Autoantibody Signature Enhances the Positive Predictive Power of Computed Tomography and Nodule-Based Risk Models for Detection of Lung Cancer.
Autoantibody Signature Enhances the Positive Predictive Power of Computed Tomography and Nodule-Based Risk Models for Detection of Lung Cancer.
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DOI：
10.1016/j.jtho.2016.08.143
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Robertson JF
中科院分区：
文献类型：
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作者：
Massion PP;Healey GF;Peek LJ;Fredericks L;Sewell HF;Murray A;Robertson JF
随着低剂量计算机断层扫描筛查肺癌的发展，肺结节的发病率正在增加。鉴于计算机断层扫描检测到大量良性结节，能够区分恶性和良性结节的辅助测试将使医生受益。 EarlyCDT-Lung 血液检测（Oncimmune Ltd.，诺丁汉，英国）通过测量七种肿瘤相关抗原的自身抗体来进行区分的能力在前瞻性登记中进行了评估。在 1987 名获得《健康保险流通与责任法案》授权的个人中，对那些检测到肺结节、影像学和病理报告的人进行了审查。所有在 EarlyCDT-Lung 测试后 6 个月内发现结节的患者均被纳入。探讨了测试与结节大小和基于结节的风险模型的可加性。共有 451 名患者（32%）至少有一个结节，排除后共有 296 名符合条件的患者，肺癌患病率为 25%。在 4 至 20 毫米的结节中，与阴性检测结果相比，阳性检测结果代表患肺癌的相对风险增加两倍以上。此外，当使用组合二元测试的“双阳性规则”时，将 EarlyCDT-Lung 添加到风险模型中可以提高诊断性能，具有高特异性 (>92%) 和阳性预测值 (>70%)。自身抗体检测结果呈阳性反映最大直径为 4 至 20 毫米的肺结节发生恶性肿瘤的风险显着增加。这些数据证实，EarlyCDT-Lung 可以为医生评估不确定性肺结节的恶性肿瘤风险增加价值。
The incidence of pulmonary nodules is increasing with the movement toward screening for lung cancer by low-dose computed tomography. Given the large number of benign nodules detected by computed tomography, an adjunctive test capable of distinguishing malignant from benign nodules would benefit practitioners. The ability of the EarlyCDT-Lung blood test (Oncimmune Ltd., Nottingham, United Kingdom) to make this distinction by measuring autoantibodies to seven tumor-associated antigens was evaluated in a prospective registry. Of the members of a cohort of 1987 individuals with Health Insurance Portability and Accountability Act authorization, those with pulmonary nodules detected, imaging, and pathology reports were reviewed. All patients for whom a nodule was identified within 6 months of testing by EarlyCDT-Lung were included. The additivity of the test to nodule size and nodule-based risk models was explored. A total of 451 patients (32%) had at least one nodule, leading to 296 eligible patients after exclusions, with a lung cancer prevalence of 25%. In 4- to 20-mm nodules, a positive test result represented a greater than twofold increased relative risk for development of lung cancer as compared with a negative test result. Also, when the “both-positive rule” for combining binary tests was used, adding EarlyCDT-Lung to risk models improved diagnostic performance with high specificity (>92%) and positive predictive value (>70%). A positive autoantibody test result reflects a significant increased risk for malignancy in lung nodules 4 to 20 mm in largest diameter. These data confirm that EarlyCDT-Lung may add value to the armamentarium of the practitioner in assessing the risk for malignancy in indeterminate pulmonary nodules.