Integrated Biomarkers for the Management of Indeterminate Pulmonary Nodules
Patients with indeterminate pulmonary nodules (IPNs) at risk of cancer undergo high rates of invasive, costly, and morbid procedures. To train and externally validate a risk prediction model that combined clinical, blood, and imaging biomarkers to improve the noninvasive management of IPNs. In this...
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| Published in | American journal of respiratory and critical care medicine Vol. 204; no. 11; pp. 1306 - 1316 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Thoracic Society
01.12.2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1073-449X 1535-4970 1535-4970 |
| DOI | 10.1164/rccm.202012-4438OC |
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| Abstract | Patients with indeterminate pulmonary nodules (IPNs) at risk of cancer undergo high rates of invasive, costly, and morbid procedures.
To train and externally validate a risk prediction model that combined clinical, blood, and imaging biomarkers to improve the noninvasive management of IPNs.
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 (
= 170) and validated in cohorts 2-4 (total
= 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.
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;
< 2 × 10
). 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.
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. |
|---|---|
| AbstractList | Patients with indeterminate pulmonary nodules (IPNs) at risk of cancer undergo high rates of invasive, costly, and morbid procedures.
To train and externally validate a risk prediction model that combined clinical, blood, and imaging biomarkers to improve the noninvasive management of IPNs.
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 (
= 170) and validated in cohorts 2-4 (total
= 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.
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;
< 2 × 10
). 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.
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. 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.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. A prospectively collected, retrospective blinded evaluation study to train and externally validate a risk prediction model that combined clinical, blood, and imaging biomarkers to improve the noninvasive management of indeterminate pulmonary nodules (IPNs) is presented. The Mayo Clinic model was used to calculate the probability of cancer for 456 patient nodules, and patients were categorized into low-, intermediate-, and high-risk groups. Integration of clinical, blood, and image biomarkers enhances noninvasive diagnosis of patients with IPNs, potentially reducing the rate of unnecessary invasive procedures while shortening the time to diagnosis. |
| Author | Rowe, Dianna J. Massion, Pierre P. Wilson, David O. Sandler, Kim Qian, Jun Barón, Anna E. Lakhani, Dhairya A. Chen, Heidi Rioth, Matthew Spira, Avrum Gillies, Robert J. Barad, Udaykamal Antic, Sanja L. Schabath, Matthew B. Balagurunathan, Yoganand New, Melissa Bauza, Joseph Diergaarde, Brenda Billatos, Ehab Grogan, Eric L. Hirsch, Erin Chen, Sheau-Chiann Mahapatra, Shayan Bornhop, Darryl J. Maldonado, Fabien Balar, Aneri B. Webster, Rebekah L. Miller, York E. Kussrow, Amanda K. Feser, William J. Strong, Jolene Kammer, Michael N. Kaizer, Alexander Walker, Ronald C. Helmey, Sherif Deppen, Stephen A. Landman, Bennett Shah, Chirayu Atwater, Thomas |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34464235$$D View this record in MEDLINE/PubMed |
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| Snippet | Patients with indeterminate pulmonary nodules (IPNs) at risk of cancer undergo high rates of invasive, costly, and morbid procedures.
To train and externally... A prospectively collected, retrospective blinded evaluation study to train and externally validate a risk prediction model that combined clinical, blood, and... Rationale: Patients with indeterminate pulmonary nodules (IPNs) at risk of cancer undergo high rates of invasive, costly, and morbid procedures. Objectives: To... |
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| SubjectTerms | Aged Biomarkers Biomarkers - metabolism Cancer Carcinoma - diagnostic imaging Carcinoma - metabolism Carcinoma - pathology Case-Control Studies Cohort Studies Female Humans Lung Neoplasms - diagnostic imaging Lung Neoplasms - metabolism Lung Neoplasms - pathology Male Mathematical models Medical diagnosis Medical prognosis Medical research Middle Aged Multiple Pulmonary Nodules - diagnostic imaging Multiple Pulmonary Nodules - metabolism Multiple Pulmonary Nodules - pathology Original Predictive Value of Tests Risk Factors ROC Curve Tomography, X-Ray Computed |
| Title | Integrated Biomarkers for the Management of Indeterminate Pulmonary Nodules |
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