Genomics Variant Interpreter

Clinical Use Cases

• Germline genetic testing interpretation: A genetic counselor receives whole exome sequencing results for a patient with a family history of hereditary breast/ovarian cancer. The skill interprets a BRCA2 variant, pulling ClinVar consensus (pathogenic, 4-star review status), gnomAD frequency (<0.0001), and NCCN management recommendations
• Tumor profiling analysis: An oncologist receives next-generation sequencing results from a solid tumor panel. The skill classifies each somatic variant by AMP/ASCO/CAP tier, identifies Tier I variants with FDA-approved companion diagnostics, and flags Tier II variants with clinical trial eligibility
• Pharmacogenomic variant interpretation: A clinical pharmacologist needs to interpret CYP2D6 star allele combinations. The skill translates diplotype results into metabolizer phenotype predictions and links to CPIC dosing guidelines for affected medications
• Variant reclassification monitoring: A molecular diagnostics lab re-evaluates a VUS reported two years ago. The skill checks for new ClinVar submissions, published functional studies, and updated population frequency data that may support reclassification

Safety & Evidence

• Safety Classification: Restricted — Genomic variant interpretation directly influences clinical decision-making including surgical prophylaxis (e.g., risk-reducing mastectomy for BRCA carriers), targeted therapy selection, reproductive planning, and cascade family testing. All interpretations must be reviewed and signed out by a board-certified molecular pathologist or clinical geneticist. Variants of uncertain significance must never be used as the sole basis for clinical action. This skill provides interpretive support, not final clinical reports.
• Evidence Level: High — Classification follows ACMG/AMP standards (Richards et al., 2015), somatic interpretation follows AMP/ASCO/CAP guidelines (Li et al., 2017), and all database annotations are sourced from expert-curated repositories (ClinVar, ClinGen, gnomAD). However, variant interpretation is an evolving field and classifications may change as new evidence emerges.

Example Usage

Germline variant interpretation:

Interpret variant: NM_000059.4(BRCA2):c.5946delT (p.Ser1982ArgfsTer22)
Clinical context: 38-year-old female with family history of breast cancer
(mother diagnosed at 42, maternal aunt at 45)

Variant Interpretation:

Variant: BRCA2 c.5946delT (p.Ser1982ArgfsTer22) Type: Frameshift deletion causing premature termination codon ACMG Classification: Pathogenic

Evidence supporting pathogenicity:

• PVS1 (Very Strong): Null variant (frameshift) in BRCA2, a gene where loss of function is a known disease mechanism
• PS1 (Strong): Same amino acid change previously established as pathogenic in ClinVar (87 submissions, 4-star review status, all concordant pathogenic)
• PM2 (Moderate): Absent from gnomAD population databases (0/251,354 alleles)
• PP1 (Supporting): Co-segregates with disease in multiple affected families in published literature

gnomAD frequency: Not observed (0.000000) ClinVar: Pathogenic (4-star consensus, 87 submitters) OMIM: Associated with Hereditary Breast-Ovarian Cancer Syndrome (OMIM #612555)

Clinical actionability:

• Refer to cancer genetics for comprehensive risk assessment
• NCCN recommends enhanced breast surveillance (annual MRI + mammography starting at age 25) and discussion of risk-reducing surgery
• Cascade genetic testing recommended for at-risk first-degree relatives
• Ovarian cancer risk management per NCCN guidelines

Technical Details

• Category: Clinical Research Summarizing
• Author: OMS Contributors
• License: MIT
• Version: 1.0.0
• Specialty: Medical Genetics, Genomics

References

• Richards S, et al. "Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the ACMG and AMP." Genet Med. 2015;17(5):405-424.
• Li MM, et al. "Standards and Guidelines for the Interpretation and Reporting of Sequence Variants in Cancer: A Joint Consensus Recommendation of AMP, ASCO, and CAP." J Mol Diagn. 2017;19(1):4-23.
• ClinVar database (NCBI) — ncbi.nlm.nih.gov/clinvar/
• gnomAD (Genome Aggregation Database) — gnomad.broadinstitute.org
• ClinGen Clinical Genome Resource — clinicalgenome.org
• COSMIC (Catalogue of Somatic Mutations in Cancer) — cancer.sanger.ac.uk/cosmic

This skill is part of Open Medical Skills, a curated marketplace of medical AI skills maintained by physicians for physicians and the healthcare industry.