Sunday, November 6, 2016

An Advance in Diagnosing IPF

Veracyte Announces Launch of Envisia™ Genomic Classifier for Improved Diagnosis of Idiopathic Pulmonary Fibrosis at CHEST Annual Meeting 2016.

This is a very large step forward in the diagnostics process of identifying IPF.  From the press release:
Each year in the United States and Europe, up to 200,000 patients are suspected of having an interstitial lung disease (ILD), including IPF, which is among the most common and most deadly of these lung-scarring diseases. IPF is notoriously difficult to diagnose, often leading to treatment delays, repeated misdiagnoses, patient distress and added healthcare expense...  
The Envisia classifier uses machine learning coupled with powerful, deep RNA sequencing to detect the presence or absence of usual interstitial pneumonia (UIP), a classic diagnostic pattern that is essential for the diagnosis of IPF. Physicians routinely use high-resolution CT imaging (HRCT) to identify UIP, but this approach frequently provides inconclusive results, leading many patients to undergo surgery to secure a more definitive diagnosis using surgical histopathology. Veracyte scientists trained the Envisia classifier to differentiate UIP from non-UIP on patient samples obtained through less-invasive outpatient bronchoscopy.
The "surgical histopathology" mentioned above is a VATS lung biopsy (video-assisted thoracoscopic surgery) . The VATS is a fairly invasive procedure that comes with a nice list of potential complications.

My Dad underwent a VATS biopsy and never really recovered from the procedure.  Dad was not a good candidate for a VATS in the first place.  He was 70 years old and had some pretty serious heart issues.  The results of a biopsy would not have made any difference in his treatment plan as there were no effective IPF treatments at the time.  It may have gotten him into a clinical trial, but that's not very likely due to his heart issues.  I honestly believe that his pulmo requested the procedure out of curiosity and not as a tool to help my father.

That being said, and even with my Dad's example fresh in my mind, I made the decision to have a VATS biopsy.  There were lots of differences between my case and Dads.  I was 50 or so and felt that an affirmation of IPF via biopsy would help get me into one of the clinical trials that were being held at the time.  As someone who just likes to have all the information that I can, I'm not unhappy that I had the procedure even though I never did make it into a drug trial.  My fibrosis had progressed beyond what most trials were accepting.

I'm mentioning all this just to illustrate that the VATS is an invasive procedure that does come with a good deal of pain.  An accurate diagnostics tool that would replace the VATS with an outpatient procedure is a huge step forward. It will save the patients pain and minimize the risk of complications, save everyone a lot of money, and open up hospital beds. A win-win-win all the way around.

If you or a loved one are considering a VATS biopsy, Dr. Lederer has an article that will help with the question of Should I undergo a lung biopsy to diagnose my pulmonary fibrosis? It is a very personal decision that isn't to be taken lightly.

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