McGann, Kevin C., Khalil, Timothy A., Kammer, Michael N., Ostrin, Edwin Justin, Pass, Harvey Ira, Tsay, Junchieh J., Segal, Leopoldo N., Potter, Melissa, Deppen, Stephen A., & Maldonado, Fabien. (2025). Biomarkers for the diagnosis of indeterminate pulmonary nodules: are we there yet? Journal of Thoracic Disease, 17(8). https://doi.org/10.21037/jtd-2024-2010
Indeterminate pulmonary nodules (IPNs) are lung nodules that cannot be clearly identified as benign or malignant at the time they are found, and millions are diagnosed each year. How best to manage IPNs is still debated, with current practice relying on a mix of overall clinical risk assessment and additional diagnostic tests or procedures that can bring significant risk, cost, and anxiety. Biomarkers—tests or indicators based on biology—can provide valuable information about normal or disease processes that are not otherwise easy for clinicians to assess. Accurate biomarkers can act as reliable stand-ins for detecting abnormal biology and, importantly, may reveal early disease before it becomes clinically obvious.
In the case of IPNs, the development of biomarkers aims to provide noninvasive tools that can help reduce diagnostic uncertainty. Effective diagnostic biomarkers could improve clinical management, allow earlier treatment when necessary, and reduce the need for extra, and sometimes unnecessary, testing. This review highlights the role of biomarkers in diagnosing IPNs, explains the process of developing successful biomarkers, and discusses current research, ongoing challenges, and future directions in the field.
