Finding Lung Cancer in the Nose

A new nasal test may allow patients suspected of having lung cancer to undergo a simple swab of their nose to determine if they have the disease. Researchers at Boston University School of Medicine (BUSM) have found that a genomic biomarker in the nasal passage can accurately determine the likelihood of a lung lesion being malignant. The findings, which appear online in the Journal of the National Cancer Institute, will allow physicians to confidently identify patients who are at low probability for having lung cancer, thus sparing them from costly and risky procedures.

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Lung cancer is the deadliest form of cancer in the United States—and in the world. According to the National Cancer Institute, it accounts for more than a quarter of cancer deaths in this country, killing about 158,000 people in 2016. Because lung cancer is so lethal, many current and former smokers undergo precautionary CT scans of the chest. These scans can detect small lesions in the lungs that may be an early sign of cancer, but false positives can lead to invasive and unnecessary lung biopsies. researchers reported in the New England Journal of Medicine that a genomic test they’d developed could detect lung cancer in a section of the bronchial airway far removed from the tumor. The test, now called Percepta, was acquired by the genomic diagnostics company Veracyte, released that year, and received Medicare approval in late 2016.

The problem, says Spira, is that “there is a subset of people with pulmonary lesions who do not undergo a bronchoscopy as part of their diagnostic workup,” either because the suspicious lesions are very deep in the lung and inaccessible to the bronchoscope or because the patient suffers from other conditions—like heart failure or emphysema—that make a bronchoscopy difficult or dangerous. But if people with lung cancer have genomic alterations in the cells in the nose too, a nasal swab could potentially serve the same purpose as a bronchial brush.

“We had previously collected the nasal samples,” says Spira. “But we thought that genomic changes in the nose that associate with lung cancer would be more difficult to detect than those found in the bronchial airway.” 

After examining nasal epithelial brushings from current and former smokers undergoing diagnostic evaluation for pulmonary lesions suspicious for lung cancer, the researchers determined that the nasal airway epithelial field of lung cancer-associated injury in smokers extends to the nose and has the potential of being a non-invasive biomarker for lung cancer detection.

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