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Nussbaumer M, Kieninger E, Tschanz SA, Savas ST, Casaulta C, Goutaki M, Blanchon S, Jung A, Regamey N, Kuehni CE, Latzin P, Müller L. Diagnosis of primary ciliary dyskinesia: discrepancy according to different algorithms. ERJ Open Res 2021; 7:00353-2021. [PMID: 34729370 PMCID: PMC8558472 DOI: 10.1183/23120541.00353-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
Background Diagnosis of primary ciliary dyskinesia (PCD) is challenging since there is no gold standard test. The European Respiratory (ERS) and American Thoracic (ATS) Societies developed evidence-based diagnostic guidelines with considerable differences. Objective We aimed to compare the algorithms published by the ERS and the ATS with each other and with our own PCD-UNIBE algorithm in a clinical setting. Our algorithm is similar to the ERS algorithm with additional immunofluorescence staining. Agreement (Cohen's κ) and concordance between the three algorithms were assessed in patients with suspicion of PCD referred to our diagnostic centre. Results In 46 out of 54 patients (85%) the final diagnosis was concordant between all three algorithms (30 PCD negative, 16 PCD positive). In eight patients (15%) PCD diagnosis differed between the algorithms. Five patients (9%) were diagnosed as PCD only by the ATS, one (2%) only by the ERS and PCD-UNIBE, one (2%) only by the ATS and PCD-UNIBE, and one (2%) only by the PCD-UNIBE algorithm. Agreement was substantial between the ERS and the ATS (κ=0.72, 95% CI 0.53–0.92) and the ATS and the PCD-UNIBE (κ=0.73, 95% CI 0.53–0.92) and almost perfect between the ERS and the PCD-UNIBE algorithms (κ=0.92, 95% CI 0.80–1.00). Conclusion The different diagnostic algorithms lead to a contradictory diagnosis in a considerable proportion of patients. Thus, an updated, internationally harmonised and standardised PCD diagnostic algorithm is needed to improve diagnostics for these discordant cases. There is no gold standard test for diagnosing PCD. The use of existing diagnostic algorithms leads to contradicting results in many patients (15% in this study). Thus, an updated and internationally harmonised diagnostic guideline is needed.https://bit.ly/2U19Vvq
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Affiliation(s)
- Mirjam Nussbaumer
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | | | - Sibel T Savas
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sylvain Blanchon
- Dept Woman-Mother-Child, Service of Pediatrics, Pediatric Pulmonology and Cystic Fibrosis Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andreas Jung
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Claudia E Kuehni
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Loretta Müller
- Division of Paediatric Respiratory Medicine and Allergology, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Dept of BioMedical Research (DBMR), University of Bern, Bern, Switzerland
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Müller L, Savas ST, Tschanz SA, Stokes A, Escher A, Nussbaumer M, Bullo M, Kuehni CE, Blanchon S, Jung A, Regamey N, Haenni B, Schneiter M, Ingold J, Kieninger E, Casaulta C, Latzin P. A Comprehensive Approach for the Diagnosis of Primary Ciliary Dyskinesia-Experiences from the First 100 Patients of the PCD-UNIBE Diagnostic Center. Diagnostics (Basel) 2021; 11:1540. [PMID: 34573882 PMCID: PMC8466881 DOI: 10.3390/diagnostics11091540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disease characterized by dyskinetic cilia. Respiratory symptoms usually start at birth. The lack of diagnostic gold standard tests is challenging, as PCD diagnostics requires different methods with high expertise. We founded PCD-UNIBE as the first comprehensive PCD diagnostic center in Switzerland. Our diagnostic approach includes nasal brushing and cell culture with analysis of ciliary motility via high-speed-videomicroscopy (HSVM) and immunofluorescence labeling (IF) of structural proteins. Selected patients undergo electron microscopy (TEM) of ciliary ultrastructure and genetics. We report here on the first 100 patients assessed by PCD-UNIBE. All patients received HSVM fresh, IF, and cell culture (success rate of 90%). We repeated the HSVM with cell cultures and conducted TEM in 30 patients and genetics in 31 patients. Results from cell cultures were much clearer compared to fresh samples. For 80 patients, we found no evidence of PCD, 17 were diagnosed with PCD, two remained inconclusive, and one case is ongoing. HSVM was diagnostic in 12, IF in 14, TEM in five and genetics in 11 cases. None of the methods was able to diagnose all 17 PCD cases, highlighting that a comprehensive approach is essential for an accurate diagnosis of PCD.
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Affiliation(s)
- Loretta Müller
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Sibel T. Savas
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Stefan A. Tschanz
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
| | - Andrea Stokes
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Anaïs Escher
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Mirjam Nussbaumer
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Marina Bullo
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Claudia E. Kuehni
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Sylvain Blanchon
- Pediatric Pulmonology and Cystic Fibrosis Unit, Service of Pediatrics, Department Woman–Mother–Child, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Andreas Jung
- Division of Respiratory Medicine, University Children’s Hospital Zurich, 8032 Zurich, Switzerland;
| | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children’s Hospital Lucerne, 6000 Lucerne, Switzerland;
| | - Beat Haenni
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
| | - Martin Schneiter
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
- Institute of Applied Physics, University of Bern, 3012 Bern, Switzerland
| | - Jonas Ingold
- Institute of Anatomy, University of Bern, 3012 Bern, Switzerland; (B.H.); (M.S.); (J.I.)
| | - Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.T.S.); (A.S.); (A.E.); (M.N.); (M.B.); (C.E.K.); (E.K.); (C.C.); (P.L.)
- Department of BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
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Progress in Diagnosing Primary Ciliary Dyskinesia: The North American Perspective. Diagnostics (Basel) 2021; 11:diagnostics11071278. [PMID: 34359360 PMCID: PMC8304305 DOI: 10.3390/diagnostics11071278] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
Primary Ciliary Dyskinesia (PCD) is a rare, under-recognized disease that affects respiratory ciliary function, resulting in chronic oto-sino-pulmonary disease. The PCD clinical phenotype overlaps with other common respiratory conditions and no single diagnostic test detects all forms of PCD. In 2018, PCD experts collaborated with the American Thoracic Society (ATS) to create a clinical diagnostic guideline for patients across North America, specifically considering the local resources and limitations for PCD diagnosis in the United States and Canada. Nasal nitric oxide (nNO) testing is recommended for first-line testing in patients ≥5 years old with a compatible clinical phenotype; however, all low nNO values require confirmation with genetic testing or ciliary electron micrograph (EM) analysis. Furthermore, these guidelines recognize that not all North American patients have access to nNO testing and isolated genetic testing is appropriate in cases with strong clinical PCD phenotypes. For unresolved diagnostic cases, referral to a PCD Foundation accredited center is recommended. The purpose of this narrative review is to provide insight on the North American PCD diagnostic process, to enhance the understanding of and adherence to current guidelines, and to promote collaboration with diagnostic pathways used outside of North America.
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