The screening role of a biomarker panel in BALF among patients with cancer-suspected pulmonary nodules less than 8 mm.

ABSTRACT

BACKGROUND: It is intractable to differentiate the malignancy from benignancy of cancer-suspected pulmonary nodules less than 8 mm. METHODS: The patients with small pulmonary nodules less than 8 mm which were suspected to be primary lung cancer underwent bronchoscopy and bronchoalveolar lavage. The level of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-ß) and hepatocyte growth factor (HGF) in bronchoalveolar lavage fluid (BALF) were assayed. Then, all patients underwent histopathological examination by means of surgical resection of nodules to determine their benignancy or malignancy. The nodules' benignancy and malignancy suggested by the biomarker panel consisted of VEGF, TGF-ß and HGF in BALF were validated by the histopathological results to determine their screening efficiency. RESULTS: Among 405 patients with pulmonary nodules less than 8 mm, 252 and 153 were predicted to be malignant and benignant, respectively, by using the biomarker panel in BALF. Finally, 180 (71.4%) of 252 and 114 (74.5%) of 153 were validated to be truly malignant and benignant, respectively, according to the histopathological results. In a receiver operating characteristic curve analysis of screening efficiency for pulmonary nodules less than 8 mm, the results demonstrated that the AUC [0.807 (0.658-0.882)] of the biomarker panel in BALF was higher compared with that [0.605 (0.433-0.738)] of the biomarker panel in blood (P = .001). CONCLUSIONS: For patients with cancer-suspected pulmonary nodules less 8 mm, a biomarker panel of VEGF, TGF-ß and HGF in BALF demonstrated more eligible screening efficiency for the preliminary differentiation of malignancy from benignancy, by contrast with their level in blood as well as PET/CT.