Tuesday, February 22, 2011

Molecular Classifier saves surgery on a suspicious nodule

Here is the result of an Afirma molecular classifier test done on a male patient set to go to surgery for a suspicious follicular lesion. they wanted to do a lobectomy.The Afirma sample was taken during a repeat FNA and the needle washout was sent to Veracyte for Afirma. The report shown below was benign. He was not a candidate for surgery, and will be followed with yearly examinations and ultrasound.

Monday, February 07, 2011

HMO Offers Poor and Outdated Thyroid Cancer Diagnosis and Therapy To One of Their Own Employees.

45 Y/O F had a isthmus nodule felt by her GI physician. An ultrasound done by a radiologist noted more nodules and one of them was biopsied. The results were suspicious, but she refused a lobectomy until an outside opinion that she had to pay for out of her own pocket.A second biopsy was even less helpful. After it they still wanted to operate. Finally, she heard about molecular classifiers that could tell if a suspicious biopsy was benign from my website. She was asymptomatic, had 2 firm nodules on my examination. My endocrine neck diagnostic ultrasound result was dramatic. She had 3 very suspicious nodules with microcalcifications, and the whole right side of her neck lateral to the biggest suspicious nodule was full of 5-10 mm abnormal lymph nodes with all the criteria for thyroid cancer spread to local regional lymph nodes. There was no mention of the nodes in the radiology report. Ultrasound techs are not taught endocrine neck changes, such as lymph nodes or parathyroid glands, and only report the thyroid. Many biopsies done by radiology departments are done by PAs, not by radiologists. The biopsy was inferior and only suggested suspicious, because they failed to do smears and only did thin prep. This is a poor substitute for smears, and caused the endocrinologist to recommend lobectomy instead of total thyroidectomy. She did not have a pre-op ultrasound lymph node evaluation before planning to send her for surgery. The second opinion changed everything. She needed a lymph node biopsy and needle washout test for cancer marker thyroglobulin. She will surely be positive for metastatic thyroid cancer in many nodes in her right neck. She now has a pre-op Thyroglobulin test which was not planned before the surgery. She will now have a total thyroidectomy, and central compartment node dissection, but will have a complete level 2-5 node dissection. This is called a Modified radical neck dissection MRND. She was on her way to have a second right neck surgery in one year, which they would have told her it was a recurrence, but it was there all the time BEFORE the first surgery, if she did not get her own second opinion. Please, do not go in for thyroid surgery without an outside second opinion. She would have had many surgeries, and multiple doses of radioiodine as a result of an initial evaluation and therapy plan which was flawed.

Wednesday, January 05, 2011

Save Unnecessary Thyroid Surgery with new Afirma Molecular Marker Test

Well thyroid patients heading to elective surgery for suspicious but not positive diagnosis of thyroid cancer, there is now a test, Afirma that can save you and 35,000 others this year from that surgery. It is a marker test with 143 genes, that if present on a 2 pass ultrasound guided FNA will give you a 96% chance it is benign. This is good enough to allow your thyroidologist to follow you yearly without surgery. The first soft opening 3 months of the year Veracyte Corp will do the test for you without out of pocket expense to you. They will bill your medicare,medical, and private insurance, and if there is any money due from you they will send you a letter telling you that you do not owe anything.
How does it work?
First, thyroid surgery is elective and is not an emergency no matter what the doctors tell you. Thyroid cancer is only 5% of all nodules, and it is slow growing to allow definite time for second opinions by experts.
There is time for more opinions, even when it is already on the surgery plan tommorow!
If the nodule was not called benign,or for sure cancer, then Afirma could be just the test you need to prevent a surgery, complications, and 12 weeks of recovery.

1. Call and make a consultation with me or a thyroidologist near you that offers Afirma.
2. Bring you FNA actual slides, or ask me to get them for you. If I decide the FNA is inadequate for diagnosis, which is a common occurence due to poor smearing and biopsy technique, i will repeat the biopsy and get the Afirma marker.
3. If the repeat FNA is benign or cancer I will discard the Afirma sample. However, if it is unclear as to the diagnosis,I will send the Afirma test to Veracyte. You get charged for my collection of the sample, and Veracyte will only bill your insurance if you have any. No out of pocket fees to you. If you have the 143 good genes the nodule is benign, and no surgery is needed. You can contact my office for more information on Afirma. 310-393-8860, fax 310-395-8147, or email dr.guttler@thyroid.com