We evaluated the aberrant promoter methylation profile of a panel of 3 genes in DNA from tumor and sputum samples, in view of a complementary approach to spiral computed tomography (CT) for early diagnosis of lung cancer. The aberrant promoter methylation of RARb2, p16 INK4A and RASSF1A genes was evaluated by methylation-specific PCR in tumor samples of 29 CTdetected lung cancer patients, of which 18 had tumor-sputum pairs available for the analysis, and in the sputum samples from 112 cancer-free heavy smokers enrolled in a spiral CT trial. In tumor samples from 29 spiral CT-detected patients, promoter hypermethylation was identified in 19/29 (65.5%) cases for RARb2, 12/29 (41.4%) for p16 INK4A and 15/29 (51.7%) for RASSF1A. Twenty-three of twenty-nine (79.3%) samples of the tumors exhibited methylation in at least 1 gene. In the sputum samples of 18 patients, methylation was detected in 8/18 (44.4%) for RARb2 and 1/18 (5%) for both RASSF1A and p16 INK4A . At least 1 gene was methylated in 9/18 (50%) sputum samples. Promoter hypermethylation in sputum from 112 cancer-free smokers was observed in 58/112 (51.7%) for RARb2 and 20/112 (17.8%) for p16, whereas methylation of the RASSF1A gene was found in only 1/112 (0.9%) sputum sample. Our study indicates that a high frequency of hypermethylation for RARb2, p16 INK4A and RASSF1A promoters is present in spiral CT-detected tumors, whereas promoter hypermethylation of this panel of genes in uninduced sputum has a limited diagnostic value in early lung cancer detection. ' 2005 Wiley-Liss, Inc.Key words: lung cancer; methylation; sputum; spiral CT Lung cancer is the leading cause of cancer deaths in the world. Although surgical resection still represents the best curative approach for this neoplasm, its efficacy strictly depends on the stage of disease presentation. Earlier diagnosis of patients with lung cancer is expected to increase the number of potentially resectable tumors. 1 Several large prospective randomized trials have demonstrated that conventional sputum cytology and chest radiography are not effective in detecting early lung cancer and reducing lung cancer mortality. 2 In this respect, over the last decade, spiral computed tomography (CT) has been tested as a powerful and fast imaging technique to detect tumors of less than 1 cm in diameter, with a proportion of detection of Stage I tumors greater than 80%, opening new possibilities for the early detection of lung cancer. 3,4 However, because of the complex algorithm of high-resolution CT employed in order to achieve the maximal performance of this approach 3 and to achieve the background noise created by the high detection rate of noncalcified nodules, 5 questions have been raised about the challenge of differential diagnosis, efficacy and costs of spiral CT screening. 6 In 2000, a prospective trial of early lung cancer detection was launched in Milan, using repeated yearly low-dose spiral CT, selective use of positron emission tomography and analysis of molecular markers in a large cohort of 1,035 high-...