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Labaki WW, Agusti A, Bhatt SP, Bodduluri S, Criner GJ, Fabbri LM, Halpin DMG, Lynch DA, Mannino DM, Miravitlles M, Papi A, Sin DD, Washko GR, Kazerooni EA, Han MK. Leveraging Computed Tomography Imaging to Detect Chronic Obstructive Pulmonary Disease and Concomitant Chronic Diseases. Am J Respir Crit Care Med 2024; 210:281-287. [PMID: 38843079 PMCID: PMC11348973 DOI: 10.1164/rccm.202402-0407pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/04/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
| | - Alvar Agusti
- Cathedra Salut Respiratoria, University of Barcelona, Barcelona, Spain
- Pulmonary Service, Respiratory Institute, Clinic Barcelona, Barcelona, Spain
- Fundació Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - David M. G. Halpin
- Respiratory Medicine, University of Exeter Medical School, Exeter, United Kingdom
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - David M. Mannino
- Department of Medicine, University of Kentucky, Lexington, Kentucky
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain
- Neumología, Hospital Universitari Vall d’Hebron/Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Alberto Papi
- Section of Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Don D. Sin
- Centre for Heart Lung Innovation, St. Paul’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine and
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ella A. Kazerooni
- Division of Pulmonary and Critical Care Medicine and
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine and
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur J Cardiothorac Surg 2023; 64:ezad302. [PMID: 37804174 PMCID: PMC10876118 DOI: 10.1093/ejcts/ezad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | - Joanna Chorostowska
- Institute of Tuberculosis and Lung Diseases, Warsaw, Genetics and Clinical Immunology, Warsaw, Poland
| | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska-Wynimko J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur Respir J 2023; 62:2300533. [PMID: 37802631 DOI: 10.1183/13993003.00533-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | | | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
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Almatrafi A, Thomas O, Callister M, Gabe R, Beeken RJ, Neal R. The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis. J Med Screen 2023; 30:3-13. [PMID: 35942779 PMCID: PMC9925896 DOI: 10.1177/09691413221117685] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comorbidity is associated with adverse outcomes for all lung cancer patients, but its burden is less understood in the context of screening. This review synthesises the prevalence of comorbidities among lung cancer screening (LCS) candidates and summarises the clinical recommendations for screening comorbid individuals. METHODS We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases from January 1990 to February 2021. We included LCS studies that reported a prevalence of comorbidity, as a prevalence of a particular condition, or as a summary score. We also summarised LCS clinical guidelines that addressed comorbidity or frailty for LCS as a secondary objective for this review. Meta-analysis was used with inverse-variance weights obtained from a random-effects model to estimate the prevalence of selected comorbidities. RESULTS We included 69 studies in the review; seven reported comorbidity summary scores, two reported performance status, 48 reported individual comorbidities, and 12 were clinical guideline papers. The meta-analysis of individual comorbidities resulted in an estimated prevalence of 35.2% for hypertension, 23.5% for history of chronic obstructive pulmonary disease (COPD) (10.7% for severe COPD), 16.6% for ischaemic heart disease (IHD), 13.1% for peripheral vascular disease (PVD), 12.9% for asthma, 12.5% for diabetes, 4.5% for bronchiectasis, 2.2% for stroke, and 0.5% for pulmonary fibrosis. CONCLUSIONS Comorbidities were highly prevalent in LCS populations and likely to be more prevalent than in other cancer screening programmes. Further research on the burden of comorbid disease and its impact on screening uptake and outcomes is needed. Identifying individuals with frailty and comorbidities who might not benefit from screening should become a priority in LCS research.
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Affiliation(s)
- Anas Almatrafi
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Epidemiology, Umm Al-Qura University, Makkah, Saudi Arabia,Anas Almatrafi, Leeds Institute of Health
Sciences, University of Leeds, Leeds LS2 9NL, UK.
| | - Owen Thomas
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK
| | - Matthew Callister
- Department of Respiratory Medicine, Leeds
Teaching Hospitals, St James's University Hospital, Leeds, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population
Health, Queen Mary University of
London, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Behavioural Science and
Health, University College London, London, UK
| | - Richard Neal
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,College of Medicine and Health, University of Exeter, Exeter, UK
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Balata H, Harvey J, Barber PV, Colligan D, Duerden R, Elton P, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Mellor S, Newton T, Sawyer R, Sharman A, Smith E, Taylor B, Taylor S, Tonge J, Walsham A, Whittaker J, Vestbo J, Booton R, Crosbie PA. Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD. Thorax 2020; 75:655-660. [DOI: 10.1136/thoraxjnl-2019-213584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022]
Abstract
BackgroundCOPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.MethodsEver smokers, age 55–74, resident in three deprived areas of Manchester were invited to a ‘Lung Health Check’ (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCOM2012)), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCOM2012 ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV1/FVC<0.7. Primary care databases were searched for any prior diagnosis of COPD.Results99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex (adjOR 1.84, 95% CI 1.37 to 2.47; p<0.0001), younger age (p=0.015), lower smoking duration (p<0.0001), fewer cigarettes per day (p=0.035), higher FEV1/FVC ratio (<0.0001) and being asymptomatic (adjOR 4.19, 95% CI 2.95 to 5.95; p<0.0001). The likelihood of screen detected lung cancer was significantly greater in those with evidence of airflow obstruction who had a previous diagnosis of COPD (adjOR 2.80, 95% CI 1.60 to 8.42; p=0.002).ConclusionsIncorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.
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Sanchez-Carpintero Abad M, Sanchez-Salcedo P, de-Torres JP, Alcaide AB, Seijo LM, Pueyo J, Bastarrika G, Zulueta JJ, Campo A. Prevalence and burden of bronchiectasis in a lung cancer screening program. PLoS One 2020; 15:e0231204. [PMID: 32282811 PMCID: PMC7153864 DOI: 10.1371/journal.pone.0231204] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The prevalence of bronchiectasis in the general population and in individuals undergoing lung cancer screening with low dose computed tomography (LDCT) is unknown. The aim of this study is to estimate the prevalence and impact of bronchiectasis in a screening lung cancer program. METHODS 3028 individuals participating in an international multicenter lung cancer screening consortium (I-ELCAP) were selected from 2000 to 2012. Patients with bronchiectasis on baseline CT were identified and compared to selected controls. Detection of nodules, need for additional studies and incidence of cancer were analyzed over the follow-up period. RESULTS The prevalence of bronchiectasis was 11.6%(354/3028). On the baseline LDCT, the number of subjects with nodules identified was 189(53.4%) in patients with bronchiectasis compared to 63(17.8%) in controls (p<0.001). The occurrence of false positives was higher in subjects with bronchiectasis (26%vs17%;p = 0.003). During follow-up, new nodules were more common among subjects with bronchiectasis (17%vs.12%; p = 0.008). The total number of false positives during follow-up was 29(17.06%) for patients with bronchiectasis vs. 88(12.17%) for controls (p = 0.008).The incidence rate of lung cancer during follow-up was 6.8/1000 and 5.1/1000 person-years for each group respectively (p = 0.62). CONCLUSIONS Bronchiectasis are common among current and former smokers undergoing lung cancer screening with LDCT. The presence of bronchiectasis is associated with greater incidence of new nodules and false positives on baseline and follow-up screening rounds. This leads to an increase need of diagnostic tests, although the lung cancer occurrence is not different.
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Affiliation(s)
| | | | - Juan P. de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana B. Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis M. Seijo
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Jesus Pueyo
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier J. Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Arantza Campo
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
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7
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Liu Y, Wang H, Li Q, McGettigan MJ, Balagurunathan Y, Garcia AL, Thompson ZJ, Heine JJ, Ye Z, Gillies RJ, Schabath MB. Radiologic Features of Small Pulmonary Nodules and Lung Cancer Risk in the National Lung Screening Trial: A Nested Case-Control Study. Radiology 2017; 286:298-306. [PMID: 28837413 DOI: 10.1148/radiol.2017161458] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To extract radiologic features from small pulmonary nodules (SPNs) that did not meet the original criteria for a positive screening test and identify features associated with lung cancer risk by using data and images from the National Lung Screening Trial (NLST). Materials and Methods Radiologic features in SPNs in baseline low-dose computed tomography (CT) screening studies that did not meet NLST criteria to be considered a positive screening examination were extracted. SPNs were identified for 73 incident case patients who were given a diagnosis of lung cancer at either the first or second follow-up screening study and for 157 control subjects who had undergone three consecutive negative screening studies. Multivariable logistic regression was used to assess the association between radiologic features and lung cancer risk. All statistical tests were two sided. Results Nine features were significantly different between case patients and control subjects. Backward elimination followed by bootstrap resampling identified a reduced model of highly informative radiologic features with an area under the receiver operating characteristic curve of 0.932 (95% confidence interval [CI]: 0.88, 0.96), a specificity of 92.38% (95% CI: 52.22%, 84.91%), and a sensitivity of 76.55% (95% CI: 87.50%, 95.35%) that included total emphysema score (odds ratio [OR] = 1.71; 95% CI: 1.39, 2.01), attachment to vessel (OR = 2.41; 95% CI: 0.99, 5.81), nodule location (OR = 3.25; 95% CI: 1.09, 8.55), border definition (OR = 7.56; 95% CI: 1.89, 30.8), and concavity (OR = 2.58; 95% CI: 0.89, 5.64). Conclusion A set of clinically relevant radiologic features were identified that that can be easily scored in the clinical setting and may be of use to determine lung cancer risk among participants with SPNs. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Ying Liu
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Hua Wang
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Qian Li
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Melissa J McGettigan
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Yoganand Balagurunathan
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Alberto L Garcia
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Zachary J Thompson
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - John J Heine
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Zhaoxiang Ye
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Robert J Gillies
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Matthew B Schabath
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
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8
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Abstract
With the expected rapid growth of the aging population worldwide, there is a clear need to understand the complex process of aging to develop interventions that might extend the health span in this group of patients. Aging is associated with increased susceptibility to a variety of chronic diseases, and lung pathologies are no exception. The prevalence of lung diseases such as idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease has been found to increase considerably with age. In October 2014, the Division of Pulmonary, Allergy, and Critical Care of the University of Pittsburgh cohosted the Pittsburgh-Munich Lung Conference focused in aging and lung disease with the Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Ludwig-Maximilians University and Helmholtz Zentrum Munich Germany. The purpose of the conference was to disseminate novel concepts in aging mechanisms that have an impact in lung physiology and pathogenesis of pulmonary diseases that commonly occur in older populations. The conference included 28 presentations on diverse topics, which are summarized in this report. The participants identified priorities for future basic and translational investigations that will assist in the identification of molecular insights involved in the pathogenesis of age-related pulmonary diseases and the design of therapeutic interventions for these lung conditions.
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9
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Schwartz AG, Lusk CM, Wenzlaff AS, Watza D, Pandolfi S, Mantha L, Cote ML, Soubani AO, Walworth G, Wozniak A, Neslund-Dudas C, Ardisana AA, Flynn MJ, Song T, Spizarny DL, Kvale PA, Chapman RA, Gadgeel SM. Risk of Lung Cancer Associated with COPD Phenotype Based on Quantitative Image Analysis. Cancer Epidemiol Biomarkers Prev 2016; 25:1341-7. [PMID: 27383774 PMCID: PMC5010488 DOI: 10.1158/1055-9965.epi-16-0176] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/31/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer. This study evaluates alternative measures of COPD based on spirometry and quantitative image analysis to better define a phenotype that predicts lung cancer risk. METHODS A total of 341 lung cancer cases and 752 volunteer controls, ages 21 to 89 years, participated in a structured interview, standardized CT scan, and spirometry. Logistic regression, adjusted for age, race, gender, pack-years, and inspiratory and expiratory total lung volume, was used to estimate the odds of lung cancer associated with FEV1/FVC, percent voxels less than -950 Hounsfield units on the inspiratory scan (HUI) and percent voxels less than -856 HU on expiratory scan (HUE). RESULTS The odds of lung cancer were increased 1.4- to 3.1-fold among those with COPD compared with those without, regardless of assessment method; however, in multivariable modeling, only percent voxels <-856 HUE as a continuous measure of air trapping [OR = 1.04; 95% confidence interval (CI), 1.03-1.06] and FEV1/FVC < 0.70 (OR = 1.71; 95% CI, 1.21-2.41) were independent predictors of lung cancer risk. Nearly 10% of lung cancer cases were negative on all objective measures of COPD. CONCLUSION Measures of air trapping using quantitative imaging, in addition to FEV1/FVC, can identify individuals at high risk of lung cancer and should be considered as supplementary measures at the time of screening for lung cancer. IMPACT Quantitative measures of air trapping based on imaging provide additional information for the identification of high-risk groups who might benefit the most from lung cancer screening. Cancer Epidemiol Biomarkers Prev; 25(9); 1341-7. ©2016 AACR.
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Affiliation(s)
- Ann G Schwartz
- Karmanos Cancer Institute, Detroit, Michigan. Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.
| | - Christine M Lusk
- Karmanos Cancer Institute, Detroit, Michigan. Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Angela S Wenzlaff
- Karmanos Cancer Institute, Detroit, Michigan. Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Donovan Watza
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Stephanie Pandolfi
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Michele L Cote
- Karmanos Cancer Institute, Detroit, Michigan. Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Ayman O Soubani
- Karmanos Cancer Institute, Detroit, Michigan. Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Garrett Walworth
- Department of Radiology, Karmanos Cancer Institute, Detroit, Michigan
| | - Antoinette Wozniak
- Karmanos Cancer Institute, Detroit, Michigan. Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Christine Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan
| | - Amy A Ardisana
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan
| | - Michael J Flynn
- Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan. Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Thomas Song
- Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan. Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - David L Spizarny
- Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan. Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Paul A Kvale
- Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan. Department of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan
| | - Robert A Chapman
- Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan. Department of Hematology/Oncology, Henry Ford Health System, Detroit, Michigan
| | - Shirish M Gadgeel
- Karmanos Cancer Institute, Detroit, Michigan. Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
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10
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Aldrich MC, Munro HM, Mumma M, Grogan EL, Massion PP, Blackwell TS, Blot WJ. Chronic obstructive pulmonary disease and subsequent overall and lung cancer mortality in low-income adults. PLoS One 2015; 10:e0121805. [PMID: 25811837 PMCID: PMC4374870 DOI: 10.1371/journal.pone.0121805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/12/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a known risk factor for lung cancer and a leading cause of mortality in the U.S., but its impact may not be fully appreciated, especially among low-income populations in the southeast where COPD prevalence and lung cancer incidence are elevated. METHODS We conducted a prospective study among 26,927 low-income adults age 40-79 in the Southern Community Cohort Study who had a Center for Medicare and Medicaid Services (CMS) encounter prior to enrollment and were followed for a median of over 6 years. Using a validated algorithm for assessing COPD from CMS claims data, we estimated COPD prevalence and potential misreporting. From Cox proportional hazard models, we computed overall and lung cancer-specific mortality according to COPD status. RESULTS The overall prevalence of CMS-diagnosed COPD was 16%, but was twice as high among whites as blacks. Only 35% of these individuals, however, self-reported having COPD, with underreporting significantly greater for blacks than whites. Smoking-adjusted all-cause mortality was increased by 1.7-fold and lung cancer mortality by 2.3-fold among those with a CMS COPD diagnosis, with similar patterns in blacks and whites, but no excess was found among those self-reporting COPD and without CMS confirmation. CONCLUSION The prevalence of COPD in this low-income population may be greater than previously recognized and misreporting is common. COPD is associated with elevated lung cancer mortality, even among those not self-reporting the condition.
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Affiliation(s)
- Melinda C. Aldrich
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Heather M. Munro
- International Epidemiology Institute, Rockville, MD, United States of America
| | - Michael Mumma
- International Epidemiology Institute, Rockville, MD, United States of America
| | - Eric L. Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Tennessee Valley Health System Veterans Affairs, Nashville, TN, United States of America
| | - Pierre P. Massion
- Division of Pulmonary and Critical Care Medicine, Thoracic Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Timothy S. Blackwell
- Departments of Medicine, Cell and Development Biology, and Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- International Epidemiology Institute, Rockville, MD, United States of America
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