Update on biomarkers for the stratification of indeterminate pulmonary nodules.


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 computed tomography 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 as our current stratification approaches are suboptimal, particularly for intermediate probability nodules. Thus, non-invasive 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, bronchial or nasal epithelium genomic classifiers, among others. While many biomarkers have been developed, few have been integrated into clinical practice as they lack clinical utility studies demonstrating improved patient centered outcomes.

Rapid technological advances and large network collaborative efforts will continue to drive the discovery and validation of many novel biomarkers, but ultimately, randomized clinical utility studies demonstrating improved patient outcomes will be required to bring biomarkers into clinical practice.

  • Balbach ML
  • Deppen S
  • Fong KM
  • Grogan EL
  • Heideman BE
  • Iams WT
  • Kammer MN
  • Lenburg ME
  • Maldonado F
  • Mallow C
  • Ning B
  • Paez R
  • Peikert T
  • Shojaee S
  • Tanner NT
  • Yarmus L
PubMed ID
Appears In
Chest, 2023