IMPACT OF PERCEPTA BRONCHIAL GENOMIC CLASSIFIER ON LUNG NODULE MANAGEMENT AT AN ACADEMIC MEDICAL CENTER

Abstract

TOPIC: Lung Pathology TYPE: Late Breaking PURPOSE: A nondiagnostic bronchoscopic biopsy of a pulmonary nodule presents a challenging clinical dilemma. Risk of alternative biopsy strategies must be weighed against the risk of a delayed diagnosis from continued surveillance. The Percepta Genomic Sequencing Classifier (GSC) is a gene expression classifier that utilizes whole transcriptome RNA sequencing from bronchial brushings to risk stratify lung nodules by both down classifying risk of malignancy (ROM) with high sensitivity, as well as up classifying ROM with high specificity in former or current smokers. We report our experience with the Percepta GSC in reclassifying the pretest ROM in both smokers and non-smokers. METHODS: This is an IRB approved single center retrospective review of all patients for which Percepta GSC was utilized following a nondiagnostic electromagnetic navigational bronchoscopy (ENB) from November 2018 to December 2020. Data collected included nodule characteristics, smoking history, pre- and post-test ROM, additional invasive and non-invasive testing, complications, and final diagnosis. The proportion of the patients who were re-classified and final outcomes were recorded. RESULTS: Percepta GSC was utilized in 29 of 204 ENB cases during the study period. 55% of Percepta GSC subjects were male, and 83% were former or current smokers. Five (17%) patients were never smokers. Mean nodule size was 2.5 cm (range: 0.8-8.0 cm). In the smoker cohort, 58% and 42% of patients had intermediate and high pretest ROM, respectively. 31% of patients were reclassified with Percepta GSC. In smokers with an intermediate pretest ROM, 28% were reclassified (2 each into the low and high-risk categories). In the smoker cohort with high pretest ROM, 30% were reclassified and all were up classified to the very high ROM category. In the intermediate pretest ROM category in non-smokers, 40% were reclassified, and all were down-classified into the low-risk category. Four patients (14%) (2 from each cohort) were reclassified to low risk from intermediate risk. None of them required any additional invasive evaluation. Two of them demonstrated stability on surveillance imaging, one was confirmed benign on a subsequent biopsy, and one was diagnosed with blastomycosis. Five patients were up classified, and all of them were in the smoker cohort. Two of these five were diagnosed with pulmonary malignancy after further testing. CONCLUSIONS: Approximately one-third of patients were reclassified by the Percepta GSC after a nondiagnostic bronchoscopy. Percepta GSC is a valuable addition to the pulmonary nodule management algorithm. CLINICAL IMPLICATIONS: Down classification of ROM with the Percepta GSC classifier helps low risk patients avoid further invasive diagnostic evaluation. Up classification of nodules with the Percepta GSC should warrant further evaluation for malignancy. DISCLOSURES: No relevant relationships by Mohammed Abdalla, source=Web Response No relevant relationships by Bryan Benn, source=Web Response No relevant relationships by Chinmay Jani, source=Web Response Speaker/Speaker's Bureau relationship with Biodesix Please note: 2018 - present Added 05/23/2021 by Jonathan Kurman, source=Web Response, value=Honoraria Consultant relationship with Level Ex Please note: 2018 - present Added 05/23/2021 by Jonathan Kurman, source=Web Response, value=Consulting fee Consultant relationship with Medtronic Please note: 2020 - present Added 05/23/2021 by Jonathan Kurman, source=Web Response, value=Consulting fee educational courses relationship with Pinnacle Biologics Please note: 2020 - present Added 05/23/2021 by Jonathan Kurman, source=Web Response, value=Travel Consultant relationship with Boston Scientific Please note: 2021 - present Added 05/23/2021 by Jonathan Kurman, source=Web Response, value=Consulting fee Consultant relationship with Cook Medical Please note: 2021 - present Added 05/22/2021 by Jonathan Kurman, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Erbe Please note: 2021 - present Added 05/22/2021 by Jonathan Kurman, source=Web Response, value=Honoraria research panel relationship with Intuitive Please note: 2020 - present Added 05/22/2021 by Jonathan Kurman, source=Web Response, value=Honoraria Consultant relationship with Pulmonx Please note: 2020 - present Added 05/22/2021 by Jonathan Kurman, source=Web Response, value=Consulting fee No relevant relationships by Harpreet Singh, source=Web Response