Lung Cancer: Lung Cancer Screening in the Real World |

Impact of a Bronchial Genomic Classifier for Lung Cancer on Reducing Invasive Procedure Recommendations Across Variations in Pulmonology Practices FREE TO VIEW

Ryan Van Wert; J Ferguson; Yoonha Choi; Michael Rosenbluth; Avrum Spira
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Stanford University, Stanford, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):732A. doi:10.1016/j.chest.2016.08.827
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SESSION TITLE: Lung Cancer Screening in the Real World

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Bronchoscopy is frequently used for the evaluation of suspicious pulmonary lesions, but its sensitivity for detecting lung cancer is limited. Recently, a bronchial genomic classifier (Percepta®) was validated to improve the sensitivity of bronchoscopy for lung cancer detection, demonstrating a high sensitivity and negative predictive value among patients at low to intermediate risk for lung cancer with an inconclusive bronchoscopy. Such a classifier may reduce the rate that physicians recommend more invasive testing among patients with an inconclusive bronchoscopy. The objective for this study was to determine if variations in physician practice patterns influence the impact of a genomic classifier result that down-classifies a patient from intermediate risk to low risk (<10%) for lung cancer.

METHODS: We conducted a randomized, prospective, decision impact survey assessing pulmonologist recommendations in patients undergoing workup for lung cancer who had an inconclusive bronchoscopy. Cases with an intermediate pretest risk for lung cancer were selected from the AEGIS trials and presented in a randomized fashion to pulmonologists either with or without the patient’s classifier result. To test whether there were differences in decision making between different physician subgroups, logistic regression models were built to assess the effect of low risk (negative) classifier results across each group.

RESULTS: 202 physicians provided 1,523 case evaluations on 36 patients. Invasive procedure recommendations were reduced from 57% without the classifier result to 18% with a low risk (negative) classifier result (p < 0.001). The effect on physician behavior of the classifier was similar between pulmonologist types (interventional pulmonologist vs other, p = 0.46), experience with navigational bronchoscopy (p = 0.28), and bronchoscopy volume (p = 0.42). There were no significant differences seen between geographic regions (p = 0.52-0.86). Lastly, the effect of the classifier was similar whether the physician was at an academic medical center (AMC) or not (p = 0.17), though those who were at an AMC tended to be more aggressive with recommending additional biopsies when classifier results were not shown (68% vs 54%).

CONCLUSIONS: These results suggest that a bronchial genomic classifier has the capacity to change decision making in patients suspected of lung cancer with an inconclusive bronchoscopy. Low risk (negative) results

CLINICAL IMPLICATIONS: Our study suggests that a bronchial genomic classifier may improve the care of patients undergoing bronchoscopy for suspect lung cancer by reducing additional invasive procedures in patients with low risk (negative) test results across a variety of physician practice patterns.

DISCLOSURE: Ryan Van Wert: Consultant fee, speaker bureau, advisory committee, etc.: Consultant Yoonha Choi: Employee: Employee of Veracyte, Inc. Michael Rosenbluth: Employee: Employee of Veracyte, Inc. Avrum Spira: Consultant fee, speaker bureau, advisory committee, etc.: Consultant to Veracyte, Inc. The following authors have nothing to disclose: J Ferguson

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