Richeldi, Luca, Scholand, Mary Beth, Lynch, David A., Colby, Thomas, V, Myers, Jeffrey L., Groshong, Steve D., Chung, Jonathan H., Benzaquen, Sadia, Nathan, Steven D., Davis, J. Russell, Schmidt, Shelley L., Hagmeyer, Lars, Sonetti, David, Hetzel, Jurgen, Criner, Gerard J., Case, Amy H., Ramaswamy, Murali, Calero, Karel, Gauhar, Umair A., Patel, Nina M., Lancaster, Lisa, Choi, Yoonha, Pankratz, Daniel G., Walsh, P. Sean, Lofaro, Lori R., Huang, Jing, Bhorade, Sangeeta M., Kennedy, Giulia C., Martinez, Fernando J. and Raghu, Ganesh (2021). Utility of a Molecular Classifier as a Complement to High-Resolution Computed Tomography to Identify Usual Interstitial Pneumonia. Am. J. Respir. Crit. Care Med., 203 (2). S. 211 - 221. NEW YORK: AMER THORACIC SOC. ISSN 1535-4970

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Abstract

Rationale: Usual interstitial pneumonia (UIP) is the defining morphology of idiopathic pulmonary fibrosis (IPF). Guidelines for IPF diagnosis conditionally recommend surgical lung biopsy for histopathology diagnosis of UIP when radiology and clinical context are not definitive. A molecular diagnosis of UIP in transbronchial lung biopsy, the Envisia Genomic Classifier, accurately predicted histopathologic UIP. Objectives: We evaluated the combined accuracy of the Envisia Genomic Classifier and local radiology in the detection of UIP pattern. Methods: Ninety-six patients who had diagnostic lung pathology as well as a transbronchial lung biopsy for molecular testing with Envisia Genomic Classifier were included in this analysis. The classifier results were scored against reference pathology. UIP identified on high-resolution computed tomography (HRCT) as documented by features in local radiologists' reports was compared with histopathology. Measurements and Main Results: In 96 patients, the Envisia Classifier achieved a specificity of 92.1% (confidence interval [CI],78.6-98.3%) and a sensitivity of 60.3% (CI, 46.6-73.0%) for histology-proven UIP pattern. Local radiologists identified UIP in 18 of 53 patients with UIP histopathology, with a sensitivity of 34.0% (CI, 21.5-48.3%) and a specificity of 96.9% (CI, 83.8-100%). In conjunction with HRCT patterns of UIP, the Envisia Classifier results identified 24 additional patients with UIP (sensitivity 79.2%; specificity 90.6%). Conclusions: In 96 patients with suspected interstitial lung disease, the Envisia Genomic Classifier identified UIP regardless of HRCT pattern. These results suggest that recognition of a UIP pattern by the Envisia Genomic Classifier combined with HRCT and clinical factors in a multidisciplinary discussion may assist clinicians in making an interstitial lung disease (especially IPF) diagnosis without the need for a surgical lung biopsy.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Richeldi, LucaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Scholand, Mary BethUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lynch, David A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Colby, Thomas, VUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Myers, Jeffrey L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Groshong, Steve D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chung, Jonathan H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Benzaquen, SadiaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nathan, Steven D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Davis, J. RussellUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmidt, Shelley L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagmeyer, LarsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sonetti, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hetzel, JurgenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Criner, Gerard J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Case, Amy H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ramaswamy, MuraliUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Calero, KarelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gauhar, Umair A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patel, Nina M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lancaster, LisaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Choi, YoonhaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pankratz, Daniel G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Walsh, P. SeanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lofaro, Lori R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huang, JingUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bhorade, Sangeeta M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kennedy, Giulia C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Martinez, Fernando J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Raghu, GaneshUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-606425
DOI: 10.1164/rccm.202003-0877OC
Journal or Publication Title: Am. J. Respir. Crit. Care Med.
Volume: 203
Number: 2
Page Range: S. 211 - 221
Date: 2021
Publisher: AMER THORACIC SOC
Place of Publication: NEW YORK
ISSN: 1535-4970
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
IDIOPATHIC PULMONARY-FIBROSIS; LUNG-DISEASE; DIAGNOSIS; PATHOLOGISTS; GUIDELINE; BIOPSYMultiple languages
Critical Care Medicine; Respiratory SystemMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60642

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