# Biopsy Results, what does it mean?



## vivien (Dec 22, 2012)

Macroscopic
We received 2 slides, 1 was rehydrated and a Surepath preparation.

Microscopic

The smears are moderately cellular and show thyroid follicular cells mostly in mircrofollicular pattern and syncitial sheets. The nuclei are degenerate, however no groves or nuclear inclusions are identified. There is a small amount of thin colloid in the background.

Comment
The thyroid follicular cells are mostly seen as microfollicles and syntical sheets. Please repeat FNAB in 3 months time or if the nodule enlarges.

summary

Ultrasound guided fnab right side thyroid nodule.
- category 111 - acus, atypia of uncertain significance.


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## Octavia (Aug 1, 2011)

Looks inconclusive to me. They're not ruling in or ruling out cancer, and want to keep an eye on the nodule.

What did your doctor say?


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## Andros (Aug 26, 2009)

vivien said:


> Macroscopic
> We received 2 slides, 1 was rehydrated and a Surepath preparation.
> 
> Microscopic
> ...


It bears watching since the biopsy was indeterminate. So, you and your doctor need to stay on top of this.

How do you feel?

Did your doctor run Thyroglobulin and Thyroglobulin Ab?


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## vivien (Dec 22, 2012)

Doctor says to do another ultrasound and biopsy in 3 months from when it it was done, so i am doing another ultrasound and biopsy end feb and will get results early march. 
As it says atypia, what is the chances of it being cancerous on next ultrasound?

I looked at the size of nodule on 1st ultrasound compared to biopsy ultrasound, and it looks like in two weeks it has grown 6mm. Is that normal to grow?


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## Octavia (Aug 1, 2011)

Hard to say the chances of it being cancerous...we couldn't tell for sure whether mine was cancerous until I had a partial thyroidectomy and they were able to put the whole darn thing under a microscope.

Regarding the size and growth in a short time...it may or may not have actually grown. Ultrasound measurements are less than perfect. For example, my ultrasound said my nodule measured 2.5 cm, but when it was surgically removed about 6 weeks later, it was actually 3.2 cm. The surgeon was not at all concerned, and said it was probably 3.2 cm when I had the ultrasound done, too.


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## crimebuff (May 25, 2012)

Next time you have a biopsy, ask your doctor to have the result analyzed if indeterminate again by tha Affirma Gene Expression Test. It will tell you what the chances of malignancy are, so you can decide if you want your thyroid removed.


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## vivien (Dec 22, 2012)

I have done two biopsies in 3 months and both state the same thing as its abnormal, atypia. 
So ent has stated to do surgery. I am having half of my thyroid removed in three weeks.

He also said i will be on tablets for the rest of my life????? hmmm. I am already on reflux medication and birth control everyday, and now more tablets.

So how soon should i be feeling better after surgery? When can i start driving? when would the pain after surgery go away? Is it easy recovery? Tell me about your recovery also?
How much does the tablets cost monthly? Is there a anything i should know or any tips ?


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## CindiG (May 9, 2013)

crimebuff said:


> Next time you have a biopsy, ask your doctor to have the result analyzed if indeterminate again by tha Affirma Gene Expression Test. It will tell you what the chances of malignancy are, so you can decide if you want your thyroid removed.


 No, please don't anyone get the Afirma test!

I don't trust this new Afirma thyroid test for very good reasons. My Afirma test came back May 6 with what the company calls 40% "suspicious".

Many endocrinologists have written articles in The American Thyroid Association's journal criticizing the inaccuracies and unrelabilities of this recent Afirma test, the strongest criticism and concern is by endocrinologist of (*50* years!) Dr.Jerome Hershman.

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. 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. He then says, However,another interpretation is that the method can be used only to classify a nodule as benign and the "suspicious" category by GEC should not be used. The other approach to molecular diagnosis of thyroid cancer is the measurement of oncogenes such as BRAF on FNA to make a positive diagnosis of thyroid cancer in cytologically indeterminate FNA biopsies. This approach is being marked by several laborartories and was reviewed in the December 2011 issue of Clinical Thyroidology. 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.

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.

He also says that out of 61 follicular neoplasms that were benign the Afirma test misclassified 31 of them as suspicious.

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. And he said he doesn't think the Afirma test is as accurate as they say. 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. 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.

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 here 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! I have since found several more women who had false Afirma test results and had surgery and their nodules were also benign!

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". 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!

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!) they misclassify benign nodules as suspicious!

Last week 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. I asked her if I have permission to email and post these articles and she said yes,they are for the public.

A woman on the excellent health site Medhelp told me she had a 3cm. something nodule with a majority of Hurthle cells with normal thyroid blood tests and the Afirma test came back 40% suspicious,it grew in two years and was hypoechoic and vascular on the ultrasound like mine and she said this concerned her and the radiologist,she said (she said my nodule sounds a lot like hers except hers was bigger) so she had half her thyroid out and this nodule was benign! She has other small nodules on her other thyroid lobe.

I also read on this Inspire site in their Thyroid Cancer Survivors Association forum,a woman had a 2cm indterminate nodule that everyone was concerned about and her Afirma test came out suspicious,and she had her thyroid removed,it turns out that the 2cm nodule was benign but they found tiny papillary cancers all under 5mm that weren't even seen on the ultrasound! 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!

On May 8th endocrinologist Dr.Steven P.Hadak who with Dr. David S. Rosenthal co-authored one of these studies for The American Thyroid Association's Clinical Affairs Committee called,Information For Clinician's:Commercially Available Molecular Diagnosis Testing In The Evaluation Of Thyroid Nodule Fine-Needle Aspiration Specimens called me back and was very nice,he even had a patient waiting! He said this Afirma test is wrong half the time misclassifying benign nodules as suspicious,(I'm sure it's even more than half!) and I said this is not a good test,and he said I don't think it's a good test either!

Please click on this link below about the woman with a 1-1 and half cm solid hypoechoic nodule who had an inconclusive Fine Needle biopsy which was suspicious as a follicular neoplasm and mine is being called a follicular neoplasm with oncocytic (hurthle cell features) ,this woman had her FNA nodule sample tested by the veractye Afirma Test which is what I had done,the results came back telling her that her that their results on her FNA was highly suspicious and that because of this her endo told her she had an 80% chance of having thyroid cancer and so she had her thyroid out and found out it was benign!

http://www.thyroidboards.com/showthread.php?t=5283

I recently found *another article written by a 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!

http://www.glandsurgery.org/article/view/1002/1193

I really hope that a much better,much more accurate reliable test like this will be created!

:banghead:


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