Nasal biomarkers for the evaluation of lung nodules found by LDCT screening

Despite advances in surgery, radiation and systemic therapies, lung cancer remains a highly lethal disease due to an inability to detect it at an early and potentially treatable stage. Although low-dose computerized tomography (LDCT) screening for lung cancer improves survival in high-risk patients by detecting the disease at potentially curable stages, nearly one-quarter of these screening exams have findings such as small pulmonary nodules that are concerning for possible lung cancer. Although most of these indeterminate nodules are ultimately proved to be benign, these false positive findings often lead to additional scans and diagnostic procedures that incur financial cost, risk of complications and anxiety for patients. Thus, there is an urgent need for tools to assist physicians in stratifying patients with indeterminate pulmonary nodules to or from additional testing based on the likelihood of malignancy. This team has previously described gene and microRNA expression changes in the bronchial and nasal epithelium induced by cigarette smoking. They have also developed a bronchoscopy-based gene-expression signature of lung cancer that can serve as an accurate diagnostic biomarker. Building upon these observations and preliminary data demonstrating that the lung cancer-associated airway field of injury extends to the nasal epithelium, they will develop a minimally-invasive nasal biomarker that can accurately classify LDCT-detected pulmonary nodules as early lung cancers or benign lesions. Such a test would ultimately allow clinicians to more accurately stratify patients to or from further diagnostic interventions, thereby reducing the overall cost and potential morbidity from false positive results of LDCT screening.