ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Role of the Envisia Genomic Classifier in Establishing a Diagnosis of Idiopathic Pulmonary Fibrosis
Session Title
TP26 - TP026 DIAGNOSIS, ASSESSMENT, AND PROGNOSIS OF FIBROTIC ILD
Abstract
A1837 - Role of the Envisia Genomic Classifier in Establishing a Diagnosis of Idiopathic Pulmonary Fibrosis
Author Block: M. Abdalla1, C. Castellani2, M. Barash3, L. H. Santo Tomas4, R. J. Lipchik5, J. S. Kurman6, L. Sosa Lozano7, N. Rao8, V. Ramalingam9, B. S. Benn1; 1Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, United States, 2Medical College of Wisconsin, Wauwatosa, WI, United States, 3Medical College of Wisconsin, MILWAUKEE, WI, United States, 4Medical College of Wisconsin, Milwaukee, WI, United States, 5Med College Of Wisconsin, Milwaukee, WI, United States, 6Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, United States, 7Radiology, Medical College of Wisconsin, Milwaukee, WI, United States, 8Pathology, Aurora Clinical Laboratories/Great Lakes Pathologists, Aurora West Allis Medical Center, West Allis, WI, United States, 9Pulmonary and Critical Care, Medical College of Wisconsin Affiliated Hospitals, MILWAUKEE, WI, United States.
Introduction: Prior to treating idiopathic pulmonary fibrosis (IPF), establishing a usual interstitial pneumonia (UIP) diagnosis on imaging or pathology is essential. Because radiographic sensitivity is variable, lung biopsy is often required to establish a diagnosis. The Envisia Genomic Classifier (EGC) differentiates UIP from non-UIP pathology in transbronchial biopsies (TBB), potentially negating an invasive surgical lung biopsy (SLB). Transbronchial lung cryobiopsy (TBLC) is a minimally invasive alternative to SLB with a similar diagnostic yield for diagnosing IPF when radiologic assessment is equivocal. TBLC with EGC testing was recently implemented at our institution. We present an analysis of our experience.
Methods: Retrospective analysis of all TBLC+Envisia procedures performed between November 2019 and October 2020. Demographic data, pulmonary function test values, radiographic findings, and histology results were included. Procedures were performed under general anesthesia with an 8.0 endotracheal tube or larger.
Results: 18 patients underwent TBLC+EGC during the study period. Average age was 68.8+7.5 years with 72.2% of patients identifying as white, and a similar number of males (8, 44%) and females (10, 56%) and never (10, 56%) or former smokers (8, 45%). Average BMI was 31.4+5.9 kg/m2 and one patient (5%) required supplemental oxygen (2 LPM).
Hypertension (65%) and GERD (56%) were the most common comorbidities. 22% had a history of, or an active, malignancy, and 33% were on immunosuppressive therapy. Average FVC was 62+14%, FEV1 was 69.7+17.2%, and DLCO was 52.2+7.7%.
TBB was performed as per the EGC protocol in all cases. TBLC was performed in two ipsilateral lobes in 83.3% of procedures with three biopsies in different segmental branches performed in 67% (range 1-3). All samples contained alveolar tissue. Pneumothorax occurred in two (11%) patients, with neither requiring chest tube drainage. EGC was positive for UIP in five patients (28%) and negative in 13 patients (72%). After multidisciplinary conference, a clinical diagnosis of IPF was confirmed in three patients and ruled out in 15. Two patients positive for UIP by EGC were given an MDC clinical diagnosis of chronic hypersensitivity pneumonitis.
Specificity and sensitivity of EGC was 87% and 100%, respectively. Negative predictive value was 100% and positive predictive value was 60%.
Conclusion: Envisia showed utility in both confirming and ruling out a clinical diagnosis of IPF when introduced into an academic medical center. Clarifying criteria for utilization to inform post-test influence on diagnosis are essential.
Author Block: M. Abdalla1, C. Castellani2, M. Barash3, L. H. Santo Tomas4, R. J. Lipchik5, J. S. Kurman6, L. Sosa Lozano7, N. Rao8, V. Ramalingam9, B. S. Benn1; 1Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, United States, 2Medical College of Wisconsin, Wauwatosa, WI, United States, 3Medical College of Wisconsin, MILWAUKEE, WI, United States, 4Medical College of Wisconsin, Milwaukee, WI, United States, 5Med College Of Wisconsin, Milwaukee, WI, United States, 6Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, United States, 7Radiology, Medical College of Wisconsin, Milwaukee, WI, United States, 8Pathology, Aurora Clinical Laboratories/Great Lakes Pathologists, Aurora West Allis Medical Center, West Allis, WI, United States, 9Pulmonary and Critical Care, Medical College of Wisconsin Affiliated Hospitals, MILWAUKEE, WI, United States.
Introduction: Prior to treating idiopathic pulmonary fibrosis (IPF), establishing a usual interstitial pneumonia (UIP) diagnosis on imaging or pathology is essential. Because radiographic sensitivity is variable, lung biopsy is often required to establish a diagnosis. The Envisia Genomic Classifier (EGC) differentiates UIP from non-UIP pathology in transbronchial biopsies (TBB), potentially negating an invasive surgical lung biopsy (SLB). Transbronchial lung cryobiopsy (TBLC) is a minimally invasive alternative to SLB with a similar diagnostic yield for diagnosing IPF when radiologic assessment is equivocal. TBLC with EGC testing was recently implemented at our institution. We present an analysis of our experience.
Methods: Retrospective analysis of all TBLC+Envisia procedures performed between November 2019 and October 2020. Demographic data, pulmonary function test values, radiographic findings, and histology results were included. Procedures were performed under general anesthesia with an 8.0 endotracheal tube or larger.
Results: 18 patients underwent TBLC+EGC during the study period. Average age was 68.8+7.5 years with 72.2% of patients identifying as white, and a similar number of males (8, 44%) and females (10, 56%) and never (10, 56%) or former smokers (8, 45%). Average BMI was 31.4+5.9 kg/m2 and one patient (5%) required supplemental oxygen (2 LPM).
Hypertension (65%) and GERD (56%) were the most common comorbidities. 22% had a history of, or an active, malignancy, and 33% were on immunosuppressive therapy. Average FVC was 62+14%, FEV1 was 69.7+17.2%, and DLCO was 52.2+7.7%.
TBB was performed as per the EGC protocol in all cases. TBLC was performed in two ipsilateral lobes in 83.3% of procedures with three biopsies in different segmental branches performed in 67% (range 1-3). All samples contained alveolar tissue. Pneumothorax occurred in two (11%) patients, with neither requiring chest tube drainage. EGC was positive for UIP in five patients (28%) and negative in 13 patients (72%). After multidisciplinary conference, a clinical diagnosis of IPF was confirmed in three patients and ruled out in 15. Two patients positive for UIP by EGC were given an MDC clinical diagnosis of chronic hypersensitivity pneumonitis.
Specificity and sensitivity of EGC was 87% and 100%, respectively. Negative predictive value was 100% and positive predictive value was 60%.
Conclusion: Envisia showed utility in both confirming and ruling out a clinical diagnosis of IPF when introduced into an academic medical center. Clarifying criteria for utilization to inform post-test influence on diagnosis are essential.
