Clinical Utility of a Plasma Protein Classifier for Indeterminate Lung Nodules

Lung. 2015 Dec;193(6):1023-7. doi: 10.1007/s00408-015-9800-0. Epub 2015 Sep 16.

Abstract

Evaluation of indeterminate pulmonary nodules is a complex challenge. Most are benign but frequently undergo invasive and costly procedures to rule out malignancy. A plasma protein classifier was developed that identifies likely benign nodules that can be triaged to CT surveillance to avoid unnecessary invasive procedures. The clinical utility of this classifier was assessed in a prospective-retrospective analysis of a study enrolling 475 patients with nodules 8-30 mm in diameter who had an invasive procedure to confirm diagnosis at 12 sites. Using this classifier, 32.0 % (CI 19.5-46.7) of surgeries and 31.8 % (CI 20.9-44.4) of invasive procedures (biopsy and/or surgery) on benign nodules could have been avoided. Patients with malignancy triaged to CT surveillance by the classifier would have been 24.0 % (CI 19.2-29.4). This rate is similar to that described in clinical practices (24.5 % CI 16.2-34.4). This study demonstrates the clinical utility of a non-invasive blood test for pulmonary nodules.

Trial registration: ClinicalTrials.gov NCT01752101.

Keywords: Biomarker; Clinical utility; Lung cancer; Lung nodule; Prospective; Xpresys lung.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / blood*
  • Blood Proteins / metabolism*
  • Bronchoscopy
  • Carcinoma, Non-Small-Cell Lung / blood*
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Female
  • Humans
  • Image-Guided Biopsy
  • Lung Neoplasms / blood*
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Prospective Studies
  • Retrospective Studies
  • Sensitivity and Specificity
  • Solitary Pulmonary Nodule / blood*
  • Solitary Pulmonary Nodule / diagnosis
  • Solitary Pulmonary Nodule / pathology
  • Tomography, X-Ray Computed
  • Tumor Burden

Substances

  • Biomarkers, Tumor
  • Blood Proteins

Associated data

  • ClinicalTrials.gov/NCT01752101