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Integrated Biomarkers for the Management of Indeterminate Pulmonary Nodules.
Kammer, Michael N; Lakhani, Dhairya A; Balar, Aneri B; Antic, Sanja L; Kussrow, Amanda K; Webster, Rebekah L; Mahapatra, Shayan; Barad, Udaykamal; Shah, Chirayu; Atwater, Thomas; Diergaarde, Brenda; Qian, Jun; Kaizer, Alexander; New, Melissa; Hirsch, Erin; Feser, William J; Strong, Jolene; Rioth, Matthew; Miller, York E; Balagurunathan, Yoganand; Rowe, Dianna J; Helmey, Sherif; Chen, Sheau-Chiann; Bauza, Joseph; Deppen, Stephen A; Sandler, Kim; Maldonado, Fabien; Spira, Avrum; Billatos, Ehab; Schabath, Matthew B; Gillies, Robert J; Wilson, David O; Walker, Ronald C; Landman, Bennett; Chen, Heidi; Grogan, Eric L; Barón, Anna E; Bornhop, Darryl J; Massion, Pierre P.
Afiliación
  • Kammer MN; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Lakhani DA; Department of Chemistry, and.
  • Balar AB; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Antic SL; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Kussrow AK; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Webster RL; Department of Chemistry, and.
  • Mahapatra S; Vanderbilt Institute for Chemical Biology, Nashville, Tennessee.
  • Barad U; Vanderbilt Ingram Cancer Center, Nashville, Tennessee.
  • Shah C; Department of Chemistry, and.
  • Atwater T; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Diergaarde B; Division of Radiology, and.
  • Qian J; Division of Radiology, and.
  • Kaizer A; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • New M; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania.
  • Hirsch E; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Feser WJ; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
  • Strong J; Pulmonary Sciences and Critical Care.
  • Rioth M; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
  • Miller YE; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
  • Balagurunathan Y; Biomedical Informatics and Personalized Medicine, and.
  • Rowe DJ; Medical Oncology and Biomedical Informatics and Personalized Medicine, School of Medicine, University of Colorado, Aurora, Colorado.
  • Helmey S; Pulmonary Sciences and Critical Care.
  • Chen SC; H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
  • Bauza J; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Deppen SA; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Sandler K; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Maldonado F; American College of Radiology, Philadelphia, Pennsylvania.
  • Spira A; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Billatos E; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Schabath MB; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Gillies RJ; Department of Medicine, Boston University, Boston, Massachusetts.
  • Wilson DO; Department of Medicine, Boston University, Boston, Massachusetts.
  • Walker RC; H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
  • Landman B; H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
  • Chen H; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
  • Grogan EL; Division of Radiology, and.
  • Barón AE; Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine.
  • Bornhop DJ; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.
  • Massion PP; American College of Radiology, Philadelphia, Pennsylvania.
Am J Respir Crit Care Med ; 204(11): 1306-1316, 2021 12 01.
Article en En | MEDLINE | ID: mdl-34464235
Rationale: 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 that combined clinical, blood, and imaging biomarkers to improve the noninvasive management of IPNs. Methods: In this prospectively collected, retrospective blinded evaluation 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 with current clinical care was evaluated in 2 cohorts. Measurements and Main Results: The CBM provided improved diagnostic accuracy over the Mayo Clinic model with an improvement in area under the curve of 0.124 (95% bootstrap confidence interval, 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 control subjects 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. Conclusions: 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma / Nódulos Pulmonares Múltiples / Neoplasias Pulmonares Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma / Nódulos Pulmonares Múltiples / Neoplasias Pulmonares Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Respir Crit Care Med Asunto de la revista: TERAPIA INTENSIVA Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos