TY - JOUR T1 - Optimising clinical care through <em>CDH1</em>-specific germline variant curation: improvement of clinical assertions and updated curation guidelines JF - Journal of Medical Genetics JO - J Med Genet DO - 10.1136/jmg-2022-108807 SP - jmg-2022-108807 AU - Xi Luo AU - Jamie L Maciaszek AU - Bryony A Thompson AU - Huei San Leong AU - Katherine Dixon AU - Sónia Sousa AU - Michael Anderson AU - Maegan E Roberts AU - Kristy Lee AU - Amanda B Spurdle AU - Arjen R Mensenkamp AU - Terra Brannan AU - Carolina Pardo AU - Liying Zhang AU - Tina Pesaran AU - Sainan Wei AU - Grace-Ann Fasaye AU - Chimene Kesserwan AU - Brian H Shirts AU - Jeremy L Davis AU - Carla Oliveira AU - Sharon E Plon AU - Kasmintan A Schrader AU - Rachid Karam A2 - , Y1 - 2022/12/07 UR - http://jmg.bmj.com/content/early/2023/03/08/jmg-2022-108807.abstract N2 - 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 The CDH1 VCEP reviewed 273 variants using updated CDH1 specifications and incorporated published and unpublished data provided by diagnostic laboratories.Results Updated CDH1-specific interpretation guidelines include 11 major modifications since the initial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.Data are available in a public, open access repository. All variants have been submitted to ClinVar by the CDH1 VCEP (https://www.ncbi.nlm.nih.gov/clinvar/submitters/506817/) and all evidence codes used in variant classifications are available in the ClinGen Evidence Repository (https://erepo.clinicalgenome.org/evrepo/). ER -