Integrated Biomarkers for the Management of Indeterminate Pulmonary Nodules.

<b>Rationale</b>- Patients with indeterminate pulmonary nodules (IPNs) at risk of cancer undergo high rates of invasive, costly, and morbid procedures. Objectives: To train and externally validate a risk prediction model which combined clinical, blood, and imaging biomarkers to improve the noninvasive management of IPNs. <b>Methods</b> - In this prospectively collected, retrospective blinded evaluation (PRoBE) study, probability of cancer was calculated for 456 patient nodules using the Mayo Clinic Model and patients were categorized into low, intermediate, and high-risk groups. A combined biomarker model (CBM) including clinical variables, serum high sensitivity CYFRA 21-1 level, and a radiomic signature, was trained in cohort 1 (n = 170) and validated in cohorts 2-4 (total n = 286). All patients were pooled to recalibrate the model for clinical implementation. The clinical utility of the CBM compared to current clinical care was evaluated in 2 cohorts. <b>Measurements and Main Results</b> - The CBM provided improved diagnostic accuracy over the Mayo Clinic model with an improvement in AUC of 0.124 (95% CI: 0.091-0.156, p<2×10-16). Applying 10% and 70% risk thresholds resulted in a bias-corrected clinical reclassification index for cases and controls of 0.15 and 0.12, respectively. A clinical utility analysis of patient medical records estimated that a CBM-guided strategy would have reduced invasive procedures from 62.9% to 50.6% in the intermediate-risk benign population and shortened the median time-to-diagnosis of cancer from 60 to 21 days in intermediate-risk cancers. <b>Conclusion</b> - Integration of clinical, blood, and image biomarkers improves noninvasive diagnosis of patients with IPNs, potentially reducing the rate of unnecessary invasive procedures while shortening the time-to-diagnosis.

Antic SL, Atwater T, Balagurunathan Y, Balar AB, Barad U, Barón AE, Bauza J, Billatos E, Bornhop DJ, Chen H, Chen SC, Deppen SA, Diergaarde B, Feser WJ, Gillies RJ, Grogan EL, Helmey S, Hirsch E, Kaizer A, Kammer MN, Kussrow AK, Lakhani DA, Landman B, Mahapatra S, Maldonado F, Massion PP, Miller Y, New M, Qian J, Rioth M, Rowe DJ, Sandler K, Schabath MB, Shah C, Spira A, Strong J, Walker RC, Webster RL, Wilson DO


Am J Respir Crit Care Med, 2021

Version 5.1.2