The Journal of Thoracic and Cardiovascular Surgery
Thoracic: Lung CancerImproving lung cancer diagnosis with cancer, fungal, and imaging biomarkers
Graphical abstract
Section snippets
Methods
Serum samples and clinical information were obtained from patients with newly detected 6- to 30-mm IPNs for this prospective specimen collection, retrospective blinded evaluation study.19 Incidentally discovered and lung cancer screening-detected IPNs from 3 cohorts (Figure E1) were used. The first cohort included patients from Vanderbilt University Medical Center and the Tennessee Valley VA Healthcare System in Nashville, Tennessee (VUMC; n = 111) who consented for research between 2003 and
Study Population
Our study population included 111 patients from a histoplasmosis-endemic region (VUMC), and 170 patients from nonendemic regions (UPMC and DECAMP; Table 1). Historical histoplasmosis prevalence was >90% in the VUMC cohort and <10% in the UPMC and DECAMP cohorts.28 Cancer prevalence was higher in the histoplasmosis-endemic cohort at 75% (83/111) compared with 44% (75/170) in the nonendemic cohort. Site level characteristics and predictions are shown in Table E1 through E6.
Prediction Model Performance in the Combined Study Population
The following results
Discussion
Noninvasive biomarkers are needed to improve the evaluation, risk stratification, and management of IPNs. We have shown an improvement in the diagnostic accuracy of IPNs with a combination biomarker approach including clinical factors (Mayo Clinic model), fungal biomarkers (histoplasmosis IgG and IgM), an imaging biomarker (radiomics), and a cancer biomarker (hsCYFRA 21-1) compared with the current standard of risk estimation (Mayo Clinic model).
Furthermore, our study has highlighted the added
Conclusions
The use of a combination biomarker model including clinical factors (Mayo Clinic model), fungal biomarkers (histoplasmosis IgG and IgM), an imaging biomarker (radiomics), and a cancer biomarker (hsCYFRA 21-1) might improve the evaluation, risk stratification, and subsequent management of IPNs (Figure 3). Although further work and validation is required, integrating a combination biomarker approach into the current diagnostic algorithm of IPNs could lead to a decrease in the number of invasive
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Cited by (0)
This work is supported by U01CA152662 (to Drs Grogan and Deppen) and T32CA106183-18 (to Dr Marmor).