Gerard Silvestri, MD
Researchers, including a professor from the Medical University of South Carolina Hollings Cancer Center, say a new genomic test is a breakthrough for lung cancer testing in some current and former smokers. It’s more accurate and less invasive than older options.
The study appears online in the New England Journal of Medicine.
Gerard Silvestri, M.D., is Hillenbrand professor of thoracic oncology at MUSC and co-leader of the study. “Clinicians want to avoid missing a cancer when one is present and avoid unnecessary invasive and perhaps harmful testing in patients ultimately found to have benign disease,” Silvestri said.
Traditionally, when a scan shows something troubling on a patient’s lungs, clinicians use bronchoscopy to try to capture some of the tumor’s cells to check for malignancy. Because lung cancer tends to develop deep in the lungs, the bronchoscope doesn’t always reach it. Consequently, the results can be inconclusive, leading to a more invasive needle biopsy or opening the chest to examine the tumor.
Researchers set out to see if they could improve the performance of the bronchoscopy. The new genomic test they studied used small brushes on the bronchoscope to collect some of the thin epithelial cells that line the patient’s airway, not just the cells suspected of being cancerous.
The study showed, as the researchers suspected, that the epithelial cells are a good indicator of whether the tumor is malignant.
The research involved 639 patients at 28 sites in the United States, Canada and Ireland. The genomic test, when evaluated with the bronchoscopy, had a combined sensitivity of 97 percent for detecting lung cancer, compared to 75 percent for bronchoscopy alone.
"This study has some important findings. The first is that there is a high non-diagnostic rate of bronchoscopy when evaluating patients with new lung masses and a suspicion of cancer,” Silvestri said.
Second, he said, “Using this bronchial genomic classifier in patients with an intermediate risk of cancer and a non-diagnostic bronchoscopy helps patients avoid unnecessary testing because a negative classifier in this patient population strongly suggests that the lesion in the lung is benign and further invasive testing could potentially be avoided."
The test was developed in the lab of Boston University School of Medicine researcher Avi Spira, M.D. Other research centers and companies involved in the study include the University of Pennsylvania School of Medicine; Veracyte, San Francisco; Elashoff Consulting; and the University of Wisconsin School of Medicine and Public Health.
About a quarter of a million patients have a bronchoscopy for suspected lung cancer each year, with approximately 40 percent of those procedures inconclusive.