they say. 42 year old female. Unauthorized use of these marks is strictly prohibited. Suspicious Nodule Surgery the Only Option? - Partial was recommended at first, though we are leaning total now with the remainder of tests now complete. The pathology database was searched for all thyroid nodules with Afirma test results over a three year period, 2013-2015. I have never really loved my endo, and have always felt like she was pressuring me into surgery. I have met with multiple surgeons, and am meeting with the one I am selecting on Friday and wanted some info on what to do, and how to proceed. t=5283[/url]. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. My journey through TT and a suspicious for cancer diagnosis, part one. Additionally, there is an increase in the benign call rate with GSC, which in this study decreased surgical interventions by 68%. I am scheduled to have a TT on March 9th and I wish I felt a little better about my decision. Right now my neck lymph nodes look good. 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 MeSH The authors reported the following rates of final diagnoses for these specimens: 65% of cases had no cancer (ie. 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 Good luck and happy thoughts! It is unclear whether mutations in these genes cause the cancer or are just associated with the cancer cells. -Male - Slightly Hypothyroid which began over the past year or so Here are some results/Info: 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! The Affirma Genomic Sequence Classifier (GSC) is based on DNA sequencing. 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." Lastly I do 25mcg of levothyroxine once a day for Hypothyroidism, it was prescribed based on lab results, not on how I was feeling. I don't think the reclassification was mentioned specifically in the WSJ article. Now can anyone shed some light on any negative effects of RAI on your body in the long-run? 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. So far, no problems with calcium. WHAT ARE THE IMPLICATIONS OF THIS STUDY? As I have learned on this board, just 'taking a pill' for the rest of your life isn't as easy as it sounds. The Afirma Xpression Atlas for thyroid nodules and thyroid cancer And she's just mostly silent about it. 2021 May 13;12:649522. doi: 10.3389/fendo.2021.649522. The Afirma gene sequencing classifier (GSC) performs better in indeterminate thyroid nodules than the Afirma gene expression classifier (GEC) BACKGROUND Thyroid nodules are very common, occurring in up to 50% of individuals. 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 . Because of this rather benign course, some pathologists have even questioned whether this subgroup is a cancer after all. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/genetic-test-two-different-results/reply/6888430/?msg_activity=reply_posted. WHAT ARE THE IMPLICATIONS OF THIS STUDY? I knew it was not good news. As said I have a lot of great important articles by many different endocrinologists written at different times for The American Thyroid Association's journal criticizing the Afirma test and how 48% (I'm sure it's much higher!) How "suspicious" is that nodule? Review of "suspicious" Afirma gene Afirma Practice Resources Molecular markers: genes and microRNAs that are expressed in benign or cancerous cells. Comparison of Afirma GEC and GSC to Nodules Without Molecular Testing How they found it was my complaint of feeling tired all the time. 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. Living beings depend on genes, as they code for all proteins and RNA chains that have functions in a cell.