The impact of the envisia genomic classifier in the diagnosis and management of patients with idiopathic pulmonary fibrosis
Rationale: The diagnosis of idiopathic pulmonary fibrosis (IPF) remains challenging and can result in delayed or misdiagnosis. IPF diagnosis is based on the presence of either a radiographic or histologic usual interstitial pneumonia (UIP) pattern in the absence of an identifiable etiology. The Envi...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2022
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| In: |
Annals of the American Thoracic Society
Year: 2022, Volume: 19, Issue: 6, Pages: 916-924 |
| ISSN: | 2325-6621 |
| DOI: | 10.1513/AnnalsATS.202107-897OC |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1513/AnnalsATS.202107-897OC Verlag, lizenzpflichtig, Volltext: https://www.atsjournals.org/doi/10.1513/AnnalsATS.202107-897OC 
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| Author Notes: | Joseph A. Lasky, Amy Case, Avraham Unterman, Michael Kreuter, Mary Beth Scholand, Sachin Chaudhary, Lori R. Lofaro, Marla Johnson, Jing Huang, Sangeeta M. Bhorade, Giulia C. Kennedy |
| Summary: | Rationale: The diagnosis of idiopathic pulmonary fibrosis (IPF) remains challenging and can result in delayed or misdiagnosis. IPF diagnosis is based on the presence of either a radiographic or histologic usual interstitial pneumonia (UIP) pattern in the absence of an identifiable etiology. The Envisia Genomic Classifier is a clinically validated molecular diagnostic test that identifies UIP in transbronchial biopsies. - - Objectives: To determine the impact of the Envisia Genomic Classifier on physicians’ clinical decision-making in the diagnosis and management of IPF. - - Methods: This prospective randomized decision impact survey was designed to test the hypothesis that including an Envisia UIP-positive result will increase IPF diagnoses, diagnostic confidence, and the recommendation for antifibrotic therapy. The survey included patients from the BRAVE (Bronchial Sample Collection for a Novel Genomic Test) study who had a high-resolution computed tomographic scan without a typical UIP pattern, an Envisia UIP-positive result, and a final diagnosis of IPF by multidisciplinary team discussion. Each case was presented in three different formats: a pre-post cohort, where each case is presented initially without and then with Envisia, and two independent cohorts, where each case is presented without and with Envisia, respectively. - - Results: U.S.-based pulmonologists from community and academic centers in geographically diverse practices were approached for inclusion in this study. 103 (65%) U.S.-based pulmonologists met the inclusion criteria and provided 605 case reviews of 11 patient cases. The number of IPF diagnoses increased with Envisia by an absolute difference of 39% from 47 (30%) before Envisia to 107 (69%) after Envisia in the pre-post cohort and by 13% in the independent cohorts. High confidence (⩾90%) of interstitial lung disease diagnoses was more commonly seen with Envisia in both the pre-post cohort and in the independent cohorts. Recommendation for antifibrotic treatment increased with Envisia by an absolute difference of 36% from 15 (10%) before Envisia to 72 (46.4%) after Envisia in the pre-post cohort and by 11% in the independent cohorts. - - Conclusions: This decision impact survey suggests the clinical utility of the Envisia Classifier by demonstrating a significant increase in IPF diagnoses, diagnostic confidence, and recommendation for antifibrotic therapies to assist physicians in effectively managing patients to improve outcomes of patients with IPF. |
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| Item Description: | Gesehen am 28.02.2023 |
| Physical Description: | Online Resource |
| ISSN: | 2325-6621 |
| DOI: | 10.1513/AnnalsATS.202107-897OC |