B80-4-06 Proteomic-based Risk Stratification of Pulmonary Nodules: Insights From Kings County Hospital

Abstract Introduction An estimated 1.6 million individuals are diagnosed with pulmonary nodules (PNs) annually in the United States. Management depends on the pretest probability of malignancy (pCA), which integrates patient risk factors and nodule characteristics. For nodules with pCA ≥ 5 to 65%, decisions between continued surveillance and tissue biopsy remain complex. Proteomic assays, including Nodify CDT and XL2, measure cancer-associated autoantibodies and proteins, respectively, and help refine the pCA. We present our data on PNs evaluated using Nodify testing at the Kings County Hospital (KCH) pulmonary clinic. Methods A retrospective study was conducted on patients with PNs measuring 8-30 mm who underwent Nodify testing between September 2022 and August 2025 at the KCH pulmonary clinic. The Mayo Clinic Pulmonary Nodule Calculator was used to estimate the pCA. Patients with a cancer diagnosis within the past five years, except for non-melanomatous skin cancer, were excluded. Patient risk factors, nodule characteristics, pre- and post-test risk stratification, and outcomes were analyzed. Results Among 33 patients (15 males, 18 females; mean age, 64.4 ± 11.4 years), 45.5% were current or former smokers. Nodules were spiculated in 42.4% of cases, 45.5% in upper lobe location, 60.6% were multiple nodules, and 15.2% had associated lymphadenopathy. Of these, 78.7% were solid, 15.2% part-solid, and 6 .1% ground-glass. Associated parenchymal findings included emphysema (36.4%), fibrosis (9.1%), and both (3%). The mean nodule size was 12.5 ± 3.9 mm, with mean pre- and post-test risk of 22.6 ± 17.0 and 20.1 ± 21.1, respectively. Seven patients (21.2%) had a CDT hit, reclassifying (6 moderate, 1 high risk). Among patients with no significant levels of autoantibodies (NSLAD), 19/26 (73.1%) had a reduction in risk based on XL2 testing. Conclusions The study demonstrated a reduction in mean post-test risk. 21.2% of patients showed an increased risk, while 73.1% of those without significant autoantibodies had risk reduction. These findings supported informed, shared decision-making between surveillance and invasive management. This abstract is funded by: None