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Tomishima Y, Kitamura A, Imai R, Ohde S. Deleterious impact of trivial to severe interstitial pneumonia and emphysema on mortality and acute exacerbation of interstitial pneumonia in patients with lung cancer: a retrospective cohort study. BMC Pulm Med 2024; 24:290. [PMID: 38909185 PMCID: PMC11193298 DOI: 10.1186/s12890-024-03105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 06/17/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Interstitial pneumonia and emphysema may complicate patients with lung cancer. However, clinical significance of trivial and mild pulmonary abnormalities remains unclear. In this study, we aimed to investigate whether trivial and mild interstitial pneumonia and emphysema, in addition to their advanced forms, impact the prognosis and lead to acute exacerbation of interstitial pneumonia (AEIP) in patients with lung cancer. METHODS This retrospective cohort study was conducted at a tertiary hospital and included patients with lung cancer. Computed tomography images were evaluated using the interstitial lung abnormality (ILA) score for interstitial pneumonia, which included no ILA, equivocal ILA, ILA, interstitial lung disease (ILD), and the Goddard score for emphysema. Cox analyses were performed using the ILA and Goddard scores as the main explanatory variables, adjusting for multiple covariates. RESULTS Among 1,507 patients with lung cancer, 1,033 had no ILA, 160 had equivocal ILA, 174 had ILA, and 140 had ILD. In total, 474 patients (31.5%) exhibited interstitial pneumonia and 638 (42.3%) showed emphysema. The log-rank trend test showed that survival probability was significantly better in patients with no ILA, followed by those with equivocal ILA, ILA, and ILD (P < 0.001). After adjustment, the ILA and Goddard scores remained significant variables for increased hazard ratios (HR) for mortality: no ILA (HR, 1.00: reference), equivocal ILA (HR, 1.31; 95% confidence interval [CI], 1.18-1.46; P < 0.001), ILA (HR, 1.71; 95% CI, 1.39-2.12; P < 0.001), ILD (HR, 2.24; 95% CI, 1.63-3.09; P < 0.001), and Goddard score (HR, 1.03; 95% CI, 1.01-1.06; P < 0.010). Moreover, both scores were associated with increased cause-specific HRs for AEIP. CONCLUSION Our results revealed that approximately one-third of patients with lung cancer had interstitial pneumonia when incorporating trivial and mild cases. Because interstitial pneumonia and emphysema, ranging from trivial to severe, significantly impact mortality and AEIP in patients with lung cancer, we should identify even trivial and mild cases of these pulmonary abnormalities among patients with lung cancer in addition to the advanced ones.
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Affiliation(s)
- Yutaka Tomishima
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
- Graduate School of Public Health, St. Luke's International University, 9-1 Akashi-cho, Chuo- ku, Tokyo, 104-8560, Japan.
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Ryosuke Imai
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Sachiko Ohde
- Graduate School of Public Health, St. Luke's International University, 9-1 Akashi-cho, Chuo- ku, Tokyo, 104-8560, Japan
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Chung JH, Park JM, Kim DH. Automated CT quantification of interstitial lung abnormality in patients with resectable stage I non-small cell lung cancer: Prognostic significance. Thorac Cancer 2024; 15:1305-1311. [PMID: 38682806 PMCID: PMC11147660 DOI: 10.1111/1759-7714.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/25/2024] [Accepted: 03/31/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND In patients with non-small cell lung cancer (NSCLC), interstitial lung abnormalities (ILA) have been linked to mortality and can be identified on computed tomography (CT) scans. In the present study we aimed to evaluate the predictive value of automatically quantified ILA based on the Fleischner Society definition in patients with stage I NSCLC. METHODS We retrospectively reviewed 948 patients with pathological stage I NSCLC who underwent pulmonary resection between April 2009 and October 2022. A commercially available deep learning-based automated quantification program for ILA was used to evaluate the preoperative CT data. The Fleischner Society definition, quantitative results, and interdisciplinary discussion led to the division of patients into normal and ILA groups. The sum of the fibrotic and nonfibrotic ILA components constituted the total ILA component and more than 5%. RESULTS Of the 948 patients with stage I NSCLC, 99 (10.4%) patients had ILA. Shorter overall survival and recurrence-free survival was associated with the presence of ILA. After controlling for confounding variables, the presence of ILA remained significant for increased risk of death (hazard ratio [HR] = 3.09; 95% confidence interval [CI]: 1.91-5.00; p < 0.001) and the presence of ILA remained significant for increased recurrence (HR = 1.96; 95% CI: 1.16-3.30; p = 0.012). CONCLUSIONS The automated CT quantification of ILA, based on the Fleischner Society definition, was significantly linked to poorer survival and recurrence in patients with stage I NSCLC.
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Affiliation(s)
- Jae Ho Chung
- Department of Internal Medicine, International St. Mary's HospitalCatholic Kwandong University College of MedicineIncheonRepublic of Korea
| | - Jong Myung Park
- Department of Thoracic and Cardiovascular SurgeryPusan National University School of MedicineBusanSouth Korea
- Department of Thoracic and Cardiovascular SurgeryPusan National University Yangsan HospitalBusanSouth Korea
- Transplantation Research Center, Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanSouth Korea
| | - Do Hyung Kim
- Department of Thoracic and Cardiovascular SurgeryPusan National University School of MedicineBusanSouth Korea
- Department of Thoracic and Cardiovascular SurgeryPusan National University Yangsan HospitalBusanSouth Korea
- Transplantation Research Center, Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanSouth Korea
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Wada N, Hunninghake GM, Hatabu H. Interstitial Lung Abnormalities: Current Understanding. Clin Chest Med 2024; 45:433-444. [PMID: 38816098 DOI: 10.1016/j.ccm.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Interstitial lung abnormalities (ILAs) are incidental findings on computed tomography scans, characterized by nondependent abnormalities affecting more than 5% of any lung zone. They are associated with factors such as age, smoking, genetic variants, worsened clinical outcomes, and increased mortality. Risk stratification based on clinical and radiological features of ILAs is crucial in clinical practice, particularly for identifying cases at high risk of progression to pulmonary fibrosis. Traction bronchiectasis/bronchiolectasis index has emerged as a promising imaging biomarker for prognostic risk stratification in ILAs. These findings suggest a spectrum of fibrosing interstitial lung diseases, encompassing from ILAs to pulmonary fibrosis.
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Affiliation(s)
- Noriaki Wada
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Gary M Hunninghake
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Xu X, Zhu M, Wang Z, Li J, Ouyang T, Chen C, Huang K, Zhang Y, Gao YL. Prognostic and predictive value of interstitial lung abnormalities and EGFR mutation status in patients with non-small cell lung cancer. Cancer Imaging 2024; 24:66. [PMID: 38783331 PMCID: PMC11119023 DOI: 10.1186/s40644-024-00712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND To determine the predictive value of interstitial lung abnormalities (ILA) for epidermal growth factor receptor (EGFR) mutation status and assess the prognostic significance of EGFR and ILA in patients with non-small cell lung cancer (NSCLC). METHODS We reviewed 797 consecutive patients with a histologically proven diagnosis of primary NSCLC from January 2013 to October 2018. Of these, 109 patients with NSCLC were found to have concomitant ILA. Multivariate logistic regression analysis was used to identify the significant clinical and computed tomography (CT) findings in predicting EGFR mutations. Cox proportional hazard models were used to identify significant prognostic factors. RESULTS EGFR mutations were identified in 22 of 109 tumors (20.2%). Multivariate analysis showed that the models incorporating clinical, tumor CT and ILA CT features yielded areas under the receiver operating characteristic curve (AUC) values of 0.749, 0.838, and 0.849, respectively. When combining the three models, the independent predictive factors for EGFR mutations were non-fibrotic ILA, female sex, and small tumor size, with an AUC value of 0.920 (95% confidence interval[CI]: 0.861-0.978, p < 0.001). In the multivariate Cox model, EGFR mutations (hazard ratio = 0.169, 95% CI = 0.042-0.675, p = 0.012; 692 days vs. 301 days) were independently associated with extended overall survival compared to the wild-type. CONCLUSION Non-fibrotic ILA independently predicts the presence of EGFR mutations, and the presence of EGFR mutations rather than non-fibrotic ILA serves as an independent good prognostic factor for patients with NSCLC.
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Affiliation(s)
- Xiaoli Xu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Min Zhu
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Zixing Wang
- Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jialu Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Tao Ouyang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Cen Chen
- Department of Radiology, Beijing Nuclear Industry Hospital, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Yuhui Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China.
| | - Yanli L Gao
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China.
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China.
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Tang XL, Sun YB, Guo XT, Yang SZ, Zhang WP. Prognostic impact of interstitial lung abnormalities in lung cancer: a systematic review and meta-analysis. Front Oncol 2024; 14:1397246. [PMID: 38800393 PMCID: PMC11116699 DOI: 10.3389/fonc.2024.1397246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background Newly identified as a radiological concept, interstitial lung abnormalities (ILA) is emerging as a prognostic factor for lung cancer. Yet, debates persist regarding the prognostic significance of ILA in lung cancer. Our inaugural meta-analysis aimed to investigate the correlation between ILA and lung cancer outcomes, offering additional insights for clinicians in predicting patient prognosis. Methods Articles meeting the criteria were found through PubMed, the Cochrane Library, EMBASE, and Web of Science by February 29, 2024. The outcomes evaluated were the survival rates such as overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and cancer-specific survival (CSS). Results A total of 12 articles with 4416 patients were included in this meta-analysis. The pooled results showed that lung cancer patients with interstitial lung abnormalities had an inferior OS (n=11; HR=2.22; 95% CI=1.68-2.95; P<0.001; I2 = 72.0%; Ph<0.001), PFS (n=3; HR=1.59; 95% CI=1.08-2.32; P=0.017; I2 = 0%; Ph=0.772), and CSS (n=2; HR=4.00; 95% CI=1.94-8.25; P<0.001; I2 = 0%; Ph=0.594) than those without, however, the ILA was not significantly associated with the DFS (n=2; HR=2.07; 95% CI=0.94-7.02; P=0.066; I2 = 90.4%; Ph=0.001). Moreover, lung cancer patients with ILA were significantly correlated with male (OR=2.43; 95% CI=1.48-3.98; P<0.001), smoking history (OR=2.11; 95% CI=1.37-3.25; P<0.001), advanced age (OR=2.50; 95% CI=1.56-4.03; P<0.001), squamous carcinoma (OR=0.42; 95% CI=0.24-0.71; P=0.01), and EGFR mutation (OR=0.50; 95% CI=0.32-0.78; P=0.002). The correlation between ILA and race, stage, ALK, however, was not significant. Conclusion ILA was a availability factors of prognosis in patients with lung cancers. These findings highlight the importance of early pulmonary fibrosis, namely ILA for prognosis in patients with lung cancer, and provide a partial rationale for future clinical work.
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Affiliation(s)
- Xian-Liang Tang
- Department of Thoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Yin-Bo Sun
- Department of Thoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Xiao-Tong Guo
- Department of Rehabilitation, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Sheng-Zhao Yang
- Department of Thoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Wen-Ping Zhang
- Department of Thoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
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Hata A, Yanagawa M, Miyata T, Hiraoka Y, Shirae M, Ninomiya K, Doi S, Yamagata K, Yoshida Y, Kikuchi N, Ogawa R, Hatabu H, Tomiyama N. Association between interstitial lung abnormality and mortality in patients with esophageal cancer. Jpn J Radiol 2024:10.1007/s11604-024-01563-x. [PMID: 38658500 DOI: 10.1007/s11604-024-01563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To investigate the relationship between interstitial lung abnormalities (ILAs) and mortality in patients with esophageal cancer and the cause of mortality. MATERIALS AND METHODS This retrospective study investigated patients with esophageal cancer from January 2011 to December 2015. ILAs were visually scored on baseline CT using a 3-point scale (0 = non-ILA, 1 = indeterminate for ILA, and 2 = ILA). ILAs were classified into subcategories of non-subpleural, subpleural non-fibrotic, and subpleural fibrotic. Five-year overall survival (OS) was compared between patients with and without ILAs using the multivariable Cox proportional hazards model. Subgroup analyses were performed based on cancer stage and ILA subcategories. The prevalences of treatment complications and death due to esophageal cancer and pneumonia/respiratory failure were analyzed using Fisher's exact test. RESULTS A total of 478 patients with esophageal cancer (age, 66.8 years ± 8.6 [standard deviation]; 64 women) were evaluated in this study. Among them, 267 patients showed no ILAs, 125 patients were indeterminate for ILAs, and 86 patients showed ILAs. ILAs were a significant factor for shorter OS (hazard ratio [HR] = 1.68, 95% confidence interval [CI] 1.10-2.55, P = 0.016) in the multivariable Cox proportional hazards model adjusting for age, sex, smoking history, clinical stage, and histology. On subgroup analysis using patients with clinical stage IVB, the presence of ILAs was a significant factor (HR = 3.78, 95% CI 1.67-8.54, P = 0.001). Subpleural fibrotic ILAs were significantly associated with shorter OS (HR = 2.22, 95% CI 1.25-3.93, P = 0.006). There was no significant difference in treatment complications. Patients with ILAs showed a higher prevalence of death due to pneumonia/respiratory failure than those without ILAs (non-ILA, 2/95 [2%]; ILA, 5/39 [13%]; P = 0.022). The prevalence of death due to esophageal cancer was similar in patients with and without ILA (non-ILA, 82/95 [86%]; ILA 32/39 [82%]; P = 0.596). CONCLUSION ILAs were significantly associated with shorter survival in patients with esophageal cancer.
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Affiliation(s)
- Akinori Hata
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
| | - Masahiro Yanagawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Tomo Miyata
- Department of Radiology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, 5938304, Japan
| | - Yu Hiraoka
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Motohiro Shirae
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Keisuke Ninomiya
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Shuhei Doi
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Kazuki Yamagata
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Yuriko Yoshida
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Noriko Kikuchi
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Ryo Ogawa
- Future Diagnostic Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
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Horiuchi K, Ikemura S, Sato T, Shimozaki K, Okamori S, Yamada Y, Yokoyama Y, Hashimoto M, Jinzaki M, Hirai I, Funakoshi T, Mizuno R, Oya M, Hirata K, Hamamoto Y, Terai H, Yasuda H, Kawada I, Soejima K, Fukunaga K. Pre-existing Interstitial Lung Abnormalities and Immune Checkpoint Inhibitor-Related Pneumonitis in Solid Tumors: A Retrospective Analysis. Oncologist 2024; 29:e108-e117. [PMID: 37590388 PMCID: PMC10769794 DOI: 10.1093/oncolo/oyad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/30/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have demonstrated efficacy over previous cytotoxic chemotherapies in clinical trials among various tumors. Despite their favorable outcomes, they are associated with a unique set of toxicities termed as immune-related adverse events (irAEs). Among the toxicities, ICI-related pneumonitis has poor outcomes with little understanding of its risk factors. This retrospective study aimed to investigate whether pre-existing interstitial lung abnormality (ILA) is a potential risk factor for ICI-related pneumonitis. MATERIALS AND METHODS Patients with non-small cell lung cancer, malignant melanoma, renal cell carcinoma, and gastric cancer, who was administered either nivolumab, pembrolizumab, or atezolizumab between September 2014 and January 2019 were retrospectively reviewed. Information on baseline characteristics, computed tomography findings before administration of ICIs, clinical outcomes, and irAEs were collected from their medical records. Pre-existing ILA was categorized based on previous studies. RESULTS Two-hundred-nine patients with a median age of 68 years were included and 23 (11.0%) developed ICI-related pneumonitis. While smoking history and ICI agents were associated with ICI-related pneumonitis (P = .005 and .044, respectively), the categories of ILA were not associated with ICI-related pneumonitis (P = .428). None of the features of lung abnormalities were also associated with ICI-related pneumonitis. Multivariate logistic analysis indicated that smoking history was the only significant predictor of ICI-related pneumonitis (P = .028). CONCLUSION This retrospective study did not demonstrate statistically significant association between pre-existing ILA and ICI-related pneumonitis, nor an association between radiologic features of ILA and ICI-related pneumonitis. Smoking history was independently associated with ICI-related pneumonitis. Further research is warranted for further understanding of the risk factors of ICI-related pneumonitis.
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Affiliation(s)
- Kohei Horiuchi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Sato
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keitaro Shimozaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Hirai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Takeru Funakoshi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kenro Hirata
- Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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8
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Escalon JG, Podolanczuk AJ, Aronson KI, Legasto AC, Gruden JF, Lynch DA, Rachid L, Rabkova Y, Steinberger S. Practice patterns in reporting interstitial lung abnormality at a tertiary academic medical center. Clin Imaging 2023; 104:109996. [PMID: 37862912 DOI: 10.1016/j.clinimag.2023.109996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Interstitial lung abnormality (ILA) is a common finding on chest CTs and is associated with higher all-cause mortality. The 2020 Fleischner Society position paper standardized the terminology and definition of ILA. Despite these published guidelines, the extent to which radiologists use this term is unknown. We evaluated practice patterns for identification of ILAs among radiologists at a tertiary academic medical center. METHODS In this retrospective review, we identified 157 radiology reports between January 1, 2010 through December 31, 2021 containing the phrase "interstitial lung abnormality" or "interstitial abnormality". After exclusions, 125 CT scans were reviewed by thoracic-trained radiologists using the sequential reading method. RESULTS Seventy-seven (62%) patients were found to have ILA (69% subpleural fibrotic, 19% subpleural non-fibrotic, and 6% non-subpleural), nine (7%) were equivocal for ILA and 39 (31%) had no ILA. The term ILA was used exclusively by thoracic-trained radiologists except for two cases. Use of the term ILA has rapidly increased since the position paper publication (none from 2010-2017, one case in 2018, 20 cases in 2019, 41 cases in 2020, and 73 cases in 2021), and cases were typically very mild (1-25% of the lung). CONCLUSION While there has been increased use of the term ILA among thoracic-trained radiologists, non-thoracic radiologists have essentially not begun to use the term. Almost one-third of cases labeled ILA on clinical reads were re-classified as not having ILA on research reads.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - Anna J Podolanczuk
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Kerri I Aronson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - James F Gruden
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA.
| | - Leena Rachid
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yana Rabkova
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Sharon Steinberger
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
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9
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Shin YJ, Yi JG, Kim MY, Son D, Ahn SY. Radiologic Progression of Interstitial Lung Abnormalities following Surgical Resection in Patients with Lung Cancer. J Clin Med 2023; 12:6858. [PMID: 37959324 PMCID: PMC10647667 DOI: 10.3390/jcm12216858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
In this study, we aimed to assess the prevalence of interstitial lung abnormalities (ILAs) and investigate the rates and risk factors associated with radiologic ILA progression among patients with lung cancer following surgical resection. Patients who underwent surgical resection for lung cancer at our institution from January 2015 to December 2020 were retrospectively evaluated and grouped according to their ILA status as having no ILAs, equivocal ILAs, or ILAs. Progression was determined by simultaneously reviewing the baseline and corresponding follow-up computed tomography (CT) scans. Among 346 patients (median age: 67 (interquartile range: 60-74) years, 204 (59.0%) men), 22 (6.4%) had equivocal ILAs, and 33 (9.5%) had ILAs detected upon baseline CT. Notably, six patients (6/291; 2.1%) without ILAs upon baseline CT later developed ILAs, and 50% (11/22) of those with equivocal ILAs exhibited progression. Furthermore, 75.8% (25/33) of patients with ILAs upon baseline CT exhibited ILA progression (76.9% and 71.4% with fibrotic and non-fibrotic ILAs, respectively). Multivariate analysis revealed that ILA status was a significant risk factor for ILA progression. ILAs and equivocal ILAs were associated with radiologic ILA progression after surgical resection in patients with lung cancer. Hence, early ILA detection can significantly affect clinical outcomes.
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Affiliation(s)
- Yoon Joo Shin
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (Y.J.S.)
| | - Jeong Geun Yi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (Y.J.S.)
| | - Mi Young Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (Y.J.S.)
| | - Donghee Son
- Research Coordinating Center, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Su Yeon Ahn
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (Y.J.S.)
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10
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McGroder CF, Hansen S, Hinckley Stukovsky K, Zhang D, Nath PH, Salvatore MM, Sonavane SK, Terry N, Stowell JT, D'Souza BM, Leb JS, Dumeer S, Aziz MU, Batra K, Hoffman EA, Bernstein EJ, Kim JS, Podolanczuk AJ, Rotter JI, Manichaikul AW, Rich SS, Lederer DJ, Barr RG, McClelland RL, Garcia CK. Incidence of Interstitial Lung Abnormalities: The MESA Lung Study. Eur Respir J 2023; 61:2201950. [PMID: 37202153 PMCID: PMC10773573 DOI: 10.1183/13993003.01950-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/18/2023] [Indexed: 05/20/2023]
Abstract
The incidence of newly developed interstitial lung abnormalities (ILA) and fibrotic ILA have not been previously reported.Trained thoracic radiologists evaluated 13 944 cardiac CT scans for the presence of ILA in 6197 Multi-Ethnic Study of Atherosclerosis longitudinal cohort study participants >45 years of age from 2000 to 2012. 5% of the scans were re-read by the same or a different observer in a blinded fashion. After exclusion of participants with ILA at baseline, incidence rates and incidence rate ratios for ILA and fibrotic ILA were calculated.The intra-reader agreement of ILA was 92.0% (Gwet AC1=0.912, ICC=0.982) and the inter-reader agreement of ILA was 83.5% (Gwet AC1=0.814; ICC=0.969). Incidence of ILA and fibrotic ILA was estimated to be 13.1 cases/1000 person-years and 3.5/1000 person-years, respectively. In multivariable analyses, age (HR 1.06 (1.05, 1.08), p <0.001; HR 1.08 (1.06, 1.11), p <0.001), high attenuation area (HAA) at baseline (HR 1.05 (1.03, 1.07), p <0.001; HR 1.06 (1.02, 1.10), p=0.002), and the MUC5B promoter SNP (HR 1.73 (1.17, 2.56) p=0.01; HR 4.96 (2.68, 9.15), p <0.001) were associated with incident ILA and fibrotic ILA, respectively. Ever smoking (HR 2.31 (1.34, 3.96), p= 0.002) and an IPF polygenic risk score (HR 2.09 (1.61-2.71), p<0.001) were associated only with incident fibrotic ILA.Incident ILA and fibrotic ILA were estimated by review of cardiac imaging studies. These findings may lead to wider application of a screening tool for atherosclerosis to identify preclinical lung disease.
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Affiliation(s)
- Claire F McGroder
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Spencer Hansen
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - David Zhang
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - P Hrudaya Nath
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | | | - Nina Terry
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Justin T Stowell
- Department of Radiology, Mayo Clinic at Jacksonville, Jacksonville, FL, USA
| | - Belinda M D'Souza
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Jay S Leb
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Shifali Dumeer
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Muhammad U Aziz
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Kiran Batra
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - John S Kim
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Anna J Podolanczuk
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ani W Manichaikul
- Department of Public Health Sciences, University of Virginia, Charlotte, VA, USA
- Center for Public Health Genomics, University of Virginia, Charlotte, VA, USA
| | - Stephen S Rich
- Department of Public Health Sciences, University of Virginia, Charlotte, VA, USA
- Center for Public Health Genomics, University of Virginia, Charlotte, VA, USA
| | - David J Lederer
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | | | - Christine Kim Garcia
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
- Center for Precision Medicine and Genomics, Columbia University Medical Center, New York, NY, USA
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11
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Ito M, Katano T, Okada H, Sakuragi A, Minami Y, Abe S, Adachi S, Oshima Y, Ohashi W, Kubo A, Fukui T, Ito S, Suzuki K. Subpleural fibrotic interstitial lung abnormalities are implicated in non-small cell lung cancer radiotherapy outcomes. Radiol Oncol 2023:raon-2023-0018. [PMID: 37078697 DOI: 10.2478/raon-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The relationship between interstitial lung abnormalities (ILAs) and the outcomes of lung cancer radiotherapy is unclear. This study investigated whether specific ILA subtypes are risk factors for radiation pneumonitis (RP). PATIENTS AND METHODS This retrospective study analysed patients with non-small cell lung cancer treated with radical-intent or salvage radiotherapy. Patients were categorised into normal (no abnormalities), ILA, and interstitial lung disease (ILD) groups. The ILA group was further subclassified into non-subpleural (NS), subpleural non-fibrotic (SNF), and subpleural fibrotic (SF) types. The Kaplan-Meier and Cox regression methods were used to determine RP and survival rates and compare these outcomes between groups, respectively. RESULTS Overall, 175 patients (normal, n = 105; ILA-NS, n = 5; ILA-SNF, n = 28; ILA-SF, n = 31; ILD, n = 6) were enrolled. Grade ≥2 RP was observed in 71 (41%) patients. ILAs (hazard ratio [HR]: 2.33, p = 0.008), intensity-modulated radiotherapy (HR: 0.38, p = 0.03), and lung volume receiving 20 Gy (HR: 54.8, p = 0.03) contributed to the cumulative incidence of RP. Eight patients with grade 5 RP were in the ILA group, seven of whom had ILA-SF. Among radically treated patients, the ILA group had worse 2-year overall survival (OS) than the normal group (35.3% vs 54.6%, p = 0.005). Multivariate analysis revealed that the ILA-SF group contributed to poor OS (HR: 3.07, p =0.02). CONCLUSIONS ILAs, particularly ILA-SF, may be important risk factors for RP, which can worsen prognosis. These findings may aid in making decisions regarding radiotherapy.
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Affiliation(s)
- Makoto Ito
- Department of Radiology, Aichi Medical University, Aichi, Japan
| | - Takuma Katano
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Aichi, Japan
| | - Hiroaki Okada
- Department of Radiology, Aichi Medical University, Aichi, Japan
| | - Ami Sakuragi
- Department of Central Radiology, Aichi Medical University, Aichi, Japan
| | - Yoshitaka Minami
- Department of Central Radiology, Aichi Medical University, Aichi, Japan
| | - Souichiro Abe
- Department of Radiology, Aichi Medical University, Aichi, Japan
| | - Sou Adachi
- Department of Radiology, Aichi Medical University, Aichi, Japan
| | - Yukihiko Oshima
- Department of Radiology, Aichi Medical University, Aichi, Japan
| | - Wataru Ohashi
- Department of Biostatistics, Clinical Research Center, Aichi Medical University, Aichi, Japan
| | - Akihito Kubo
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Aichi, Japan
| | - Takayuki Fukui
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Aichi, Japan
| | - Satoru Ito
- Department of Respiratory Medicine and Allergology, Aichi Medical University, Aichi, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, Aichi, Japan
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12
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Tseng SC, Hino T, Hatabu H, Park H, Sanford NN, Lin G, Nishino M, Mamon H. Interstitial Lung Abnormalities in Patients With Locally Advanced Esophageal Cancer: Prevalence, Risk Factors, and Clinical Implications. J Comput Assist Tomogr 2022; 46:871-877. [PMID: 35995596 PMCID: PMC9675694 DOI: 10.1097/rct.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Interstitial lung abnormalities (ILAs) represent nondependent abnormalities on chest computed tomography (CT) indicating lung parenchymal damages due to inflammation and fibrosis. Interstitial lung abnormalities have been studied as a predictor of clinical outcome in lung cancer, but not in other thoracic malignancies. The present study investigated the prevalence of ILA in patients with esophageal cancer and identified risk factors and clinical implications of ILA in these patients. METHODS The study included 208 patients with locally advanced esophageal cancer (median age, 65.6 years; 166 males, 42 females). Interstitial lung abnormality was scored on baseline CT scans before treatment using a 3-point scale (0 = no evidence of ILA, 1 = equivocal for ILA, 2 = ILA). Clinical characteristics and overall survival were compared in patients with ILA (score 2) and others. RESULTS An ILA was present in 14 of 208 patients (7%) with esophageal cancer on pretreatment chest CT. Patients with ILA were significantly older (median age, 69 vs 65, respectively; P = 0.011), had a higher number of pack-years of smoking ( P = 0.02), and more commonly had T4 stage disease ( P = 0.026) than patients with ILA score of 1 or 0. Interstitial lung abnormality on baseline scan was associated with a lack of surgical resection after chemoradiotherapy (7/14, 50% vs 39/194, 20% respectively; P = 0.016). Interstitial lung abnormality was not associated with overall survival (log-rank P = 0.75, Cox P = 0.613). CONCLUSIONS An ILA was present in 7% of esophageal cancer patients, which is similar to the prevalence in general population and in smokers. Interstitial lung abnormality was strongly associated with a lack of surgical resection after chemoradiotherapy, indicating an implication of ILA in treatment selection in these patients, which can be further studied in larger cohorts.
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Affiliation(s)
- Shu-Chi Tseng
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Takuya Hino
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Hyesun Park
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
| | - Harvey Mamon
- Department of Radiation Oncology, Brigham and Women’s Hospital and Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave. Boston MA, 02215, USA
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13
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Hata A, Hino T, Yanagawa M, Nishino M, Hida T, Hunninghake GM, Tomiyama N, Christiani DC, Hatabu H. Interstitial Lung Abnormalities at CT: Subtypes, Clinical Significance, and Associations with Lung Cancer. Radiographics 2022; 42:1925-1939. [PMID: 36083805 PMCID: PMC9630713 DOI: 10.1148/rg.220073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
Interstitial lung abnormality (ILA) is defined as an interstitial change detected incidentally on CT images. It is seen in 4%-9% of smokers and 2%-7% of nonsmokers. ILA has a tendency to progress with time and is associated with respiratory symptoms, decreased exercise capability, reduced pulmonary function, and increased mortality. ILAs can be classified into three subcategories: nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic. In cases of ILA, clinically significant interstitial lung disease should be identified and requires clinically driven management by a pulmonologist. Risk factors for the progression of ILA include clinical elements (ie, inhalation exposures, medication use, radiation therapy, thoracic surgery, physiologic findings, and gas exchange findings) and radiologic elements (ie, basal and peripheral predominance and fibrotic findings). It is recommended that individuals with one or more clinical or radiologic risk factors for progression of ILA be actively monitored with pulmonary function testing and CT. To avoid overcalling ILA at CT, radiologists must recognize the imaging pitfalls, including centrilobular nodularity, dependent abnormality, suboptimal inspiration, osteophyte-related lesions, apical cap and pleuroparenchymal fibroelastosis-like lesions, aspiration, and infection. There is a close association between ILA and lung cancer, and many studies have reported an increased incidence of lung cancer, worse prognoses, and/or increased pulmonary complications in relation to cancer treatment in patients with ILA. ILA is considered to be an important comorbidity in patients with lung cancer. Accordingly, all radiologists involved with body CT must have sound knowledge of ILAs owing to the high prevalence and potential clinical significance of these anomalies. An overview of ILAs, including a literature review of the associations between ILAs and lung cancer, is presented. ©RSNA, 2022.
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Affiliation(s)
- Akinori Hata
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Takuya Hino
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Masahiro Yanagawa
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Mizuki Nishino
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Tomoyuki Hida
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Gary M. Hunninghake
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Noriyuki Tomiyama
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - David C. Christiani
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
| | - Hiroto Hatabu
- From the Department of Diagnostic and Interventional Radiology,
Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka
5650871, Japan (A.H., M.Y., N.T.); Center for Pulmonary Functional Imaging,
Department of Radiology (A.H., T.H., M.N., G.M.H., H.H.) and Pulmonary and
Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard
Medical School, Boston, MA; Department of Clinical Radiology, Graduate School of
Medical Sciences, Kyushu University, Fukuoka, Japan (T. Hino, T. Hida);
Department of Imaging, Dana Farber Cancer Institute, Boston, MA (M.N.); and
Department of Environmental Health, Harvard TH Chan School of Public Health,
Boston, Mass (D.C.C.)
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14
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Oh AS, Lynch DA. Interstitial Lung Abnormality—Why Should I Care and What Should I Do About It? Radiol Clin North Am 2022; 60:889-899. [DOI: 10.1016/j.rcl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Tomassetti S, Poletti V, Ravaglia C, Sverzellati N, Piciucchi S, Cozzi D, Luzzi V, Comin C, Wells AU. Incidental discovery of interstitial lung disease: diagnostic approach, surveillance and perspectives. Eur Respir Rev 2022; 31:31/164/210206. [PMID: 35418487 PMCID: PMC9488620 DOI: 10.1183/16000617.0206-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
The incidental discovery of pre-clinical interstitial lung disease (ILD) has led to the designation of interstitial lung abnormalities (ILA), a radiological entity defined as the incidental finding of computed tomography (CT) abnormalities affecting more than 5% of any lung zone. Two recent documents have redefined the borders of this entity and made the recommendation to monitor patients with ILA at risk of progression. In this narrative review, we will focus on some of the limits of the current approach, underlying the potential for progression to full-blown ILD of some patients with ILA and the numerous links between subpleural fibrotic ILA and idiopathic pulmonary fibrosis (IPF). Considering the large prevalence of ILA in the general population (7%), restricting monitoring only to cases considered at risk of progression appears a reasonable approach. However, this suggestion should not prevent pulmonary physicians from pursuing an early diagnosis of ILD and timely treatment where appropriate. In cases of suspected ILD, whether found incidentally or not, the pulmonary physician is still required to make a correct ILD diagnosis according to current guidelines, and eventually treat the patient accordingly. In patients with interstitial lung abnormalities (ILA), monitoring of those at risk of progression is currently recommended, and pulmonary physicians should pursue an early diagnosis when ILA become clinically significant to facilitate timely treatment https://bit.ly/3HKOQc8
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Affiliation(s)
- Sara Tomassetti
- Dept of Experimental and Clinical Medicine, Florence University, Florence, Italy .,Interventional Pneumology, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Dept of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Claudia Ravaglia
- Dept of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | | | | | - Diletta Cozzi
- Dept of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Valentina Luzzi
- Interventional Pneumology, Careggi University Hospital, Florence, Italy
| | - Camilla Comin
- Dept of Experimental and Clinical Medicine, Florence University, Florence, Italy
| | - Athol U Wells
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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16
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Sato Y, Sumikawa H, Shibaki R, Morimoto T, Sakata Y, Oya Y, Tamiya M, Suzuki H, Matsumoto H, Yokoi T, Hashimoto K, Kobe H, Hino A, Inaba M, Tsukita Y, Ikeda H, Arai D, Maruyama H, Hara S, Tsumura S, Sakata S, Fujimoto D. Drug-Related Pneumonitis Induced by Osimertinib as First-Line Treatment for Epidermal Growth Factor Receptor Mutation-Positive Non-Small Cell Lung Cancer. Chest 2022; 162:1188-1198. [DOI: 10.1016/j.chest.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/17/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
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17
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Axelsson GT, Gudmundsson G. Interstitial lung abnormalities - current knowledge and future directions. Eur Clin Respir J 2021; 8:1994178. [PMID: 34745461 PMCID: PMC8567914 DOI: 10.1080/20018525.2021.1994178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Efforts to grasp the significance of radiologic changes similar to interstitial lung disease (ILD) in undiagnosed individuals have intensified in the recent decade. The term interstitial lung abnormalities (ILA) is an emerging definition of such changes, defined by visual examination of computed tomography scans. Substantial insights have been made in the origins and clinical consequences of these changes, as well as automated measures of early lung fibrosis, which will likely lead to increased recognition of early fibrotic lung changes among clinicians and researchers alike. Interstitial lung abnormalities have an estimated prevalence of 7–10% in elderly populations. They correlate with many ILD risk factors, both epidemiologic and genetic. Additionally, histopathological similarities with IPF exist in those with ILA. While no established blood biomarker of ILA exists, several have been suggested. Distinct imaging patterns indicating advanced fibrosis correlate with worse clinical outcomes. ILA are also linked with adverse clinical outcomes such as increased mortality and risk of lung cancer. Progression of ILA has been noted in a significant portion of those with ILA and is associated with many of the same features as ILD, including advanced fibrosis. Those with ILA progression are at risk of accelerated FVC decline and increased mortality. Radiologic changes resembling ILD have also been attained by automated measures. Such measures associate with some, but not all the same factors as ILA. ILA and similar radiologic changes are in many ways analogous to ILD and likely represent a precursor of ILD in some cases. While warranting an evaluation for ILD, they are associated with poor clinical outcomes beyond possible ILD development and thus are by themselves a significant finding. Among the present objectives of this field are the stratification of patients with regards to progression and the discovery of biomarkers with predictive value for clinical outcomes.
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Affiliation(s)
- Gisli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
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18
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Liu Q, Zhang H, Han B, Jiang H, Chung KF, Li F. Interstitial lung abnormalities: What do we know and how do we manage? Expert Rev Respir Med 2021; 15:1551-1561. [PMID: 34689661 DOI: 10.1080/17476348.2021.1997598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Interstitial lung abnormalities (ILAs), which refer to mild or subtle nongravity-dependent interstitial changes, may be neglected by some clinicians due to many reasons, such as lack of diagnostic criteria for ILAs and absence of available treatments and surveillance strategies. However, without intervention, some ILAs may progress to interstitial lung disease (ILD). This review summarizes our current knowledge of this condition and ways of diagnosing it together with current management. We hope that this will lead to better recognition of ILAs. AREAS COVERED We reviewed the literature on PubMed between 2008 and 2020 focusing on prevalence, etiology, symptoms, diagnostic biomarkers, clinical associations, and management of ILAs. EXPERT OPINION Timely diagnosis with close monitoring of ILAs and appropriate intervention should be recognized as the management approach to ILAs. Research into ILAs should continue to improve its management.
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Affiliation(s)
- Qi Liu
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Hai Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Baohui Han
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Handong Jiang
- Department of Respiratory and Critical Care Medicine, Shanghai Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Kian Fan Chung
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, UK
| | - Feng Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
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19
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Hino T, Hida T, Nishino M, Lu J, Putman RK, Gudmundsson EF, Hata A, Araki T, Valtchinov VI, Honda O, Yanagawa M, Yamada Y, Kamitani T, Jinzaki M, Tomiyama N, Ishigami K, Honda H, San Jose Estepar R, Washko GR, Johkoh T, Christiani DC, Lynch DA, Gudnason V, Gudmundsson G, Hunninghake GM, Hatabu H. Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study. Eur J Radiol Open 2021; 8:100334. [PMID: 33748349 PMCID: PMC7960545 DOI: 10.1016/j.ejro.2021.100334] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The aim of this study is to assess the role of traction bronchiectasis/bronchiolectasis and its progression as a predictor for early fibrosis in interstitial lung abnormalities (ILA). METHODS Three hundred twenty-seven ILA participants out of 5764 in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who had undergone chest CT twice with an interval of approximately five-years were enrolled in this study. Traction bronchiectasis/bronchiolectasis index (TBI) was classified on a four-point scale: 0, ILA without traction bronchiectasis/bronchiolectasis; 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; 2, ILA with mild to moderate traction bronchiectasis; 3, ILA and severe traction bronchiectasis and/or honeycombing. Traction bronchiectasis (TB) progression was classified on a five-point scale: 1, Improved; 2, Probably improved; 3, No change; 4, Probably progressed; 5, Progressed. Overall survival (OS) among participants with different TB Progression Score and between the TB progression group and No TB progression group was also investigated. Hazard radio (HR) was estimated with Cox proportional hazards model. RESULTS The higher the TBI at baseline, the higher TB Progression Score (P < 0.001). All five participants with TBI = 3 at baseline progressed; 46 (90 %) of 51 participants with TBI = 2 progressed. TB progression was also associated with shorter OS with statistically significant difference (adjusted HR = 1.68, P < 0.001). CONCLUSION TB progression was visualized on chest CT frequently and clearly. It has the potential to be the predictor for poorer prognosis of ILA.
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Affiliation(s)
- Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Corresponding author.
| | - Tomoyuki Hida
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Junwei Lu
- Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - Rachel K. Putman
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Akinori Hata
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Tetsuro Araki
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Vladimir I. Valtchinov
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Osamu Honda
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 8128582, Japan
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - George R. Washko
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan,Department of Radiology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo, 6608511, Japan
| | - David C. Christiani
- Department of Environmental Health, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA, 02115, USA
| | - David A. Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Hjartavernd, Holtasmári 1, 201, Kópavogur, Iceland,University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101, Reykjavík, Iceland
| | - Gunnar Gudmundsson
- University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101, Reykjavík, Iceland,Department of Respiratory Medicine, Landspitali University Hospital, Fossvogur 108, Reykjavík, Iceland
| | - Gary M. Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,Pulmonary and Critical Care Division, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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20
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Dobre IA, Frank AJ, D'Silva KM, Christiani DC, Okin D, Sharma A, Montesi SB. Outcomes of Patients With Interstitial Lung Disease Receiving Programmed Cell Death 1 Inhibitors: A Retrospective Case Series. Clin Lung Cancer 2021; 22:e738-e744. [PMID: 33663958 DOI: 10.1016/j.cllc.2021.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/17/2021] [Accepted: 01/28/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs), such as programmed cell death 1 (PD-1) inhibitors, are used to treat multiple cancers. Limited data exist as to the use of ICIs in patients with coexistent interstitial lung disease (ILD). We conducted a retrospective case series to assess clinical and radiologic outcomes of patients with ILD treated with PD-1 inhibitors. METHODS Eligible patients were 18 years of age or older, treated with pembrolizumab or nivolumab for oncologic indications, and had evidence of ILD on chest computed tomography scan not attributable to radiotherapy before initiation of ICI therapy. Outcomes of interest included mortality, hospitalizations for respiratory-related causes, development of pneumonitis, and radiologic change in ILD over a 1-year follow-up period. RESULTS We included 41 patients in the analysis. At 1 year, 17 patients (41.5%) were alive, 23 had died (56.1%), and 1 (2.4%) was lost to follow-up. Of 23 deaths, 16 (69.6%) were due to cancer, 4 (17.4%) to causes excluding cancer and ILD, and 3 (13.0%) to hypoxemic respiratory failure from ILD- or ICI-induced pneumonitis. Three patients (7.3%) required hospitalization owing to ILD, including drug-induced pneumonitis, and 3 (7.3%) developed pneumonitis attributable to anti-PD-1 therapy. On follow-up computed tomography scans, 32 patients (78.0%) had stable or improved ILD and 9 (22.0%) had progression. CONCLUSION Patients with ILD receiving PD-1 inhibitors more frequently died of cancer-related causes than from ILD. Further research is needed to determine the safety of ICIs in patients with ILD and if ILD subtype may help to refine ICI-associated risks.
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Affiliation(s)
- Ioana A Dobre
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Angela J Frank
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kristin M D'Silva
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - David C Christiani
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Daniel Okin
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massachusetts
| | - Sydney B Montesi
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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21
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Hida T, Hata A, Lu J, Valtchinov VI, Hino T, Nishino M, Honda H, Tomiyama N, Christiani DC, Hatabu H. Interstitial lung abnormalities in patients with stage I non-small cell lung cancer are associated with shorter overall survival: the Boston lung cancer study. Cancer Imaging 2021; 21:14. [PMID: 33468255 PMCID: PMC7816399 DOI: 10.1186/s40644-021-00383-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/08/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Interstitial lung abnormalities (ILA) can be detected on computed tomography (CT) in lung cancer patients and have an association with mortality in advanced non-small cell lung cancer (NSCLC) patients. The aim of this study is to demonstrate the significance of ILA for mortality in patients with stage I NSCLC using Boston Lung Cancer Study cohort. METHODS Two hundred and thirty-one patients with stage I NSCLC from 2000 to 2011 were investigated in this retrospective study (median age, 69 years; 93 males, 138 females). ILA was scored on baseline CT scans prior to treatment using a 3-point scale (0 = no evidence of ILA, 1 = equivocal for ILA, 2 = ILA) by a sequential reading method. ILA score 2 was considered the presence of ILA. The difference of overall survival (OS) for patients with different ILA scores were tested via log-rank test and multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) including ILA score, age, sex, smoking status, and treatment as the confounding variables. RESULTS ILA was present in 22 out of 231 patients (9.5%) with stage I NSCLC. The presence of ILA was associated with shorter OS (patients with ILA score 2, median 3.85 years [95% confidence interval (CI): 3.36 - not reached (NR)]; patients with ILA score 0 or 1, median 10.16 years [95%CI: 8.65 - NR]; P < 0.0001). In a Cox proportional hazards model, the presence of ILA remained significant for increased risk for death (HR = 2.88, P = 0.005) after adjusting for age, sex, smoking and treatment. CONCLUSIONS ILA was detected on CT in 9.5% of patients with stage I NSCLC. The presence of ILA was significantly associated with a shorter OS and could be an imaging marker of shorter survival in stage I NSCLC.
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Affiliation(s)
- Tomoyuki Hida
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.177174.30000 0001 2242 4849Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akinori Hata
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.136593.b0000 0004 0373 3971Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junwei Lu
- grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Vladimir I. Valtchinov
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
| | - Takuya Hino
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.177174.30000 0001 2242 4849Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuki Nishino
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA ,grid.65499.370000 0001 2106 9910Department of Imaging, Dana Farber Cancer Institute, Boston, MA USA
| | - Hiroshi Honda
- grid.177174.30000 0001 2242 4849Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Tomiyama
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - David C. Christiani
- grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA USA ,Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA USA
| | - Hiroto Hatabu
- grid.62560.370000 0004 0378 8294Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 USA
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22
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Nam BD, Hwang JH. Update in Diagnosis of Idiopathic Pulmonary Fibrosis and Interstitial Lung Abnormality. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:770-790. [PMID: 36238071 PMCID: PMC9514410 DOI: 10.3348/jksr.2021.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/15/2022]
Abstract
최신 국제 임상진료지침을 기반으로 한 특발폐섬유증의 진단은 부합하는 임상 소견과 함께 고해상 CT에서 전형적인 상용간질폐렴 소견을 보일 때 조직학적 폐 생검 없이 진단 가능하다. 영상 검사는 특발폐섬유증의 평가 및 진단에 중추적인 역할을 하며, 정확한 진단을 위하여 임상적, 영상의학적 및 병리학적 소견에 대한 다학제 검토의 중요성이 강조된다. 간질성 폐이상(interstitial lung abnormality)은 우연히 발견된 영상의학적 이상 소견을 지칭하며, 간질성폐이상과 임상적으로 의미 있는 간질폐질환에 대한 구분은 적절한 임상 평가를 기반으로 이루어져야 한다. 저자들은 이번 종설을 통하여 특발폐섬유증 진단의 최신 지견 및 간질성폐이상에 대한 이해를 도움으로써 미만성 간질폐섬유증 환자의 정확한 진단과 치료 및 예후 증진에 도움이 되고자 한다.
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Affiliation(s)
- Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
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23
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Chae KJ, Jin GY, Goo JM, Chung MJ. Interstitial Lung Abnormalities: What Radiologists Should Know. Korean J Radiol 2020; 22:454-463. [PMID: 33169548 PMCID: PMC7909860 DOI: 10.3348/kjr.2020.0191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023] Open
Abstract
Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentally on chest CT that are potentially related to interstitial lung diseases. Several articles have reported that ILAs are associated with increased mortality, and they can show radiologic progression. With the increased recognition of ILAs on CT, the role of radiologists in reporting them is critical. This review aims to discuss the clinical significance and radiologic characteristics of ILAs to facilitate and enhance their management.
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Affiliation(s)
- Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung Ja Chung
- Department of Pathology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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24
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Araki T, Washko GR, Schiebler ML, O'Connor GT, Hatabu H. The Framingham Heart Study: Populational CT-based phenotyping in the lungs and mediastinum. Eur J Radiol Open 2020; 7:100260. [PMID: 32984450 PMCID: PMC7495061 DOI: 10.1016/j.ejro.2020.100260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023] Open
Abstract
The Framingham Heart Study (FHS) is one of the largest and established longitudinal populational cohorts. CT cohorts of the FHS since 2002 provided a unique opportunity to assess non-cardiac thoracic imaging findings. This review deals with image-based phenotyping studies from recent major publications regarding interstitial lung abnormalities (ILAs), pulmonary cysts, emphysema, pulmonary nodules, pleural plaques, normal spectrum of the thymus, and anterior mediastinal masses, concluding with the discussion of future directions of FHS CT cohorts studies in the era of radiomics and artificial intelligence.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Department of Pulmonology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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25
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Hatabu H, Hunninghake GM, Richeldi L, Brown KK, Wells AU, Remy-Jardin M, Verschakelen J, Nicholson AG, Beasley MB, Christiani DC, San José Estépar R, Seo JB, Johkoh T, Sverzellati N, Ryerson CJ, Graham Barr R, Goo JM, Austin JHM, Powell CA, Lee KS, Inoue Y, Lynch DA. Interstitial lung abnormalities detected incidentally on CT: a Position Paper from the Fleischner Society. THE LANCET RESPIRATORY MEDICINE 2020; 8:726-737. [PMID: 32649920 DOI: 10.1016/s2213-2600(20)30168-5] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
The term interstitial lung abnormalities refers to specific CT findings that are potentially compatible with interstitial lung disease in patients without clinical suspicion of the disease. Interstitial lung abnormalities are increasingly recognised as a common feature on CT of the lung in older individuals, occurring in 4-9% of smokers and 2-7% of non-smokers. Identification of interstitial lung abnormalities will increase with implementation of lung cancer screening, along with increased use of CT for other diagnostic purposes. These abnormalities are associated with radiological progression, increased mortality, and the risk of complications from medical interventions, such as chemotherapy and surgery. Management requires distinguishing interstitial lung abnormalities that represent clinically significant interstitial lung disease from those that are subclinical. In particular, it is important to identify the subpleural fibrotic subtype, which is more likely to progress and to be associated with mortality. This multidisciplinary Position Paper by the Fleischner Society addresses important issues regarding interstitial lung abnormalities, including standardisation of the definition and terminology; predisposing risk factors; clinical outcomes; options for initial evaluation, monitoring, and management; the role of quantitative evaluation; and future research needs.
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Affiliation(s)
- Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gary M Hunninghake
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luca Richeldi
- Unitá Operativa Complessa di Pneumologia, Universitá Cattolica del Sacro Cuore, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | - Kevin K Brown
- Department of Medicine, Denver, CO, USA; National Jewish Health, Denver, CO, USA
| | - Athol U Wells
- Department of Respiratory Medicine, Royal Brompton and Hospital NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Martine Remy-Jardin
- Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille, Lille, France
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Hospital NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Mary B Beasley
- Department of Pathology, Icahn School of Medicine at Mount, New York, NY, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joon Beom Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | | | - Christopher J Ryerson
- Department of Medicine, University of British Columbia and Centre for Heart Lung Innovations, St Paul's Hospital, Vancouver, BC, Canada
| | - R Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - John H M Austin
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Charles A Powell
- Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount, New York, NY, USA
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
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