title: Added value of a serum proteomic signature in the diagnostic evaluation of lung nodules.
abstract: BACKGROUND
  Current management of lung nodules is complicated by nontherapeutic resections and missed chances for cure. We hypothesized that a serum proteomic signature may add diagnostic information beyond that provided by combined clinical and radiographic data.
  
  
  METHODS
  Cohort A included 265 and cohort B 114 patients. Using multivariable logistic regression analysis we calculated the area under the receiver operating characteristic curve (AUC) and quantified the added value of a previously described serum proteomic signature beyond clinical and radiographic risk factors for predicting lung cancer using the integration discrimination improvement (IDI) index.
  
  
  RESULTS
  The average computed tomography (CT) measured nodule size in cohorts A and B was 37.83 versus 23.15 mm among patients with lung cancer and 15.82 versus 17.18 mm among those without, respectively. In cohort A, the AUC increased from 0.68 to 0.86 after adding chest CT imaging variables to the clinical results, but the proteomic signature did not provide meaningful added value. In contrast, in cohort B, the AUC improved from 0.46 with clinical data alone to 0.61 when combined with chest CT imaging data and to 0.69 after adding the proteomic signature (IDI of 20% P = 0.0003). In addition, in a subgroup of 100 nodules between 5 and 20 mm in diameter, the proteomic signature added value with an IDI of 15% (P ≤ 0.0001).
  
  
  CONCLUSIONS
  The results show that this serum proteomic biomarker signature may add value to the clinical and chest CT evaluation of indeterminate lung nodules.
  
  
  CONCLUSIONS
  This study suggests a possible role of a blood biomarker in the evaluation of indeterminate lung nodules.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Chad V
authors.initials: CV
authors.lastname: Pecot
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Xueqiong J
authors.initials: XJ
authors.lastname: Zhang
authors.forename: Rama
authors.initials: R
authors.lastname: Rajanbabu
authors.forename: Ciara
authors.initials: C
authors.lastname: Calitri
authors.forename: Aaron
authors.initials: A
authors.lastname: Bungum
authors.forename: James R
authors.initials: JR
authors.lastname: Jett
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Carol
authors.initials: C
authors.lastname: Callaway-Lane
authors.forename: Steve
authors.initials: S
authors.lastname: Deppen
authors.forename: Eric L
authors.initials: EL
authors.lastname: Grogan
authors.forename: David P
authors.initials: DP
authors.lastname: Carbone
authors.forename: John A
authors.initials: JA
authors.lastname: Worrell
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.forename: Yu
authors.initials: Y
authors.lastname: Shyr
authors.forename: Pierre P
authors.initials: PP
authors.lastname: Massion
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood*; D011446:Prospective Studies; D040901:Proteomics / Q000379:methods*; D012307:Risk Factors; D003074:Solitary Pulmonary Nodule / Q000097:blood* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins