Pecan PIE

Authors Michael Edmonson, Aman Patel
Publication Edmonson et al., Genome Research 2019
Technical Support Contact Us

Pecan PIE (the **Pe**diatric **Can**cer Variant **P**athogenicity **I**nformation **E**xchange) is a cloud-based variant classification and interpretation service. It annotates and ranks variants by putative pathogenicity, then displays them in an interactive web interface for formal review and classification following ACMG guidelines. The portal also contains a repository of expert-reviewed germline mutations that may predispose individuals to cancer. It is free for non-commercial use.

Pecan PIE utilizes St. Jude Medal Ceremony, the same pipeline that powers our clinical and research genomics projects. Medal Ceremony provides a 3-level ranking of putative pathogenicity - Gold, Silver or Bronze - for mutations within disease-related genes. Medal assignment is based on matches to 22 mutation databases, mutation type, population frequency, tumor suppressor status and predicted functional impact. The evidence used for medal assignment is imported into an interactive variant review page where an analyst can enter additional curated information such as primary diagnosis, presence of subsequent neoplasm, family history and related literature. Classification tags can be assigned to curated data enabling automated calculation of pathogenicity rating based on ACMG/AMP 2015 guidelines.

See file_download PowerPoint slides presented at the ASHG 2017 annual meeting (note that some of this information is out of date, various improvements have been made since then).

Go to to get started!


An overview of the Pecan PIE workflow:

  1. Log in and upload a VCF of SNVs and indels.
  2. The portal will process your variants, notifying you upon completion. Variants are annotated with VEP+ (VEP with postprocessing for enhanced splice variant calling) then classified with Medal Ceremony.
  3. Browse results, which include a detailed page for each variation. Variants may be formally classified with an interface based on ACMG guidelines.

Getting started

Start by logging into the portal with a DNAnexus account, creating an account if you need one. PIE uses DNAnexus as a secure cloud backend. Logging in is required for private storage of your data and so that we can send you e-mail notifications when your analysis jobs are complete. PIE is free for non-commercial use. St. Jude pays the (small) cloud computing costs, your DNAnexus account will not be billed.

Uploading data

Pecan PIE takes standard VCF files as input, which may be either uncompressed or compressed with bgzip.

  1. Click the "Securely upload a VCF file" button.
  2. Choose the genome your variants were mapped to, which may be either GRCh37-lite or GRCh38.

Advanced options

The "Advanced option" panel lets you customize the behavior of the pipeline:

  • Gene list: Pick a gene list from the pulldown. This filters your variants to genes in the specified list. This option is required and turned on automatically if your uploaded file is 2 megabytes or larger. See the frequently asked questions for more information. This option reduces the variant processing burden on PIE by removing variants that will not be assigned a medal in any case because they are not on the cancer predisposition gene list. You can review the genes by clicking on the link that will appear just below the pull down titled "See gene list".
  • Custom gene list: Choosing "custom" as your gene list will open a window that will let you paste in a list of genes. Any invalid genes will be dropped from your list automatically. You can separate your genes by spaces or new lines.
  • Max Population frequency: PIE by default will not call medals for variants present in the ExAC (ex-TCGA) database at an allele frequency greater than 0.001. This option lets you override the filtering threshold to whatever frequency you prefer. To disable filtering altogether, specify a value of 1.

Progress page

After uploading is complete you will be taken to a status screen showing the progress of your job through the system. Analysis typically takes 10-15 minutes depending on file size and system availability.

It isn't necessary to keep your browser open on this page until your results are ready: the system will e-mail you with a link to return to your results. Optional browser notifications are also available.

Analysis of Results

Results browser

When your job is complete you will be taken to an overview page where you can browse your results and examine a detailed results page for each variant.

The variants in the results can be filtered by:

Filter Meaning
Class Predicted effect of variant on protein coding, e.g. missense, nonsense, etc.
Somatic medal Medal assigned to the variant by the somatic classifier.
Germline medal Medal assigned to the variant by the germline classifier.
Committee Classification If the variant has been reviewed by the St. Jude germline variant review committee, the result will appear in this column, otherwise it will be blank.

The "search" box lets you filter the results by gene and/or amino acid change. The view is dynamically filtered to matching variants as you type.

Medal meaning

Medals are only assigned for coding and splice-related variants in disease predisposition genes. Germline medals are only assigned for novel variants or those present in the ExAC (ex-TCGA) database with a MAF no greater than 0.1% (0.001 expressed fractionally).

  • Gold medals are assigned to truncations in tumor suppressor genes, hotspots derived from the COSMIC database, as well as perfect matches to variants in the IARC TP53, PCGP, ASU TERT, ARUP RET, and BIC databases.
  • Silver medals are assigned to in-frame indels, truncations in non-tumor suppressor genes, variants predicted deleterious by damage-prediction algorithms, variants receiving a gold medal from the somatic classifier, and perfect matches to variants in the following databases: ClinVar (predicted pathogenic or likely pathogenic), RB1, LOVD, and UMD.
  • Bronze medals are assigned to variants predicted tolerated by damage-prediction algorithms. Variants having an imperfect match to a database (i.e. different variants at the same genomic position or codon) typically receive a lesser medal.

A summary graphic can be found in slide 4 of the ASHG 2017 presentation (download here). For additional details see Zhang et al., NEJM 2015 (supplementary appendix pp. 7-10).

Variant page

Each variant links to a detailed variant page, which integrates data from a variety of sources. If either you or the St. Jude germline variant review committee have annotated a variant, that information will be pre-populated.

Summary information

The top of the page shows a summary of the variant, including its genomic and HGVS annotations, predicted effect on the protein, and somatic and germline medals. A description of the gene from Entrez follows, and a custom description or selection rationale may also be entered.

Medal call information

Clicking on one of the medal icons (gold, silver, bronze, unknown) or on the top of the page will show a summary of information related to the medal call.


An embedded version of ProteinPaint (Zhou et al., Nat. Genet. 2016) appears next, showing the variant in the context of a number of pediatric datasets including PCGP. A link is provided to the main ProteinPaint application which provides visualizations for additional datasets, including COSMIC and ClinVar.

ASHG pathogenicity classification

Formal variant pathogenicity classification is supported by an interface implementing ACMG guidelines (Richards et al., Genet Med. 2015). The analyst reviews a series of curated category tags, assigning applicable tags to the variant and optionally supplying additional information for each such as PubMed IDs and supporting evidence. The system will then compute an appropriate pathogenicity score based on the user-flagged categories. Additional free-form custom evidence can also be entered. This structured approach both helps eliminate arbitrary decision-making from the pathogenicity classification process and also constructs a concise summary of the logic and evidence supporting the final call.

ClinVar and allele frequency

Matches of the variant in ClinVar are also provided, along with predicted clinical significance and review status.

Allele frequencies for the variant in the PCGP (somatic and germline), NHLBI ESP 6500, and ExAC databases are presented both as fractional values and on a log10 plot. Detailed allele population breakdowns are provided for ExAC.

Damage prediction algorithms

Precomputed damage-prediction algorithm calls for nonsynonymous coding SNVs are presented from the dbNSFP database. Available algorithms are PolyPhen2 (HVAR), SIFT, CADD, REVEL, FATHMM, MutationAssessor, and LRT. The calls are presented in a circular diagram with entries color-coded based on the predicted severity of the result.

Medal ceremony and linkouts

Additional output from medal ceremony classification can also be reviewed. This is only loosely structured, additional fields here may eventually be integrated into Pecan PIE.

Links are provided to relevant dbSNP entries and other information sources.

Final classification

The final 5-tier ACMG classification can be selected after which the decision will be marked as reviewed. A checkbox is also available to indicate this variant is a potential candidate for functional review.

Standalone usage

This section is intended only for users who want to invoke Pecan PIE's underlying analysis pipelines independently on the DNAnexus platform. If you just want to use the Pecan PIE website you can safely ignore this section of the documentation. We assume familiarity with the DNAnexus platform. If you aren't familiar with this, DNAnexus' quickstart guide is a great place to start.


This section of the guide is only relevant to power users!

Two DNAnexus cloud application pipelines were created during the development of Pecan PIE:

Name Corresponding DNAnexus App Description
VEP+ app-stjude_vep_plus A cloud installation of VEP with improved logic for splice variant calls. Converts an input VCF of variants to annotated, tab-delimited format.
Medal Ceremony app-stjude_medal_ceremony Additional annotation and automated variant classification. Requires a special input format which is produced by VEP+.


In order to run the cloud pipelines independently, your DNAnexus account needs to be granted permissions to access them. After your initial login to St. Jude Cloud and/or Pecan PIE, these permissions will be granted automatically. A single login is required even if you just want to use the standalone pipelines rather than the Pecan PIE portal (contact us if you encounter problems accessing the pipelines).

There are two methods of running pipelines on DNAnexus:

  1. DNAnexus GUI. DNAnexus provides a standardized graphical user interface for configurating, launching, and monitoring jobs on the cloud. Our pipelines can be run like any other DNAnexus pipeline.
  2. Command line. Jobs may also be invoked via the dx command line client. Command-line use allows submitting cloud jobs without interacting with a GUI, and so supports scripting and easier integration with local workflows. See this section for information on how to get set up with the dx-toolkit.


The following examples demonstrate command-line usage.

Uploading files

All input files must be uploaded onto the DNAnexus platform. When specifying files for input you can use either the DNAnexus fie IDs (e.g. file-FBgvp680gz1bGQ5p8yZKz69g), or the filenames if they are unique. For an idea of how to upload files to DNAnexus, see this guide.

Step 1: Running VEP+

To run the VEP+ DNAnexus app, you can use the following dx command with your own inputs in place of the example's:

dx run app-stjude_vep_plus -iinput_file=my_vcf.vcf -igenome_string=GRCh37-lite -igermline_reviewable_only=true


  • genome_string must be either GRCh37-lite or GRCh38. If GRCh38 is specified, variants will be lifted over to GRCh37-lite in output, i.e. the output will always be GRCh37-lite (Medal Ceremony currently only supports GRCh37-lite).
  • The input VCF specified by input_file may be either uncompressed, or compressed with bgzip only (htslib/tabix packages).
  • The germline_reviewable_only parameter is optional, but strongly recommended. If specified, only variants in disease-gene related intervals will be annotated, which is appropriate for Medal Ceremony. If this option is not specified all variants will be annotated, which depending on the size of your VCF might take a lot longer, and many of the resulting variants won't be usable by Medal Ceremony. If you want to do this anyway and have a large number of variants, consider submitting your job to an instance with more CPU cores (e.g. mem1_ssd1_x16 or mem1_ssd1_x32) as the code will take advantage of the additional cores. If you are using a custom gene list (below) that takes precedence and this parameter is not needed.
  • The optional parameter custom_genes_file specifies a plain text file of HUGO gene symbols to analyze (whitespace separated, or one per line). If specified, analysis will be restricted to these genes only.
  • This pipeline produces two output files, output_file contains annotations for all variants, while medal_prep_output_file is the specially-filtered and formatted file required as input to Medal Ceremony below.

Step 2: Running Medal Ceremony

To run the medal ceremony DNAnexus app, you can use the following dx command with your own inputs in place of the example's:

dx run app-stjude_medal_ceremony -iinfile=medal_prep_output_file


  • The optional parameter custom_genes_file operates in the same way as in the VEP+ pipeline above. For custom gene lists to work properly this parameter must be specified when running both the VEP+ and Medal Ceremony pipelines.
  • The optional parameter max_population_frequency may be specified, a fractional value representing the maximum population frequency allowed for a variant in the ExAC (ex-TCGA) database to receive a medal. The default is 0.001, a.k.a. ".1%".

Frequently asked questions

If you have any questions not covered here, feel free to reach out on our contact form.

Q: Which files are supported?

PIE works with variants in VCF format:

  • Uploaded files must be compliant with the VCF specification.
  • VCF files may be either uncompressed, or compressed with bgzip only. bgzip is part of the htslib/tabix packages (see below).

Improperly formatted VCF files will not work with PIE. Some common problems include:

  • Missing header line
  • Missing required columns
  • Files were compressed by gzip, zip, or any method other than the required bgzip

To verify compatibility of your VCF you can try one of these methods:

  1. Compressing your VCF with bgzip and indexing it with tabix, both programs from the HTSlib package (some systems also use the earlier, pre-HTSlib "tabix" package). This process will only succeed for compliant VCF files, and can help diagnose failures.
  2. Running "vcf-validator" program from the vcftools package.

While the VCF specification also requires that variants be sorted by chromosome name and position, PIE is now often able to automatically correct sorting issues in uploaded files. PIE requires sorted data in order to query data for targeted genes.

Q: Are there limits on the size of VCF files?

Uploaded files must not exceed 4 gigabytes. If an uploaded file is larger than 2 megabytes, the cancer predisposition gene list filter will be automatically enabled unless you are using a custom gene list. This reduces the processing burden on the system by removing variants outside of targeted genes.

Q: Is there an example/demo VCF I can try with PIE?

A. You can use this VCF from the Genome in a Bottle project. This ~133 megabyte bgzip-compressed VCF was used during testing of Pecan PIE and is known to work. These variants are mapped to GRCh37.

Q. What genome versions are supported?

A. Pecan PIE will accept variants mapped to either GRCh37-lite/hg19 or GRCh38. GRCh38 variants are automatically lifted over to 37, as the system uses 37 internally. The liftover process is able to compensate for strand and reference/variant allele swaps which can occur. A native hg38 version is in development, but is not yet available.

Pecan PIE only works for human data.

Q. What genes are on the curated gene list?

A. The list consists of disease-related genes, both cancer and non-cancer, see the file_download Excel spreadsheet for details. Filtering the source variants to a target list of genes reduces the processing burden on the system.

When browsing the results the view may be filtered to disease sub-categories of interest.

You can also specify your own custom list of genes to process when submitting your VCF file (see the advanced options panel).

Q. Why is the classification column blank in my results?

Q. This column displays the classification assigned by the St. Jude Germline Committee reviewers. If a variant was not classified by this committee before, this field will be blank.

Pecan PIE provides classifications from the Medal Ceremony pipeline, which may assign variants gold, silver, or bronze medals. An "Unknown" medal may be assigned for non-disease-predisposition genes, variants present in the ExAC (ex-TCGA) database at an allele frequency > 0.1%, or variants without functional annotations (which includes most silent variants).

Q. What do the medals mean?

A. The medal column is a rough indicator of the likelihood of the variant being clinically significant as predicted by the medal ceremony software. Variants with gold medals are most likely to be significant, and those with no medal are least likely. More details can be found in the Analysis of Results <results> section.

Q. Why are some of my variants missing?

A. Currently only coding and splice-related variants in disease-related genes make it to the medaling process. Intergenic, intronic, and UTR variants are excluded, as are those in non-coding transcripts.

Q. Why does the ExAC allele frequency shown differ from the ExAC portal?

A. The reported ExAC frequency may differ for several reasons:

  1. PIE uses the TCGA-subtracted distribution of ExAC rather than the main distribution.
  2. PIE reports the primary allele frequencies in the ExAC database, specifically the AC, AN, and AF fields from the VCF distribution. The ExAC portal appears to use the "adjusted" frequencies which may be different.

Q. Is Pecan PIE free?

A. Pecan PIE is free for non-commercial use. St. Jude covers the cost of running the pipeline and hosting. DNANexus accounts are required to keep track of your jobs in the cloud so that you can retrieve and manage from multiple locations. Accounts also make it possible to alert you of job completion via email.