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J Thorac Cardiovasc Surg 2009;138:474-479
© 2009 The American Association for Thoracic Surgery

Evolving Technology/Basic Science

Gene expression analysis of endobronchial epithelial lining fluid in the evaluation of indeterminate pulmonary nodules

^a Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Germany
^b Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany
^c Translational Research Unit, Thoraxklinik, University of Heidelberg, Germany
^d Division of Clinical Chemistry and Microbiology, Thoraxklinik, University of Heidelberg, Germany
^e Division of Molecular Genome Analysis, German Cancer Research Center, Heidelberg, Germany
^f Institute of Pathology, University of Heidelberg, Germany
^g Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

Received for publication December 22, 2008; revisions received March 12, 2009; accepted for publication April 23, 2009.

^_* Address for reprints: Ruprecht Kuner, PhD, Division of Molecular Genome Analysis, German Cancer Research Center, Im Neuenheimer Feld 580, 69120 Heidelberg, Germany. (Email: r.kuner{at}dkfz.de).

Objective: Making a definitive preoperative diagnosis in patients with indeterminate pulmonary nodules is still a challenge. Gene expression profiling may be a useful adjunctive diagnostic utility in this regard. We investigated the feasibility of bronchoscopic microsampling to collect endobronchial epithelial lining fluid to obtain RNA as a starting point for gene expression profiling.

Methods: In 15 patients, epithelial lining fluid was collected in triplicate from subsegmental bronchi close to the pulmonary nodules and from contralateral lungs. Diagnosis was confirmed by transbronchial biopsy or surgery (non–small cell lung cancer, n = 11; benign or other lesions, n = 4). Total RNA was isolated from the samples and evaluated concerning quantity and quality. The complementary DNA was generated and analyzed by quantitative real-time polymerase chain reaction for potential lung cancer associated genes like matrix metalloprotinase (MMP9).

Results: Total RNA of adequate amount (>0.8 µg) and sufficient quality was obtained in 13 (86%) of the 15 patients. In patients with lung cancer, normalized MMP9 gene expression levels in endobronchial lining fluid samples collected close to the lesions were in median 12 times higher than levels in the matching contralateral samples. MMP9 expression levels were particularly high in endobronchial lining fluid samples collected from patients with squamous cell carcinoma but not elevated in the case of benign lesions.

Conclusions: Our results show that quantitative gene expression analysis of endobronchial lining fluid collected by bronchoscopic microsampling is both feasible and reliable and may therefore be a useful additional diagnostic method in patients with indeterminate pulmonary nodules.