Using markers of endemic fungal infection to predict malignancy in lung nodules identified on screening CT
Principal Investigator
Name
Laszlo Vaszar
Degrees
MD
Institution
Mayo Clinic Arizona
Position Title
Assistant Professor of Medicine, Mayo Clinic College of Medicine
Email
About this CDAS Project
Study
NLST
(Learn more about this study)
Project ID
NLST-205
Initial CDAS Request Approval
Apr 13, 2016
Title
Using markers of endemic fungal infection to predict malignancy in lung nodules identified on screening CT
Summary
The vast majority of pulmonary nodules detected on lung cancer screening CTs are due to benign causes such as granulomatous infections.
In the United States, environmental fungi such as Histoplasma and Coccidioides species are the most common causes of granulomas. Coccidioides sp. are endemic in the American desert southwest, causing an estimated 150,000 new infections each year in permanent and seasonal residents and tourists, and its incidence is increasing. Due to the seasonal (winter) population movements among retirees, many Americans whose primary residence is outside of the prevalence area are exposed to Coccidioides. Histoplasma capsulatum is a fungus that is present worldwide in bird and bat droppings, but is, additionally, endemic in the soil in the Midwestern and eastern US states, where 60-90% of the population has likely undergone subclinical infection (as suggested by positive skin testing). The primary pulmonary infection caused by these fungi is often asymptomatic, and 5-10% of patients are left with pulmonary sequelae, that are usually nodular. These nodules will reduce the specificity of future lung cancer screening CTs.
In the United States, environmental fungi such as Histoplasma and Coccidioides species are the most common causes of granulomas. Coccidioides sp. are endemic in the American desert southwest, causing an estimated 150,000 new infections each year in permanent and seasonal residents and tourists, and its incidence is increasing. Due to the seasonal (winter) population movements among retirees, many Americans whose primary residence is outside of the prevalence area are exposed to Coccidioides. Histoplasma capsulatum is a fungus that is present worldwide in bird and bat droppings, but is, additionally, endemic in the soil in the Midwestern and eastern US states, where 60-90% of the population has likely undergone subclinical infection (as suggested by positive skin testing). The primary pulmonary infection caused by these fungi is often asymptomatic, and 5-10% of patients are left with pulmonary sequelae, that are usually nodular. These nodules will reduce the specificity of future lung cancer screening CTs.
Aims
We have developed a risk prediction model for pulmonary nodules that includes (in addition to the demographic and clinical predictors published previously) radiographic markers of endemic fungal infections and we aim to test it in the NSLT data set.
Collaborators
David E. Midthun, M.D., Professor of Medicine, Mayo Clinic College of Medicine
Fabien Maldonado, M.D., Assistant Professor of Medicine, Vanderbilt University School of Medicine