Impact of a bronchial genomic classifier on clinical decision making in patients undergoing diagnostic evaluation for lung cancer
Bronchoscopy is frequently used for the evaluation of suspicious pulmonary lesions found on computed tomography, but its sensitivity for detecting lung cancer is limited. Recently, a bronchial genomic classifier was validated to improve the sensitivity of bronchoscopy for lung cancer detection, demo...
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| Veröffentlicht in: | BMC pulmonary medicine 2016-05, Vol.16 (1), p.66-66, Article 66 |
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| creator | Ferguson, J Scott Van Wert, Ryan Choi, Yoonha Rosenbluth, Michael J Smith, Kate Porta Huang, Jing Spira, Avrum |
| description | Bronchoscopy is frequently used for the evaluation of suspicious pulmonary lesions found on computed tomography, but its sensitivity for detecting lung cancer is limited. Recently, a bronchial genomic classifier was validated to improve the sensitivity of bronchoscopy for lung cancer detection, demonstrating a high sensitivity and negative predictive value among patients at intermediate risk (10-60 %) for lung cancer with an inconclusive bronchoscopy. Our objective for this study was to determine if a negative genomic classifier result that down-classifies a patient from intermediate risk to low risk ( |
| doi_str_mv | 10.1186/s12890-016-0217-1 |
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| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4869188</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A452641696</galeid><sourcerecordid>A452641696</sourcerecordid><originalsourceid>FETCH-LOGICAL-c494t-b835f445b1c9e30d2817abbec8fd760c80be9b8fce9db367b5373ca648f3a7da3</originalsourceid><addsrcrecordid>eNptUstu3SAQtapWTZr2A7qpkLrpxikYzGNTKYr6iBQpm3SNAA8OqQ23YEfKsn9erJukSRWxAGbOOcwMp2neE3xMiOSfC-mkwi0mvMUdES150RwSJkjbMc5fPjofNG9KucaYCNnT181BJ4hkWNHD5s_ZvDNuQckjg2xO0V0FM6ERYpqDQ24ypQQfIKMU6y3E4Gp6ABdKqJHZ_ApxRCGinVkCxKWgNQ6Qx7SFh2DGmMpSheDGTGuFVI5PGU1rTTsTHeS3zStvpgLv7vaj5ue3r5enP9rzi-9npyfnrWOKLa2VtPeM9ZY4BRQPnSTCWAtO-kFw7CS2oKz0DtRgKRe2p4I6w5n01IjB0KPmy153t9oZBleLzWbSuxxmk291MkE_zcRwpcd0o5nkikhZBT7dCeT0e4Wy6DkUB9NkIqS16DpcJXrRd6RCP_4HvU5rjrW9ilKCdb2i3T_UaCbQIfpU33WbqD5hfccZ4YpX1PEzqLoGqD-UIvhQ408IZE9wOZWSwT_0SLDefKP3vtHVN3rzjd4K_vB4OA-Me6PQv-wWwFc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1797425932</pqid></control><display><type>article</type><title>Impact of a bronchial genomic classifier on clinical decision making in patients undergoing diagnostic evaluation for lung cancer</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>SpringerNature Journals</source><source>PubMed Central Open Access</source><source>Springer Nature OA Free Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Ferguson, J Scott ; Van Wert, Ryan ; Choi, Yoonha ; Rosenbluth, Michael J ; Smith, Kate Porta ; Huang, Jing ; Spira, Avrum</creator><creatorcontrib>Ferguson, J Scott ; Van Wert, Ryan ; Choi, Yoonha ; Rosenbluth, Michael J ; Smith, Kate Porta ; Huang, Jing ; Spira, Avrum</creatorcontrib><description>Bronchoscopy is frequently used for the evaluation of suspicious pulmonary lesions found on computed tomography, but its sensitivity for detecting lung cancer is limited. Recently, a bronchial genomic classifier was validated to improve the sensitivity of bronchoscopy for lung cancer detection, demonstrating a high sensitivity and negative predictive value among patients at intermediate risk (10-60 %) for lung cancer with an inconclusive bronchoscopy. Our objective for this study was to determine if a negative genomic classifier result that down-classifies a patient from intermediate risk to low risk (<10 %) for lung cancer would reduce the rate that physicians recommend more invasive testing among patients with an inconclusive bronchoscopy.
We conducted a randomized, prospective, decision impact survey study assessing pulmonologist recommendations in patients undergoing workup for lung cancer who had an inconclusive bronchoscopy. Cases with an intermediate pretest risk for lung cancer were selected from the AEGIS trials and presented in a randomized fashion to pulmonologists either with or without the patient's bronchial genomic classifier result to determine how the classifier results impacted physician decisions.
Two hundred two physicians provided 1523 case evaluations on 36 patients. Invasive procedure recommendations were reduced from 57 % without the classifier result to 18 % with a negative (low risk) classifier result (p < 0.001). Invasive procedure recommendations increased from 50 to 65 % with a positive (intermediate risk) classifier result (p < 0.001). When stratifying by ultimate disease diagnosis, there was an overall reduction in invasive procedure recommendations in patients with benign disease when classifier results were reported (54 to 41 %, p < 0.001). For patients ultimately diagnosed with malignant disease, there was an overall increase in invasive procedure recommendations when the classifier results were reported (50 to 64 %, p = 0.003).
Our findings suggest that a negative (low risk) bronchial genomic classifier result reduces invasive procedure recommendations following an inconclusive bronchoscopy and that the classifier overall reduces invasive procedure recommendations among patients ultimately diagnosed with benign disease. These results support the potential clinical utility of the classifier to improve management of patients undergoing bronchoscopy for suspect lung cancer by reducing additional invasive procedures in the setting of benign disease.</description><identifier>ISSN: 1471-2466</identifier><identifier>EISSN: 1471-2466</identifier><identifier>DOI: 10.1186/s12890-016-0217-1</identifier><identifier>PMID: 27184093</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Bronchoscopy - methods ; Care and treatment ; Clinical Decision-Making ; Clinical medicine ; Complications and side effects ; Consent ; CT imaging ; Decision making ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Gene expression ; Genomics - methods ; Humans ; Hypotheses ; Lung - diagnostic imaging ; Lung cancer ; Lung Neoplasms - classification ; Lung Neoplasms - diagnosis ; Lung Neoplasms - genetics ; Male ; Middle Aged ; Mortality ; Prospective Studies ; Pulmonology ; Reproducibility of Results ; Review boards ; Statistical analysis ; Studies ; Tomography, X-Ray Computed - methods ; Ultrasonic imaging</subject><ispartof>BMC pulmonary medicine, 2016-05, Vol.16 (1), p.66-66, Article 66</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>Ferguson et al. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-b835f445b1c9e30d2817abbec8fd760c80be9b8fce9db367b5373ca648f3a7da3</citedby><cites>FETCH-LOGICAL-c494t-b835f445b1c9e30d2817abbec8fd760c80be9b8fce9db367b5373ca648f3a7da3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869188/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869188/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27184093$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferguson, J Scott</creatorcontrib><creatorcontrib>Van Wert, Ryan</creatorcontrib><creatorcontrib>Choi, Yoonha</creatorcontrib><creatorcontrib>Rosenbluth, Michael J</creatorcontrib><creatorcontrib>Smith, Kate Porta</creatorcontrib><creatorcontrib>Huang, Jing</creatorcontrib><creatorcontrib>Spira, Avrum</creatorcontrib><title>Impact of a bronchial genomic classifier on clinical decision making in patients undergoing diagnostic evaluation for lung cancer</title><title>BMC pulmonary medicine</title><addtitle>BMC Pulm Med</addtitle><description>Bronchoscopy is frequently used for the evaluation of suspicious pulmonary lesions found on computed tomography, but its sensitivity for detecting lung cancer is limited. Recently, a bronchial genomic classifier was validated to improve the sensitivity of bronchoscopy for lung cancer detection, demonstrating a high sensitivity and negative predictive value among patients at intermediate risk (10-60 %) for lung cancer with an inconclusive bronchoscopy. Our objective for this study was to determine if a negative genomic classifier result that down-classifies a patient from intermediate risk to low risk (<10 %) for lung cancer would reduce the rate that physicians recommend more invasive testing among patients with an inconclusive bronchoscopy.
We conducted a randomized, prospective, decision impact survey study assessing pulmonologist recommendations in patients undergoing workup for lung cancer who had an inconclusive bronchoscopy. Cases with an intermediate pretest risk for lung cancer were selected from the AEGIS trials and presented in a randomized fashion to pulmonologists either with or without the patient's bronchial genomic classifier result to determine how the classifier results impacted physician decisions.
Two hundred two physicians provided 1523 case evaluations on 36 patients. Invasive procedure recommendations were reduced from 57 % without the classifier result to 18 % with a negative (low risk) classifier result (p < 0.001). Invasive procedure recommendations increased from 50 to 65 % with a positive (intermediate risk) classifier result (p < 0.001). When stratifying by ultimate disease diagnosis, there was an overall reduction in invasive procedure recommendations in patients with benign disease when classifier results were reported (54 to 41 %, p < 0.001). For patients ultimately diagnosed with malignant disease, there was an overall increase in invasive procedure recommendations when the classifier results were reported (50 to 64 %, p = 0.003).
Our findings suggest that a negative (low risk) bronchial genomic classifier result reduces invasive procedure recommendations following an inconclusive bronchoscopy and that the classifier overall reduces invasive procedure recommendations among patients ultimately diagnosed with benign disease. These results support the potential clinical utility of the classifier to improve management of patients undergoing bronchoscopy for suspect lung cancer by reducing additional invasive procedures in the setting of benign disease.</description><subject>Bronchoscopy - methods</subject><subject>Care and treatment</subject><subject>Clinical Decision-Making</subject><subject>Clinical medicine</subject><subject>Complications and side effects</subject><subject>Consent</subject><subject>CT imaging</subject><subject>Decision making</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gene expression</subject><subject>Genomics - methods</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Lung - diagnostic imaging</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - classification</subject><subject>Lung Neoplasms - diagnosis</subject><subject>Lung Neoplasms - genetics</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Prospective Studies</subject><subject>Pulmonology</subject><subject>Reproducibility of Results</subject><subject>Review boards</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Ultrasonic imaging</subject><issn>1471-2466</issn><issn>1471-2466</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptUstu3SAQtapWTZr2A7qpkLrpxikYzGNTKYr6iBQpm3SNAA8OqQ23YEfKsn9erJukSRWxAGbOOcwMp2neE3xMiOSfC-mkwi0mvMUdES150RwSJkjbMc5fPjofNG9KucaYCNnT181BJ4hkWNHD5s_ZvDNuQckjg2xO0V0FM6ERYpqDQ24ypQQfIKMU6y3E4Gp6ABdKqJHZ_ApxRCGinVkCxKWgNQ6Qx7SFh2DGmMpSheDGTGuFVI5PGU1rTTsTHeS3zStvpgLv7vaj5ue3r5enP9rzi-9npyfnrWOKLa2VtPeM9ZY4BRQPnSTCWAtO-kFw7CS2oKz0DtRgKRe2p4I6w5n01IjB0KPmy153t9oZBleLzWbSuxxmk291MkE_zcRwpcd0o5nkikhZBT7dCeT0e4Wy6DkUB9NkIqS16DpcJXrRd6RCP_4HvU5rjrW9ilKCdb2i3T_UaCbQIfpU33WbqD5hfccZ4YpX1PEzqLoGqD-UIvhQ408IZE9wOZWSwT_0SLDefKP3vtHVN3rzjd4K_vB4OA-Me6PQv-wWwFc</recordid><startdate>20160517</startdate><enddate>20160517</enddate><creator>Ferguson, J Scott</creator><creator>Van Wert, Ryan</creator><creator>Choi, Yoonha</creator><creator>Rosenbluth, Michael J</creator><creator>Smith, Kate Porta</creator><creator>Huang, Jing</creator><creator>Spira, Avrum</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160517</creationdate><title>Impact of a bronchial genomic classifier on clinical decision making in patients undergoing diagnostic evaluation for lung cancer</title><author>Ferguson, J Scott ; Van Wert, Ryan ; Choi, Yoonha ; Rosenbluth, Michael J ; Smith, Kate Porta ; Huang, Jing ; Spira, Avrum</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-b835f445b1c9e30d2817abbec8fd760c80be9b8fce9db367b5373ca648f3a7da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Bronchoscopy - methods</topic><topic>Care and treatment</topic><topic>Clinical Decision-Making</topic><topic>Clinical medicine</topic><topic>Complications and side effects</topic><topic>Consent</topic><topic>CT imaging</topic><topic>Decision making</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gene expression</topic><topic>Genomics - methods</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Lung - diagnostic imaging</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - classification</topic><topic>Lung Neoplasms - diagnosis</topic><topic>Lung Neoplasms - genetics</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Prospective Studies</topic><topic>Pulmonology</topic><topic>Reproducibility of Results</topic><topic>Review boards</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferguson, J Scott</creatorcontrib><creatorcontrib>Van Wert, Ryan</creatorcontrib><creatorcontrib>Choi, Yoonha</creatorcontrib><creatorcontrib>Rosenbluth, Michael J</creatorcontrib><creatorcontrib>Smith, Kate Porta</creatorcontrib><creatorcontrib>Huang, Jing</creatorcontrib><creatorcontrib>Spira, Avrum</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC pulmonary medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferguson, J Scott</au><au>Van Wert, Ryan</au><au>Choi, Yoonha</au><au>Rosenbluth, Michael J</au><au>Smith, Kate Porta</au><au>Huang, Jing</au><au>Spira, Avrum</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of a bronchial genomic classifier on clinical decision making in patients undergoing diagnostic evaluation for lung cancer</atitle><jtitle>BMC pulmonary medicine</jtitle><addtitle>BMC Pulm Med</addtitle><date>2016-05-17</date><risdate>2016</risdate><volume>16</volume><issue>1</issue><spage>66</spage><epage>66</epage><pages>66-66</pages><artnum>66</artnum><issn>1471-2466</issn><eissn>1471-2466</eissn><abstract>Bronchoscopy is frequently used for the evaluation of suspicious pulmonary lesions found on computed tomography, but its sensitivity for detecting lung cancer is limited. Recently, a bronchial genomic classifier was validated to improve the sensitivity of bronchoscopy for lung cancer detection, demonstrating a high sensitivity and negative predictive value among patients at intermediate risk (10-60 %) for lung cancer with an inconclusive bronchoscopy. Our objective for this study was to determine if a negative genomic classifier result that down-classifies a patient from intermediate risk to low risk (<10 %) for lung cancer would reduce the rate that physicians recommend more invasive testing among patients with an inconclusive bronchoscopy.
We conducted a randomized, prospective, decision impact survey study assessing pulmonologist recommendations in patients undergoing workup for lung cancer who had an inconclusive bronchoscopy. Cases with an intermediate pretest risk for lung cancer were selected from the AEGIS trials and presented in a randomized fashion to pulmonologists either with or without the patient's bronchial genomic classifier result to determine how the classifier results impacted physician decisions.
Two hundred two physicians provided 1523 case evaluations on 36 patients. Invasive procedure recommendations were reduced from 57 % without the classifier result to 18 % with a negative (low risk) classifier result (p < 0.001). Invasive procedure recommendations increased from 50 to 65 % with a positive (intermediate risk) classifier result (p < 0.001). When stratifying by ultimate disease diagnosis, there was an overall reduction in invasive procedure recommendations in patients with benign disease when classifier results were reported (54 to 41 %, p < 0.001). For patients ultimately diagnosed with malignant disease, there was an overall increase in invasive procedure recommendations when the classifier results were reported (50 to 64 %, p = 0.003).
Our findings suggest that a negative (low risk) bronchial genomic classifier result reduces invasive procedure recommendations following an inconclusive bronchoscopy and that the classifier overall reduces invasive procedure recommendations among patients ultimately diagnosed with benign disease. These results support the potential clinical utility of the classifier to improve management of patients undergoing bronchoscopy for suspect lung cancer by reducing additional invasive procedures in the setting of benign disease.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27184093</pmid><doi>10.1186/s12890-016-0217-1</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Bronchoscopy - methods Care and treatment Clinical Decision-Making Clinical medicine Complications and side effects Consent CT imaging Decision making Diagnosis, Differential Female Follow-Up Studies Gene expression Genomics - methods Humans Hypotheses Lung - diagnostic imaging Lung cancer Lung Neoplasms - classification Lung Neoplasms - diagnosis Lung Neoplasms - genetics Male Middle Aged Mortality Prospective Studies Pulmonology Reproducibility of Results Review boards Statistical analysis Studies Tomography, X-Ray Computed - methods Ultrasonic imaging |
| title | Impact of a bronchial genomic classifier on clinical decision making in patients undergoing diagnostic evaluation for lung cancer |
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