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Jiang N, Zhou J, Zhang W, Li P, Liu Y, Shi H, Zhang C, Wang Y, Zhou C, Peng C, Zhang W, Hao Y, Sun Q, Li Y, Zhao X. RNF213 gene mutation in circulating tumor DNA detected by targeted next-generation sequencing in the assisted discrimination of early-stage lung cancer from pulmonary nodules. Thorac Cancer 2020; 12:181-193. [PMID: 33200540 PMCID: PMC7812078 DOI: 10.1111/1759-7714.13741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 01/04/2023] Open
Abstract
Background To distinguish early‐stage lung cancer from benign disease in pulmonary nodules, especially lesions with ground‐glass opacity (GGO), we assessed gene mutations of ctDNA in peripheral blood using targeted next‐generation sequencing (NGS). Methods Single pulmonary nodule patients without mediastinal lymph nodes and symptoms that were hard to diagnose by chest CT and lung cancer biomarker measurement in multiple medical centers were enrolled into the study. All patients accepted minimally invasive surgery but refused preoperative biopsy. Gene mutations in preoperative blood samples were detected by targeted NGS. Mutations with significant differences between lung tumors and benign lesions, as grouped by postoperative pathology, were screened. Protein expression was determined by immunohistochemistry. Highly expressed genes were selected as biomarkers to verify the mutations in peripheral blood. Results In the training set, the RNF213, KMT2D, CSMD3 and LRP1B genes were mutated more frequently in early‐stage lung cancer (27 cases) than in benign nodules (15 cases) (P < 0.05). High expression of the RNF213 gene in lung cancers and low expression in benign diseases were seen by immunohistochemistry. The RNF213 gene was mutated in 25% of lung cancer samples in the validation set of 28 samples and showed high specificity (100%). In GGO patients, RNF213 was mutated more frequently in early‐stage lung cancer compared to benign diseases (P < 0.05). Conclusions RNF213 gene mutations were observed more frequently in early‐stage lung cancer, but not in benign nodules. Mutation of the RNF213 gene in peripheral blood may be a high specificity biomarker for the assisted early diagnosis of lung cancer in pulmonary nodules. Key points Significant findings of the study: In peripheral venous blood and tumor tissue, RNF213 gene mutated more frequently in lung cancer than benign pulmonary nodules. What this study adds: Detection mutation of the RNF213 gene in peripheral blood may be a high specificity method for the assisted early diagnosis of lung cancer in pulmonary nodules.
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Affiliation(s)
- Ning Jiang
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China.,Key Laboratory of Chest Cancer, Shandong University, Jinan, China
| | - Jie Zhou
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenhao Zhang
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peichao Li
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yu Liu
- Department of Thoracic Surgery, The 960th Hospital of People's Liberation Army of China, Jinan, China
| | - Hubo Shi
- Department of Thoracic Surgery, Shandong Provincial Chest Hospital, Jinan, China
| | - Chengke Zhang
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China.,Key Laboratory of Chest Cancer, Shandong University, Jinan, China
| | - Yunshan Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, China
| | - Chengjun Zhou
- Pathology Department, The Second Hospital of Shandong University, Jinan, China
| | - Chuanliang Peng
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China.,Key Laboratory of Chest Cancer, Shandong University, Jinan, China
| | - Weiquan Zhang
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China.,Key Laboratory of Chest Cancer, Shandong University, Jinan, China
| | - Yingtao Hao
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China.,Key Laboratory of Chest Cancer, Shandong University, Jinan, China
| | - Qifeng Sun
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute, Shandong University, Jinan, China
| | - Xiaogang Zhao
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China.,Key Laboratory of Chest Cancer, Shandong University, Jinan, China
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Gilbert CR, Carlson AS, Wilshire CL, Aye RW, Farivar AS, Bograd AJ, Gorden JA. The decision to biopsy in a lung cancer screening program: Potential impact of risk calculators. J Med Screen 2018; 26:50-56. [PMID: 30419779 DOI: 10.1177/0969141318811362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The National Lung Screening Trial demonstrated the benefits of lung cancer screening, but the potential high incidence of unnecessary invasive testing for ultimately benign radiologic findings causes concern. We aimed to review current biopsy patterns and outcomes in our community-based program, and retrospectively apply malignancy prediction models in a lung cancer screening population, to identify the potential impact these calculators could have on biopsy decisions. METHODS Retrospective review of lung cancer-screening program participants from 2013 to 2016. Demographic, biopsy, and outcome data were collected. Malignancy risk calculators were retrospectively applied and results compared in patients with positive imaging findings. RESULTS From 520 individuals enrolled in the screening program, pulmonary nodule(s) ≥6 mm were identified in 166, with biopsy in 30. Malignancy risk probabilities were significantly higher (Brock p < 0.00001; Mayo p < 0.00001) in those undergoing diagnostic sampling than those not undergoing sampling. However, there was no difference in the Brock ( p = 0.912) or Mayo ( p = 0.435) calculators when discriminating a final diagnosis of cancer from not cancer in those undergoing sampling. CONCLUSIONS In our screening program, 5.7% of individuals undergo invasive testing, comparable with the National Lung Screening Trial (6.1%). Both Brock and Mayo calculators perform well in indicating who may be at risk of malignancy, based on clinical and radiologic factors. However, in our invasive testing group, the Brock and Mayo calculators and Lung Cancer Screening Program clinical assessment all lacked clarity in distinguishing individuals who have a cancer from those with a benign abnormality.
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Affiliation(s)
- Christopher R Gilbert
- 1 Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA
| | | | - Candice L Wilshire
- 1 Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA
| | - Ralph W Aye
- 1 Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA
| | - Alexander S Farivar
- 1 Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA
| | - Adam J Bograd
- 1 Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA
| | - Jed A Gorden
- 1 Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA
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