{"id":44959,"date":"2017-03-01T09:37:29","date_gmt":"2017-03-01T14:37:29","guid":{"rendered":"http:\/\/www.bumc.bu.edu\/busm\/?p=44959"},"modified":"2017-03-01T09:37:29","modified_gmt":"2017-03-01T14:37:29","slug":"finding-lung-cancer-in-the-nose","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/camed\/2017\/03\/01\/finding-lung-cancer-in-the-nose\/","title":{"rendered":"Finding Lung Cancer in the Nose"},"content":{"rendered":"
\n
\"The
The work of Avrum Spira and his group may eventually lead to a simple screening for lung cancer. Photo by Cydney Scott<\/figcaption><\/figure>\n

Lung cancer is the deadliest form of cancer in the United States\u2014and in the world. According to the National Cancer Institute<\/a>, it accounts for more than a quarter of cancer deaths in this country, killing about 158,000 people in 2016.<\/p>\n

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. New research points to a better path to diagnosis: a genomic test that may eventually require only a simple nasal swab. The findings appeared online in the Journal of the National Cancer Institute<\/em><\/a> (JNCI<\/em>) on February 27, 2017.<\/p>\n

\u201cThe idea that we can sample cells from the nose and tell if someone has lung cancer\u2014that is sort of out there,\u201d says\u00a0JNCI<\/em> <\/span>paper senior author Marc Lenburg<\/a>, a School of Medicine professor of medicine. \u201cTo sample cells that far from the tumor and still find a genetic signal is really exciting.\u201d<\/p>\n

The findings build on previous research led by Lenburg<\/a> and JNCI<\/em> paper corresponding author Avrum Spira\u00a0<\/a>(ENG\u201902),\u00a0Alexander Graham Bell Professor in Health Care Entrepreneurship and\u00a0<\/span>a MED professor of medicine, pathology, and laboratory medicine. In 2015, the researchers reported in the New England Journal of Medicine<\/em><\/a> that a genomic test they\u2019d developed could detect lung cancer in a section of the bronchial airway far removed from the tumor. The test, now called Percepta<\/a>, was acquired by the genomic diagnostics company Veracyte<\/a>, released that year, and received Medicare approval in late 2016.<\/p>\n

During the Percepta test, which is performed at the same time as a bronchoscopy, a doctor uses a small brush to collect cells in the upper bronchial airway. Spira discovered that these cells, while appearing normal, reside in the cancer\u2019s \u201cfield of injury\u201d and contain genetic markers that signal a high likelihood of cancer elsewhere in the lung.<\/p>\n

\"Lung
Lung cancer\u2019s \u201cfield of injury\u201d extends well beyond the tumor. New work by Avrum Spira and colleagues demonstrates genetic changes in nasal cells of patients who went on to develop lung cancer. Courtesy of Avrum Spiranet<\/figcaption><\/figure>\n

The problem, says Spira, is that \u201cthere is a subset of people with pulmonary lesions who do not undergo a bronchoscopy as part of their diagnostic workup,\u201d either because the suspicious lesions are very deep in the lung and inaccessible to the bronchoscope or because the patient suffers from other conditions\u2014like heart failure or emphysema\u2014that 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.<\/p>\n

To explore this possibility, Spira and Lenburg analyzed genomic changes in nasal swabs from patients recruited for the Percepta clinical trials. \u201cWe had previously collected the nasal samples,\u201d says Spira. \u201cBut 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.\u201d This proved to be true, but recent improvements in computational approaches to genomic data analysis allowed the team to find a lung cancer signal in the nasal samples. They found 535 genes that were expressed differently in the nasal passages of patients who went on to develop lung cancer, but not in patients with benign lesions. Of those genes, 30 were sufficiently distinctive to be useful as a diagnostic biomarker.<\/p>\n

The researchers say that the nasal test needs additional testing. \u201cThe people in the original study were already at substantially elevated risk for lung cancer,\u201d says Lenburg. \u201cWe need to confirm that these results are valid for a wider population.\u201d Nevertheless, the researchers hope that their findings will eventually lead to a widely used test.<\/p>\n

\u201cIn the short term, we\u2019ll use the nasal biomarker as a diagnostic test for people who have something suspicious on a CT scan of the chest, but are not undergoing bronchoscopy,\u201d says Spira. \u201cBut eventually, the nasal test could impact a lot more people as a mass screening tool for lung cancer. That\u2019s the really exciting potential.\u201d<\/p>\n<\/div>\n

This BU Today<\/em> article was written by Barbara Moran<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

BUSM researchers\u2019 genetic test may open door to easy diagnosis.<\/p>\n","protected":false},"author":903,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[91,90],"tags":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/44959"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/users\/903"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/comments?post=44959"}],"version-history":[{"count":1,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/44959\/revisions"}],"predecessor-version":[{"id":44962,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/posts\/44959\/revisions\/44962"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/media?parent=44959"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/categories?post=44959"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/camed\/wp-json\/wp\/v2\/tags?post=44959"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}