Optimising clinical care through CDH1-specific germline variant curation: improvement of clinical assertions and updated curation guidelines

Luo, X; Maciaszek, JL; Thompson, BA; Leong, HS; Dixon, K; Sousa, S; Anderson, M; Roberts, ME; Lee, K; Spurdle, AB; Mensenkamp, AR; Brannan, T; Pardo, C; Zhang, L; Pesaran, T; Wei, S; Fasaye, GA; Kesserwan, C; Shirts, BH; Davis, JL; Oliveira, C; Plon, SE; Schrader, KA; Karam, R; ClinGen CDH1 Variant Curation Expert Panel

Author(s): Luo, X; Maciaszek, JL; Thompson, BA; Leong, HS; Dixon, K; Sousa, S; Anderson, M; Roberts, ME; Lee, K; Spurdle, AB; Mensenkamp, AR; Brannan, T; Pardo, C; Zhang, L; Pesaran, T; Wei, S; Fasaye, GA; Kesserwan, C; Shirts, BH; Davis, JL; Oliveira, C; Plon, SE; Schrader, KA; Karam, R; ClinGen CDH1 Variant Curation Expert Panel;
Details: Publication Year 2023-06,Volume 60,Issue #6,Page 568-575
Journal Title: Journal of Medical Genetics
Publication Type: Research article
Abstract: BACKGROUND: Germline pathogenic variants in CDH1 are associated with increased risk of diffuse gastric cancer and lobular breast cancer. Risk reduction strategies include consideration of prophylactic surgery, thereby making accurate interpretation of germline CDH1 variants critical for physicians deciding on these procedures. The Clinical Genome Resource (ClinGen) CDH1 Variant Curation Expert Panel (VCEP) developed specifications for CDH1 variant curation with a goal to resolve variants of uncertain significance (VUS) and with ClinVar conflicting interpretations and continues to update these specifications. METHODS: CDH1 variant classification specifications were modified based on updated genetic testing clinical criteria, new recommendations from ClinGen and expert knowledge from ongoing CDH1 variant curations. The CDH1 VCEP reviewed 273 variants using updated CDH1 specifications and incorporated published and unpublished data provided by diagnostic laboratories. RESULTS: Updated CDH1-specific interpretation guidelines include 11 major modifications since the initial specifications from 2018. Using the refined guidelines, 97% (36 of 37) of variants with ClinVar conflicting interpretations were resolved to benign, likely benign, likely pathogenic or pathogenic, and 35% (15 of 43) of VUS were resolved to benign or likely benign. Overall, 88% (239 of 273) of curated variants had non-VUS classifications. To date, variants classified as pathogenic are either nonsense, frameshift, splicing, or affecting the translation initiation codon, and the only missense variants classified as pathogenic or likely pathogenic have been shown to affect splicing. CONCLUSIONS: The development and evolution of CDH1-specific criteria by the expert panel resulted in decreased uncertain and conflicting interpretations of variants in this clinically actionable gene, which can ultimately lead to more effective clinical management recommendations.
Publisher: BMJ
Keywords: Humans; *Genetic Variation; Genetic Testing; Germ-Line Mutation/genetics; *Stomach Neoplasms/genetics; Germ Cells; Antigens, CD/genetics; Cadherins/genetics; Gastrointestinal Diseases; Genetic Predisposition to Disease; Genetic Variation; Genetics, Medical
Department(s): Pathology
PubMed ID: 36600593
Publisher's Version: https://doi.org/10.1136/jmg-2022-108807
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-09-12 01:58:43

Last Modified: 2023-09-12 01:59:21