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Finally got my FNA Tuesday what does it mean?

FNA result: “ATYPIA OF UNDETERMINED SIGNIFICANCE” - Low cellularity specimen with predominantly Hurthle cells, watery colloid present. Affirmative Genomic Sequencing Classifier study pending. “ My Dr has not contacted me yet. I work in the medical field and retrieved my results myself. Looks to me like either not enough sample OR abnormal Hurthle  cells present, but not enough to confirm a cancer diagnosis? Sent for genetic testing to give an answer? Anybody? Thanks
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Hi Tiredgirl68,

I had a similar biopsy.  Mine was described as "suspicious for neoplasm", and I believe it was described as mainly Hurthle cells with few lymphocytes present.   In this case I think "indeterminant" means that the types of cells they see are suspicious, it could be benign or cancerous but it is impossible to tell by the FNA.  (Certain types of cancers can be determined by FNA, but if it is follicular or Hurthle cell neoplasms, then genetic testing or surgery is the only way to tell if actually is cancer or not).

Mine was sent off to Afirma genetic testing - there are 3 results possible with the Afirma test 1.) benign, 2.) suspicious, ~50% risk for cancer, and 3.) malignant, greater than 99% risk.

Mine came back as still suspicious after Afirma testing.  At this point, there was a very good chance the nodule was benign, but Hurthle cells have gone through some genetic changes that makes it difficult to use Afirma to decide whether it is cancerous or not, so I was expecting it to come back as suspicious. (see info from article below)

I had a thyroid lobectomy removing the lobe that had the suspicious nodule.  In my case, the nodule was cancerous (but had not spread anywhere, so surgery was all I needed), but there are studies that suggest that the majority of nodules that show up as suspicious for Hurthle cell neoplasms are not cancerous:


If that link doesn't show up, here is the title: THYROID NODULES Hürthle-Cell Nodules classified as suspicious by the Afirma gene expression classifier had a low cancer rate

and here is some info that is important to know:  "The study included patients followed at three tertiary care centers who had HCNs with indeterminate biopsy results reported as suspicious for a Hürthle-cell nodule or with a predominance of Hürthle cells. "     AGEC refers to Afirma genetic test.

"A total of 72 out of the 169 patients who had the AGEC were treated based on this test results; among these patients, 45 (63%) had suspicious AGEC results, 26 (36%) had benign results and one was nondiagnostic. Only 6 out of the 43 patients (14%) with suspicious AGEC results who underwent surgery had cancerous nodules. A total of 23 out of the 26 patients with benign AGEC results (88%) were followed clinically; only 3 patients had surgery and all 3 nodules were non-cancerous. "

(above is a summary from: CLINICAL THYROIDOLOGY FOR THE PUBLIC A publication of the American Thyroid Association, the actual research article was published in Clinical Thyroidology in 2015).

The "good new bad news" about this is that even if it still shows up as suspicious on the Afirma test, there is a good chance it is benign, but the only way to actually determine that is benign is to have the nodule removed and pathology done on it (usually a thyroid lobectomy or total thyroidectomy).  There is also  a chance it will show up as benign on the Afirma testing (36% of cases in that study showed up as benign).   For some reason I was absolutely positive mine would come back as suspicious based on this article, but 65 vs 35 doesn't mean it always comes back suspicious (I had a lot of thyroid related anxiety going on at the time, so I was probably being pessimistic with my thinking).

Good luck with your genetic testing - it took about two weeks for me to get the results back on mine.  Hopefully yours will come back benign, and if it doesn't, please know that this still doesn't necessarily mean that it is cancer.
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Thanks for all the info. I think in my mind I need a definitive answer on test results and sounds like that may not be possible. I hate to have an unnecessary surgery that comes with risks and lifelong consequences if the nodule is benign.  I apparently have nodules in both sides of the thyroid, but, the nodule I had the biopsy on is over 3 cm and solid. I am an X-ray tech and had a chance to look at the scan before the biopsy. It really only had a few characteristics that necessitated the biopsy. Solid, size and blood flow. I didn’t see any calcifications or irregular shape. I did see one area that appeared to be cystic (in my mind, I’m not an expert on ultrasound, but have general knowledge). So, I wasn’t expecting any result other then benign etc. I’m not afraid of it being cancer, I would just like to know for sure before I go through any surgery, especially if I could instead just watch this with conservative treatment. I have, however, started noticing symptoms in the last 6 months. Choking on food voice changes, lots of hoarseness. I hadn’t thought the two were related until they found the thyroid issue. Idk. I’ve also got the most amazing endocrinologist. The ent I started with and who ordered the FNA hasn’t called me with results yet. I faxed all the results I obtained myself and asked my endo to call me. I trust him more then the surgeon. Surgeons want to do surgeries not explain the nuances of results. No calls from either dr yet. Thanks so much for your info.
I agree with not wanting the surgery unless you know for sure.  I felt better about having the surgery once mine was diagnosed as cancer because at least I had a good reason to have had the surgery, but odds were high it wasn't cancer and living without a thyroid can be a real pain sometimes.  By the time the cancer was diagnosed it was already removed from my body and no further treatment was necessary.  (In many cases, thyroid cancer is very treatable with an excellent prognosis, but you probably already know that).  

My thyroid was pretty messed up from chronic undiagnosed Hashimoto's  - I had multinodular goiter which the pathologist doing my FNA described to me as "a bunch of nodules just growing into each, other", and there was so much inflammation in my neck (swollen lymph nodes from the Hashimoto's, none with any cancer cells), so I think it was easier for me to make the decision to get the surgery since it was not an otherwise healthy thyroid I was removing.

I ended up doing mine as a lobectomy first and then had thyroidectomy completion surgery two months later, in hopes that it wasn't cancer and that my remaining thyroid would help me out and produce some hormone, but once that nodule (and two more nodules on the lobe that was removed) was diagnosed as cancer, we decided just to get the rest out because the odds weren't good for the remaining lobe.

Afirma genetic testing can be helpful in deciding whether to do surgery or not - hopefully yours comes back as benign and it's just a monitoring situation, although if it is causing trouble swallowing and voice problems, those are other factors that have to influence whether to have the surgery or not.

(I do feel like there are a whole lot of unnecessary thyroid surgeries and living without a thyroid is no joke, but at least in my case I think it was the right decision.)
I still don’t have the afirma Genomic results back yet....wth? My Dr called me one week after the FNA to tell me the results still weren’t back. I asked him how long they take to get back and he said, a week. We are going past 2 weeks....
I just looked up mine.  It took 12 days for me (almost 2 weeks), and that was a year ago.  How fast they process the biopsies probably depends on how many different patient biopsies are coming in at one time and the time to get results may vary a bit depending on their workload.

I hope you get your result soon.
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