0
Lung Cancer |

Clinical Utility of a Bronchial Genomic Classifier: An Analysis of Invasive Procedure Utilization in the AEGIS Trials FREE TO VIEW

Anil Vachani, MD; Edward Parsons, PhD; J Ferguson; Duncan Whitney, PhD; Kate Porta; Michael Rosenbluth, PhD; Gerard Silvestri; Avrum Spira
Author and Funding Information

University of Pennsylvania, Philadelphia, PA


Chest. 2015;148(4_MeetingAbstracts):545A. doi:10.1378/chest.2270755
Text Size: A A A
Published online

Abstract

SESSION TITLE: Lung Cancer Diagnosis

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM

PURPOSE: Bronchoscopy is often the first diagnostic procedure performed in patients with pulmonary lesions suspicious for lung cancer however its sensitivity is imperfect. When malignancy is not found, physicians are left with the ambiguity of pursuing additional invasive diagnostic procedures or choosing imaging surveillance. In the previously reported AEGIS trials, a bronchial genomic classifier was clinically validated to identify patients at low risk for lung cancer when bronchoscopy was non-diagnostic. In this study, we modeled the clinical utility of the classifier to reduce unnecessary procedures by observing classifier results, additional procedure use, and disease diagnosis following non-diagnostic bronchoscopy in patients with suspicious pulmonary lesions.

METHODS: The AEGIS-1 and AEGIS-2 trials, two multicenter observational studies, prospectively collected normal appearing bronchial epithelial cells from a mainstem bronchus during the initial bronchoscopy for gene-expression analysis. Treating physicians assessed each patient’s pre-test probability of malignancy (POM) prior to bronchoscopy and were blinded to classifier results. Procedures subsequent to initial bronchoscopy were categorized as invasive (second bronchoscopy, trans-thoracic biopsy, or surgery) or non-invasive (imaging). Patients were followed for up to 12 months until a final diagnosis of lung cancer or benign disease was established.

RESULTS: 139 patients had an intermediate POM (10-60% probability) and 84% (117 of 139) had a bronchoscopy that was non-diagnostic for lung cancer. Additional invasive procedures were performed on 53% (62 of 117) of these patients, with 42% (26 of 62) undergoing more than one. Although 53% of patients (33 of 62) undergoing subsequent procedures were diagnosed with lung cancer, 47% (29 of 62) were diagnosed with benign lesions. Based on classifier performance, unnecessary procedures could have been avoided in 41% (12 of 29) of them. Among patients that did not undergo further invasive testing, surveillance imaging was performed in 38% by 3 months and in 69% by 12 months.

CONCLUSIONS: There are a considerable number of patients with benign disease that undergo avoidable procedures following a non-diagnostic bronchoscopy. The bronchial genomic classifier may lead to a reduction in invasive procedures in this population.

CLINICAL IMPLICATIONS: The classifier has the potential to substantially reduce avoidable procedures and their associated morbidity in patients undergoing an evaluation for suspicion of lung cancer.

DISCLOSURE: Anil Vachani: Grant monies (from industry related sources): Allegro Diagnostics, Consultant fee, speaker bureau, advisory committee, etc.: Allegro Diagnostics (scientific advisory board) - ended Sept 2014 Edward Parsons: Consultant fee, speaker bureau, advisory committee, etc.: Veracyte, Inc. J Ferguson: Grant monies (from industry related sources): Allegro Diagnostics, Consultant fee, speaker bureau, advisory committee, etc.: Allegro Diagnostics (scientific advisory board) - ended Sept 2014 Duncan Whitney: Employee: Veracyte, Inc. Kate Porta: Employee: Veracyte, Inc. Michael Rosenbluth: Employee: Veracyte, Inc. Gerard Silvestri: Grant monies (from industry related sources): Allegro Diagnostics, Consultant fee, speaker bureau, advisory committee, etc.: Allegro Diagnostics (scientific advisory board) - ended Sept 2014 Avrum Spira: Other: Founder, Allegro Diagnostics, Consultant fee, speaker bureau, advisory committee, etc.: Veracyte, Inc.

No Product/Research Disclosure Information


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543