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. Currently, gene tests can provide more information as to whether an indeterminate nodule is a cancer or not. So the probabilities of malignancy for the various Bethesda risk categories are going to change. Recommended surgery for suspicious cancer cells. The Annual International Thyroid Cancer Survivors' Conference and Regional Workshops, Download our free Low-Iodine Cookbook (PDF), Rally for Research and Thyroid Cancer Research Grants. Don't want to gain weight or feel less optimal then I am now. Used for FNA suspicious nodules (bethesda V-VI) or nodules deemed suspicious by the GSC classifier. Don't get me wrong, it hurts, but I'm able to swallow (soft foods) and talk ok. I almost want to cancel the surgery. 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. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous. 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. The Afirma MTC may not be billed separately using an additional unit or procedure code. I don't trust this new Afirma thyroid test for very good reasons. 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. Epub 2020 May 21. But it is saying that actual surgical results show that 40% "suspicion" turns out to send lots of people to surgery and then about 50% of the surgeries done yield results that show that the nodules were not cancerous at all. The good news is that if your insurance refuses to pay for the test, then you will only have to pay 300.00 out of pocket. First off, I understand about 25% of suspicious actually turn out to be cancer (not that I should just "roll the dice") BACKGROUND One > 2cm, undetermined twice and "suspicious for follicular neoplasm" the most recent FNA Wong KS et al. Thyroid cancer is found in ~5% of thyroid nodules, so the vast majority are benign (noncancerous). BTW, I'm about to turn 50 and I have no thyroid issues other than this. I'm now 3 days post op and other than some difficulty swallowing and talking loud, I'm feeling great. 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! SUMMARY OF THE STUDY -Lymph Node US: Mostly clear in neck, 1 ovoid focus in submandibular region that may be enlarged LN or Submandibular Lesion However, its relatively low positive predictive value (PPV) limited its use as a classifier for patients with suspicious results. A publication of the American Thyroid Association, Suspicious readings of the Afirma gene-expression classifier include some noninvasive encapsulated follicular variant of papillary thyroid carcinomas. Complex nodule. Please Help! Would you like email updates of new search results? I didn't take the nodule too seriously, but did see a specialist and also got the FNA. I'm ready for my next step. (although it is so small, you can see it in my neck). 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 I am still holding off on surgery for now. Can someone give me their take on my fna results? If you have benign results they always wonder. Everyone's story and experience seemed to be totally different. I really hope that a much better,much more accurate reliable test like this will be created! Awaiting pathology. However, the interesting twist was that cancer was not detected on the nodules being monitored, there was a little sucker hidden behind all these years according to my surgeon and this was why the pathologist at my local hosp could not come up with definitive conclusion as he/she was only focused on the biopsied nodules:( 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. But, I am concerned about the report I just received. In May 2013 I spoke to Barbara Rath Smith the executive director of The American Thyroid Association and she said she was going to email articles as files to download and she did. Patients usually return home or to work after the biopsy without any ill effects. Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/. Polavarapu P, Fingeret A, Yuil-Valdes A, Olson D, Patel A, Shivaswamy V, Matthias TD, Goldner W. J Endocr Soc. https://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/need-advice-surgery-or-not-based-on-40-afirma-test/?page=2#replies. Cancer Cytopathol. http://www.thyroidboards.com/showthread.php? Thoughts or experiences?? 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. -Male - Slightly Hypothyroid which began over the past year or so Patient medical records were retrospectively reviewed for clinical history, FNA results, radiologic findings, management and follow-up. Home Patients Portal Clinical Thyroidology for the Public October 2016 Vol 9 Issue 10 p.11-12, CLINICAL THYROIDOLOGY FOR THE PUBLIC http://onlinelibrary.wiley.com/doi/10.1002/cncy.21455/full. I do not have calcifications but all 4 nodules are solid, hypoechoic and vascular. They did not address that issue in their letter, just my income. The GSC incorporates nuclear and mitochondrial RNA transcriptome gene expression, RNA sequencing, and genomic copy number analysis. Seeking a second opinion I went to a leading hospital. False Positives. He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious. This is about 25% of all thyroid cancers currently. I am hesitant to go to surgery with the 30% cancer chance without more information. 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. 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. I don't think the reclassification was mentioned specifically in the WSJ article. Thanks again, Ok so this is all brand new to me so please bear with me. malignant - The chance of cancer is very high >99% malignancy, surgery is necessary. You cannot become a thyroid cancer specialist in 24 hours needless to say. Euphemia I just read your post about classifications changing. Current analysis of thyroid biopsy results cannot differentiate between follicular or hurthle cell cancer from noncancerous adenomas. FOIA 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! Multiple nodules. 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. Mild lymphocytic thyroiditis ( nonspecific) There was no follow up in 13% of cases and 87% were resected (50% lobectomies and 50% total thyroidectomies). Local surgical pathology diagnoses were available for 11 of these nodules. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. An important limitation of this study is that the authors did not examine the rate of noninvasive follicular variant papillary thyroid cancer in specimens that were not reported as suspicious by the GEC test. He recently called me back and said that my criticism of the test is valid. Our offering enables physicians to answer multiple clinical questions for their thyroid patients using a single, minimally invasive fine needle aspiration (FNA) sample. Bethesda, MD 20894, Web Policies This all new to me and I have a lot to learn. they misclassify benign nodules as suspicious! HHS Vulnerability Disclosure, Help The overall PPV of an Afirma GSC suspicious nodule was 47%, regardless of variant/fusion status. The .gov means its official. And it keeps growing. They incidentally found a nodule on my right thyroid tru CTSCAN in Dec.2014. 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. Baca SC, Wong KS, Strickland KC, Heller HT, Kim MI, Barletta JA, Cibas ES, Krane JF, Marqusee E, Angell TE. Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. I've read a lot about this test (both good and bad). I'd done enough research to know that Thyroid cancer is generally treatable, and was sure to tell them about that. SUMMARY OF THE STUDIES Thyroseq The doctor uses a very thin needle to withdraw cells from the thyroid nodule. Hi, I am joining this group because I was recommended surgery.. 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. Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis. Afirma was suspicious. 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. There are risks and benefits to any decision - and humans are very bad at assessing both. Neither will talk to the other. Noninvasive follicular variant of papillary thyroid carcinoma and the Afirma gene-expression classifier. t=5283[/url]. I'm looking for any and all help and/information you can share with me. 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 original Afirma Xpression Atlas (XA) panel reported on 761 genomic variants and 130 fusion pairs from 511 genes ( 6 ). I tried to avoid it for 10 years I am 52 years old , I have a multinodular goiter with many, many , many nodules,the biggest on the left side 2.2 cm right side 2.6 all TSH test results are good , in fact , my thyroid is fonctioning perfectly well. Additionally, there is an increase in the benign call rate with GSC, which in this study decreased surgical interventions by 68%. On the day before Thanksgiving, I returned home from work to discover a recorded phone message from the endocrinologist's office. 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. The moment that I've been so nervous about finally came yesterday. undefined will no longer be visible to you including posts, replies, and photos. doi: 10.1210/jendso/bvab148. 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. Epub 2020 Mar 17. Forth, I have absolutely no symptoms and feel fine. 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. One of the hardest things about all of this is the adjustment. She then tells me that at a recent conference, there was a lot of discussion of Afirma, and the general consensus seemed to be that it was good at detecting papillary cancer, but not necessarily follicular. Molecular markers can be used in thyroid biopsy specimens to either to diagnose cancer or to determine that the nodule is benign. Since then, I've had yearly scans (ultrasounds) and two biopsies, both came back negative. 1). My Afirma results came back suspicious. 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). Cytopathol. Clipboard, Search History, and several other advanced features are temporarily unavailable. On cytologic evaluation 3.0% of the cases were non diagnostic (ND), 9% benign, 62% AUS, and 26% suspicious for neoplasm (SN). 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. Mine did, and that can also be a sign of cancer.
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