Diagnosis of Cystic Fibrosis in Nonscreened Populations

Patrick R. Sosnay, Terry B. White, Philip M. Farrell, Clement L. Ren, Nico Derichs, Michelle Howenstine, Jerry A. Nick, Kris De Boeck

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective Although the majority of cases of cystic fibrosis (CF) are now diagnosed through newborn screening, there is still a need to standardize the diagnostic criteria for those diagnosed outside of the neonatal period. This is because newborn screening started relatively recently, it is not performed everywhere, and even for individuals who were screened, there is the possibility of a false negative. To limit irreversible organ pathology, a timely diagnosis of CF and institution of CF therapies can greatly benefit these patients. Study design Experts on CF diagnosis were convened at the 2015 CF Foundation Diagnosis Consensus Conference. The participants reviewed and discussed published works and instructive cases of CF diagnosis in individuals presenting with signs, symptoms, or a family history of CF. Through a modified Delphi methodology, several consensus statements were agreed upon. These consensus statements were updates of prior CF diagnosis conferences and recommendations. Results CF diagnosis in individuals outside of newborn screening relies on the clinical evidence and on evidence of CF transmembrane conductance regulator (CFTR) dysfunction. Clinical evidence can include typical organ pathologies seen in CF such as bronchiectasis or pancreatic insufficiency but often represent a broad range of severity including mild cases. CFTR dysfunction can be demonstrated using sweat chloride testing, CFTR molecular genetic analysis, or CFTR physiologic tests. On the basis of the large number of patients with bona fide CF currently followed in registries with sweat chloride levels between 30 and 40 mmol/L, the threshold considered “intermediate” was lowered from 40 mmol/L in the prior diagnostic guidelines to 30 mmol/L. The CF diagnosis was also discussed in the context of CFTR-related disorders in which CFTR dysfunction may be present, but the individual does not meet criteria for CF. Conclusions CF diagnosis remains a rare but important condition that can be diagnosed when characteristic clinical features are seen in an individual with demonstrated CFTR dysfunction.

Original languageEnglish (US)
Pages (from-to)S52-S57
JournalJournal of Pediatrics
Volume181
DOIs
StatePublished - Feb 1 2017

Fingerprint

Cystic Fibrosis
Population
Consensus
Sweat
Newborn Infant
Chlorides
Pathology
Exocrine Pancreatic Insufficiency
Cystic Fibrosis Transmembrane Conductance Regulator
Bronchiectasis
Signs and Symptoms
Registries
Molecular Biology
Guidelines

Keywords

  • adult diagnosis of CF
  • atypical CF
  • CFTR-related disorder
  • cystic fibrosis
  • genotype
  • mutation
  • penetrance
  • variant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Sosnay, P. R., White, T. B., Farrell, P. M., Ren, C. L., Derichs, N., Howenstine, M., ... De Boeck, K. (2017). Diagnosis of Cystic Fibrosis in Nonscreened Populations. Journal of Pediatrics, 181, S52-S57. https://doi.org/10.1016/j.jpeds.2016.09.068

Diagnosis of Cystic Fibrosis in Nonscreened Populations. / Sosnay, Patrick R.; White, Terry B.; Farrell, Philip M.; Ren, Clement L.; Derichs, Nico; Howenstine, Michelle; Nick, Jerry A.; De Boeck, Kris.

In: Journal of Pediatrics, Vol. 181, 01.02.2017, p. S52-S57.

Research output: Contribution to journalArticle

Sosnay, PR, White, TB, Farrell, PM, Ren, CL, Derichs, N, Howenstine, M, Nick, JA & De Boeck, K 2017, 'Diagnosis of Cystic Fibrosis in Nonscreened Populations', Journal of Pediatrics, vol. 181, pp. S52-S57. https://doi.org/10.1016/j.jpeds.2016.09.068
Sosnay, Patrick R. ; White, Terry B. ; Farrell, Philip M. ; Ren, Clement L. ; Derichs, Nico ; Howenstine, Michelle ; Nick, Jerry A. ; De Boeck, Kris. / Diagnosis of Cystic Fibrosis in Nonscreened Populations. In: Journal of Pediatrics. 2017 ; Vol. 181. pp. S52-S57.
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abstract = "Objective Although the majority of cases of cystic fibrosis (CF) are now diagnosed through newborn screening, there is still a need to standardize the diagnostic criteria for those diagnosed outside of the neonatal period. This is because newborn screening started relatively recently, it is not performed everywhere, and even for individuals who were screened, there is the possibility of a false negative. To limit irreversible organ pathology, a timely diagnosis of CF and institution of CF therapies can greatly benefit these patients. Study design Experts on CF diagnosis were convened at the 2015 CF Foundation Diagnosis Consensus Conference. The participants reviewed and discussed published works and instructive cases of CF diagnosis in individuals presenting with signs, symptoms, or a family history of CF. Through a modified Delphi methodology, several consensus statements were agreed upon. These consensus statements were updates of prior CF diagnosis conferences and recommendations. Results CF diagnosis in individuals outside of newborn screening relies on the clinical evidence and on evidence of CF transmembrane conductance regulator (CFTR) dysfunction. Clinical evidence can include typical organ pathologies seen in CF such as bronchiectasis or pancreatic insufficiency but often represent a broad range of severity including mild cases. CFTR dysfunction can be demonstrated using sweat chloride testing, CFTR molecular genetic analysis, or CFTR physiologic tests. On the basis of the large number of patients with bona fide CF currently followed in registries with sweat chloride levels between 30 and 40 mmol/L, the threshold considered “intermediate” was lowered from 40 mmol/L in the prior diagnostic guidelines to 30 mmol/L. The CF diagnosis was also discussed in the context of CFTR-related disorders in which CFTR dysfunction may be present, but the individual does not meet criteria for CF. Conclusions CF diagnosis remains a rare but important condition that can be diagnosed when characteristic clinical features are seen in an individual with demonstrated CFTR dysfunction.",
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AB - Objective Although the majority of cases of cystic fibrosis (CF) are now diagnosed through newborn screening, there is still a need to standardize the diagnostic criteria for those diagnosed outside of the neonatal period. This is because newborn screening started relatively recently, it is not performed everywhere, and even for individuals who were screened, there is the possibility of a false negative. To limit irreversible organ pathology, a timely diagnosis of CF and institution of CF therapies can greatly benefit these patients. Study design Experts on CF diagnosis were convened at the 2015 CF Foundation Diagnosis Consensus Conference. The participants reviewed and discussed published works and instructive cases of CF diagnosis in individuals presenting with signs, symptoms, or a family history of CF. Through a modified Delphi methodology, several consensus statements were agreed upon. These consensus statements were updates of prior CF diagnosis conferences and recommendations. Results CF diagnosis in individuals outside of newborn screening relies on the clinical evidence and on evidence of CF transmembrane conductance regulator (CFTR) dysfunction. Clinical evidence can include typical organ pathologies seen in CF such as bronchiectasis or pancreatic insufficiency but often represent a broad range of severity including mild cases. CFTR dysfunction can be demonstrated using sweat chloride testing, CFTR molecular genetic analysis, or CFTR physiologic tests. On the basis of the large number of patients with bona fide CF currently followed in registries with sweat chloride levels between 30 and 40 mmol/L, the threshold considered “intermediate” was lowered from 40 mmol/L in the prior diagnostic guidelines to 30 mmol/L. The CF diagnosis was also discussed in the context of CFTR-related disorders in which CFTR dysfunction may be present, but the individual does not meet criteria for CF. Conclusions CF diagnosis remains a rare but important condition that can be diagnosed when characteristic clinical features are seen in an individual with demonstrated CFTR dysfunction.

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