Clinical Validity of a Gene Expression Signature in Diagnostically Uncertain Neoplasms

• DOI: 10.2217/pme-2020-0048
• Publication Date: 2020-06-17T15:37:59Z
• Authors: Loren E Clarke; Brent Mabey; Darl D Flake II; Stephanie Meek; David S Cassarino; Lyn M Duncan; Whitney A High; Karl M Napekoski; Victor G Prieto; Michael T Tetzlaff; Patricia Vitale; David E Elder
• Keywords: Adult; Male; 2. Zero hunger; Reverse Transcriptase Polymerase Chain Reaction; Gene Expression Profiling; Middle Aged; Sensitivity and Specificity; 3. Good health; Gene Expression Regulation, Neoplastic; 03 medical and health sciences; 0302 clinical medicine; Case-Control Studies; Biomarkers, Tumor; Humans; Female; Gene Regulatory Networks; Melanoma; Early Detection of Cancer; Aged; Retrospective Studies

Aim: Evaluate the accuracy of a 23-gene expression signature in differentiating benign nevi from melanoma by comparing test results with clinical outcomes. Materials & methods: Seven dermatopathologists blinded to gene expression test results and clinical outcomes examined 181 lesions to identify diagnostically uncertain cases. Participants independently recorded diagnoses and responses to questions quantifying diagnostic certainty. Test accuracy was determined through comparison with clinical outcomes (sensitivity and percent negative agreement). Results: Overall, 125 cases fulfilled criteria for diagnostic uncertainty (69.1%; 95% CI: 61.8-75.7%). Test sensitivity and percent negative agreement in these cases were 90.4% (95% CI: 79.0-96.8%) and 95.5% (95% CI: 87.3-99.1%), respectively. Conclusion: The 23-gene expression signature has high diagnostic accuracy in diagnostically uncertain cases when evaluated against clinical outcomes.