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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Cryobiopsy and Genomic Classifier (Envisia) in the Diagnosis of Usual Interstitial Pneumonia
Session Title
TP107 - TP107 PULMONARY FIBROSIS: MOLECULAR AND CELLULAR MECHANISMS
Abstract
A4236 - Cryobiopsy and Genomic Classifier (Envisia) in the Diagnosis of Usual Interstitial Pneumonia
Author Block: R. Ronaghi1, M. Carroll2, T. He3, C. Oberg4, C. L. Channick5, I. Susanto6, S. S. Oh7; 1Pulmonary, UCLA, Torrance, CA, United States, 2Pulmonary, UCLA, Los Angeles, CA, United States, 3David Geffen School of Medicine at UCLA, Santa Monica, CA, United States, 4Interventional Pulmonology, UCLA, Torrance, CA, United States, 5UCLA Medical Center, Los Angeles, CA, United States, 6UCLA Sch of Med, Santa Monica, CA, United States, 7Pulmonary & Critical Care, UCLA - Interventional Pulmonology, Santa Monica, CA, United States.
Title: Introduction:Interstitial lung disease (ILD) is a group of disorders which cause progressive scarring of lung tissue. Diagnosis of ILD is usually via imaging, history and pathological diagnosis. Because imaging and history can sometimes be non-diagnostic, pathological confirmation may be necessary. Pathological samples are usually acquired via a wedge resection using video assisted thoracic surgery (VATS). Usual interstitial pneumonia (UIP) may be diagnosed by typical radiographic findings or by histopathology. Traditional transbronchial biopsies are small with a low diagnostic yield for UIP. Larger surgical biopsies are associated with a relatively higher morbidity, mortality, and a hospital stay. Transbronchial lung cryobiopsy (TBLC) offers a less invasive alternative but have shown diagnostic yields ranging from 70-90% compared with VATS biopsy with variable complication rates. Herein we describe our experience with the Envisia® genomic classifier when combined with transbronchial lung cryobiopsy for the diagnosis of ILD. Methods:This was a retrospective study looking at all cryobiopsy cases done at the University of California, Los Angeles Medical Center from 2017-2020 who also had Envisia done at the time of the procedure. Chart review revealed a total of 41 patients who met criteria. Charts were then reviewed and data was collected then analyzed. Patients were followed for at least 6 months to ensure diagnostic accuracy and to determine response to treatment and whether any further procedures were needed to determine the final diagnosis. Data were then analyzed using SPSS, and where appropriate t-test was used for analysis. Results:A total of 41 patients were in the study. Demographics are shown in table 1. Table 2 lists the diagnosis of each subject based on TBLC and Envisia®. The sensitivity of Envisia® for UIP was 87% with a specificity of 92%. The overall diagnostic yield of TBLC combined with Envisia® was 98% for UIP. There was no pneumothorax, major bleeding or unplanned hospitalization. No subjects underwent further biopsy for diagnosis after undergoing TBLC with Envisia® testing. Discussion:UIP portends a poor prognosis and radiographically atypical UIP can be challenging to diagnose. TBLC is a less invasive outpatient biopsy for the evaluation of ILD. However, diagnostic yield from TBLC has varied from 70-90% with variable complication rates. The addition of Envisia® to TBLC increased our diagnostic yield by 8% to an overall diagnostic yield of 98%. Our small case series suggests that the addition of Envisia to cryobiopsy is safe and increases the diagnostic yield for both UIP and non-UIP ILD.
Author Block: R. Ronaghi1, M. Carroll2, T. He3, C. Oberg4, C. L. Channick5, I. Susanto6, S. S. Oh7; 1Pulmonary, UCLA, Torrance, CA, United States, 2Pulmonary, UCLA, Los Angeles, CA, United States, 3David Geffen School of Medicine at UCLA, Santa Monica, CA, United States, 4Interventional Pulmonology, UCLA, Torrance, CA, United States, 5UCLA Medical Center, Los Angeles, CA, United States, 6UCLA Sch of Med, Santa Monica, CA, United States, 7Pulmonary & Critical Care, UCLA - Interventional Pulmonology, Santa Monica, CA, United States.
Title: Introduction:Interstitial lung disease (ILD) is a group of disorders which cause progressive scarring of lung tissue. Diagnosis of ILD is usually via imaging, history and pathological diagnosis. Because imaging and history can sometimes be non-diagnostic, pathological confirmation may be necessary. Pathological samples are usually acquired via a wedge resection using video assisted thoracic surgery (VATS). Usual interstitial pneumonia (UIP) may be diagnosed by typical radiographic findings or by histopathology. Traditional transbronchial biopsies are small with a low diagnostic yield for UIP. Larger surgical biopsies are associated with a relatively higher morbidity, mortality, and a hospital stay. Transbronchial lung cryobiopsy (TBLC) offers a less invasive alternative but have shown diagnostic yields ranging from 70-90% compared with VATS biopsy with variable complication rates. Herein we describe our experience with the Envisia® genomic classifier when combined with transbronchial lung cryobiopsy for the diagnosis of ILD. Methods:This was a retrospective study looking at all cryobiopsy cases done at the University of California, Los Angeles Medical Center from 2017-2020 who also had Envisia done at the time of the procedure. Chart review revealed a total of 41 patients who met criteria. Charts were then reviewed and data was collected then analyzed. Patients were followed for at least 6 months to ensure diagnostic accuracy and to determine response to treatment and whether any further procedures were needed to determine the final diagnosis. Data were then analyzed using SPSS, and where appropriate t-test was used for analysis. Results:A total of 41 patients were in the study. Demographics are shown in table 1. Table 2 lists the diagnosis of each subject based on TBLC and Envisia®. The sensitivity of Envisia® for UIP was 87% with a specificity of 92%. The overall diagnostic yield of TBLC combined with Envisia® was 98% for UIP. There was no pneumothorax, major bleeding or unplanned hospitalization. No subjects underwent further biopsy for diagnosis after undergoing TBLC with Envisia® testing. Discussion:UIP portends a poor prognosis and radiographically atypical UIP can be challenging to diagnose. TBLC is a less invasive outpatient biopsy for the evaluation of ILD. However, diagnostic yield from TBLC has varied from 70-90% with variable complication rates. The addition of Envisia® to TBLC increased our diagnostic yield by 8% to an overall diagnostic yield of 98%. Our small case series suggests that the addition of Envisia to cryobiopsy is safe and increases the diagnostic yield for both UIP and non-UIP ILD.
