To help guide treatment decision making, accurate assessment of the probability of lung cancer is critically important in patients with pulmonary nodules also known as lung nodules. [1]

Clinical validation data published in the journal CHEST shows that Veracyte’s ’s Percepta Nasal Swab test determines lung cancer risk, with high accuracy, among people who currently smoke or have previously smoked and have lung nodules.

The findings suggest that the novel, non-invasive genomic test can help physicians guide next steps for these patients, enabling them to potentially avoid unnecessary invasive procedures or accelerate time to appropriate treatment.

Leading cause of cancer death
Lung cancer is the leading cause of cancer death worldwide. Lung nodules are an early indicator of lung cancer and are typically found using computed tomography (CT) scans. In the United States, approximately 15 million people are eligible for annual lung cancer screening with low-dose CT scans based on their smoking history and other factors and currently an estimated 1.6 million lung nodules are found incidentally each year in patients being evaluated with a CT scan for an unrelated condition. While most lung nodules are not cancerous, their detection can result in unnecessary diagnostic procedures and anxiety for patients. At the same time, early detection of cancerous nodules can lead to better patient outcomes.

“Physicians need an objective, accurate tool to help guide care for patients when a lung nodule is found on a CT scan,” explained Bill Bulman, M.D., Veracyte’s medical director for Pulmonology and an author on the CHEST manuscript.

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“Our findings reinforce the ability of the Percepta Nasal Swab test to improve risk assessment of lung nodules and help avoid unnecessary diagnostic procedures for those at low risk of cancer while supporting timely diagnosis and treatment for those with high risk of cancer,” Bulman added.

Simple and non-invasive
Veracyte’s Percepta Nasal Swab test is a genomic test which uses a simple, non-invasive nasal brushing to objectively assess cancer risk in lung nodules found on computed tomography (CT) scans.- The test can be done in the physician’s office and is designed to assess lung cancer risk in patients who currently smoke or have previously smoked and have lung nodules found on CT scans. The test reports whether a patient has a high-, moderate- or low-risk for lung cancer, providing insights to help physicians objectively determine and identify which patients with lung nodules may need to proceed to further diagnostic workup and appropriate treatment and which patients may only require simply monitoring with imaging. In turn, this may potentially help in avoiding unnecessary invasive procedures. [1][2]

The test evaluates genomic changes associated with lung cancer that can be found in the nasal passages of current and former smokers. [2] The Percepta Nasal Swab is currently available to hospitals and clinics that are participating in Veracyte’s NIGHTINGALE trial to assess the impact of its use on patient care.

Study design
For the study published in CHEST, researchers used the Percepta Nasal Swab test, which was trained on a cohort of 1,120 patients with lung nodules that were either malignant or benign, to evaluate nasal samples from an independent cohort of 312 eligible patients followed for at least 12 months or until a final diagnosis of benign or malignant was determined.

Results demonstrate that the Percepta Nasal Swab test is highly accurate in identifying patients with low-risk nodules (97% sensitivity, with 40% specificity). This high sensitivity provides a negative predictive value, or NPV, of 98% in a population with a 25% cancer prevalence, meaning the test could assist physicians in avoiding unnecessary invasive procedures in patients with a benign nodule, with a very small risk of missing a cancer.

Similarly, researchers found that the test is highly accurate in identifying patients with high-risk nodules (92% specificity, with 57% sensitivity). This high specificity provides a positive predictive value, or PPV, of 70% in a population with a 25% cancer prevalence, meaning the test could assist physicians in directing these patients to further procedures so they could obtain an accurate diagnosis and speed time to treatment, if necessary.

Consistent high performance
The Percepta Nasal Swab test had consistently high performance across various groups of patients within the study cohort, including those with prior cancers and different lung cancer subtypes, lung nodule sizes (including nodules <8 mm), smoking histories and lung cancer screening eligibility, suggesting the test’s potential clinical value in a wide range of patients. In contrast, currently available physician risk calculators were developed with specific patient populations in mind and tend to perform unevenly across different types of patients.

“We believe our Percepta Nasal Swab test can be paradigm-changing in the evaluation of lung cancer risk among patients with lung nodules,” Bulman noted

“By helping to guide next steps for physicians and their patients, we aim to help make lung nodule evaluation, including through lung cancer screening programs, more efficient and effective.”

Machine learning
Veracyte’s Percepta Nasal Swab test was developed with RNA whole-transcriptome sequencing and machine-learning technology. It utilizes foundational “field of injury” science, which evaluates genomic changes associated with lung cancer that can be found in epithelial cells in the nasal passages of current and former smokers

The publication of the Percepta Nasal Swab test clinical validation study is an important step in Veracyte’s journey toward securing payer reimbursement for the test, prior to the test being made widely available. Additionally, the company is currently conducting a prospective clinical utility study, known as NIGHTINGALE, at hospitals and clinics around the United States to demonstrate the test’s ability to improve patient care and outcomes.

[1] Lamb CR, Rieger-Christ KM, Reddy C, Huang J, Ding J, Johnson M, Walsh PS, Bulman WA, Lofaro LR, Wahidi MM, Feller-Kopman DJ, Spira A, Kennedy GC, Mazzone PJ. A Nasal Swab Classifier to Evaluate the Probability of Lung Cancer in Patients with Pulmonary Nodules. Chest. 2023 Nov 27:S0012-3692(23)05828-2. doi: 10.1016/j.chest.2023.11.036. Epub ahead of print. PMID: 38030063.
[2] Lamb C. Oral presentation at CHEST Annual Meeting. October 2021. Virtual format.
[3] AEGIS Study Team. Shared Gene Expression Alterations in Nasal and Bronchial Epithelium for Lung Cancer Detection. J Natl Cancer Inst. 2017 Jul 1;109(7):djw327. doi: 10.1093/jnci/djw327. PMID: 28376173; PMCID: PMC6059169.

Featured image by Robina Weermeijer on Unsplash. Used with permission.

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