Molecular Predictors of Cancer in Patients at High Risk of Lung Cancer

OBJECTIVES:

* To use fixed lung tissue for histological evaluation and fresh tissue samples for molecular studies to study DNA, RNA, and protein abnormalities in lung preneoplastic and neoplastic lesions.
* To use proteomic techniques, including matrix-assisted laser desorption ionization-mass spectrometry (MALDI-MS), to develop a method of diagnosing and staging both pre-invasive and invasive lesions, using less invasive methods.

OUTLINE: Blood, urine, nasal cell, and sputum samples are collected. Lung tissue samples are also collected using fluorescence bronchoscopy and epithelial cell collection.

Samples are studied by genetic and proteomic analyses, including comparative genomic hybridization, expression microarray, and protein profiling.

• comparative genomic hybridization (Genetic): Collection of sputum, blood, urine, and a small amount of lung tissue.
• gene expression microarray analysis (Genetic): Collection of sputum, blood, urine, and a small amount of lung tissue.
• proteomic profiling analysis (Genetic): Collection of sputum, blood, urine, and a small amount of lung tissue.
• biologic sample preservation procedure (Other): Collection of sputum, blood, urine, and a small amount of lung tissue.
• nasal brushing (Procedure): Using a brush, superficial cells are removed from the nose.
• Blood draw (Procedure): Venous blood will be collected
• Urine collection (Procedure): Subjects will be asked to provide a urine specimen.
• sputum sample (Procedure): Prior to their bronchoscopy, subjects will be asked for a sputum specimen. This is a collection of mucous that you cough up.
• fluorescence bronchoscopy with airway biopsy (Procedure): A flexible tube attached to a fluorescent light source will be inserted into the subject's mouth or nose to reach the airway. Samples of the lining of the airway will be taken, as well as bronchial secretions and epithelial cell from brushings of the lining of the airway.
• fine needle aspiration of the lung (Procedure): A small needle is inserted into the lung to collect tissue. This procedure will only be performed if the patient's physician orders it.
• thoracentesis (Procedure): A small needle is inserted into the patient's lung cavity and a small amount of fluid is collected. This procedure will only be performed if the patient's physician orders it.

Primary outcomes

• To quantitate the molecular changes during lung cancer development [After collection of designated samples]: As a part of the study nasal brushing specimens, sputum, blood, urine, and a small amount of other tissue will be collected during standard of care procedures (bronchial epithelial, trans-thoracic fine needle aspiration (FNA) and thoracentesis as part of patient work up. Clinical diagnosis is the primary goal of the procedure. All the research specimens are collected after the primary goal of the procedure is met.

Secondary outcomes

• Develop a method to diagnose and stage pre-invasive and invasive lesions [After collection of designated samples]: Use of proteomic techniques in the laboratory to find a method of diagnosing lung tissue as benign or malignant rather than relying on invasive open-chest surgery for a diagnosis

Sex: All, ages: 18 Years to any

Inclusion Criteria:

-All adults referred to Vanderbilt Medical Center, Veterans Administration Medical Center, St. Thomas Hospital and Meharry Medical Center for evaluation of signs or symptoms of lung cancer.

Exclusion Criteria:

* Inability to provide informed consent
* Minors
* Pregnant women

• Fabien Maldonado, MD, Study chair, Vanderbilt-Ingram Cancer Center

NIH grants: P30CA068485