A Comparative Study on Ferritin Concentration in Serum and Bilateral Bronchoalveolar Lavage Fluid of Patients with Peripheral Lung Cancer versus Control Subjects

Abstract

Objectives: To assess the diagnostic value of bronchoalveolar lavage fluid (BALF) ferritin as a lung tumor marker by comparing serum and BALF ferritin concentrations in patients with peripheral lung cancer versus control subjects with benign lung disease, and to examine the theory of ferritin compartmentalization around the tumor area by comparing ferritin concentrations in serum and bilateral (affected and unaffected side) BALF in cancer patients. Methods: Four groups of patients were investigated: 10 control nonsmokers, 10 control smokers, 10 smokers with chronic obstructive pulmonary disease (COPD), and 22 patients with primary bronchogenic carcinoma. A bronchoalveolar lavage (BAL) was performed in all subjects (both sides in 13 oncological patients, one side in the others) and samples of BALF and blood were submitted to biochemical analysis. Results: As a lung tumor marker, BALF ferritin showed 54% sensitivity and 93% specificity and serum ferritin 22% sensitivity and 93% specificity. A significant difference was observed between the two sides in the cancer patients (p = 0.033), and between BALF ferritin from the affected side and COPD patients (p = 0.025). Greater differences were obtained when BALF ferritin in the affected side of cancer patients was compared with values in both control nonsmokers (p < 0.0001) and control smokers (p < 0.001). Conclusions: These findings seem to confirm the relative diagnostic value of BALF ferritin as a lung tumor marker and the theory of ferritin compartmentalization. However, further studies are required to clarify the relations between iron and ferritin on the one hand and inflammation, tumorigenesis and host response on the other.

Could exhaled ferritin and SOD be used as markers for lung cancer and prognosis prediction purposes?

“…Both ferritin and SOD have been measured in serum, BAL and pleural effusion of patients with lung cancer [4–6,8,9,18,21]. In accordance with previous results, we also described an increase in ferritin and SOD concentrations in the serum of patients with NSCLC compared with controls [4–6,8,9,18,21].…”

“…In accordance with the recent theory of ferritin compartmentalization around the tumour area previously confirmed by Fracchia et al. [6], this protein was also measured in samples from airways such as bronchoalveolar lavage (BAL) and bronchial secretion [4–6]. Ferritin was also studied in pleural essudate from metastatic carcinoma where it was seen to be elevated [9].…”

The “Iron”-y of Iron Overload and Iron Deficiency in Chronic Obstructive Pulmonary Disease

“…Regulating extracellular free iron levels in the lung, numerous soluble iron-related proteins or carriers are found in BAL fluid, including transferrin (one of the most abundant BAL proteins [44.5%]) (34), ferritin (35), lactoferrin (a glycoprotein belonging to the transferrin family that sequesters iron) (36), ceruloplasmin (a ferroxidase that oxidizes iron to the Fe 31 state) (37), and lipocalin 2 (a siderophore that sequesters iron) (38), all of which are thought to be produced by secretory leukocytes, epithelial cells (EPIs), and/or ECs. Lung EPIs, AMs, and ECs transport iron out of the cell via the transmembrane iron transporter ferroportin (also known as SLC40A1) (39; Figure 1).…”

“…As is true of smokers, iron content and iron-binding molecules, including ferritin, lipocalin 2, and lactoferrin, are all increased in the lung tissue, sputum, BAL fluid, and AMs of patients with COPD (20,35,38,51,53,55). Iron levels increase with disease severity and with reductions in lung function.…”

The Contribution of Bronchoalveolar Lavage Performed Before and After Bronchoscopic Biopsies to the Diagnosis of Peripheral Lung Cancer

“…6-10 Bronchoalveolar lavage is not only a diagnostic procedure but also a procedure that many tumor markers and other parameters are being searched. 11,12 In the study, it was aimed to assess the contribution of BAL performed before and after standard biopsy procedures in the diagnosis of peripheral lung cancer.…”