Update on Biomarkers for the Stratification of Indeterminate Pulmonary Nodules.
Rafael Paez, Michael N Kammer, Nicole T Tanner, Samira Shojaee, Brent E Heideman, Tobias Peikert, Meridith L Balbach, Wade T Iams, Boting Ning, Marc E Lenburg, Christopher Mallow, Lonny Yarmus, Kwun M Fong, Stephen Deppen, Eric L Grogan, Fabien Maldonado
Author Information
Rafael Paez: Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Michael N Kammer: Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Nicole T Tanner: Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC.
Samira Shojaee: Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Brent E Heideman: Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Tobias Peikert: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Meridith L Balbach: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Wade T Iams: Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN.
Boting Ning: Department of Medicine, Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA.
Marc E Lenburg: Department of Medicine, Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA.
Christopher Mallow: Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL.
Lonny Yarmus: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Kwun M Fong: University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
Stephen Deppen: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN; Tennessee Valley Healthcare System, Nashville, TN.
Eric L Grogan: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN; Tennessee Valley Healthcare System, Nashville, TN.
Fabien Maldonado: Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: fabien.maldonado@vumc.org.
Lung cancer is the leading cause of cancer-related deaths. Early detection and diagnosis are critical, as survival decreases with advanced stages. Approximately 1.6 million nodules are incidentally detected every year on chest CT scan images in the United States. This number of nodules identified is likely much larger after accounting for screening-detected nodules. Most of these nodules, whether incidentally or screening detected, are benign. Despite this, many patients undergo unnecessary invasive procedures to rule out cancer because our current stratification approaches are suboptimal, particularly for intermediate probability nodules. Thus, noninvasive strategies are urgently needed. Biomarkers have been developed to assist through the continuum of lung cancer care and include blood protein-based biomarkers, liquid biopsies, quantitative imaging analysis (radiomics), exhaled volatile organic compounds, and bronchial or nasal epithelium genomic classifiers, among others. Although many biomarkers have been developed, few have been integrated into clinical practice as they lack clinical utility studies showing improved patient-centered outcomes. Rapid technologic advances and large network collaborative efforts will continue to drive the discovery and validation of many novel biomarkers. Ultimately, however, randomized clinical utility studies showing improved patient outcomes will be required to bring biomarkers into clinical practice.
