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Seok J, Park S, Yoon EC, Yoon HY. Clinical outcomes of interstitial lung abnormalities: a systematic review and meta-analysis. Sci Rep 2024; 14:7330. [PMID: 38538680 PMCID: PMC10973382 DOI: 10.1038/s41598-024-57831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/22/2024] [Indexed: 07/23/2024] Open
Abstract
Interstitial lung abnormalities (ILA), incidental findings on computed tomography scans, have raised concerns due to their association with worse clinical outcomes. Our meta-analysis, which included studies up to April 2023 from PubMed/MEDLINE, Embase, and Cochrane Library, aimed to clarify the impact of ILA on mortality, lung cancer development, and complications from lung cancer treatments. Risk ratios (RR) with 95% confidence intervals (CI) were calculated for outcomes. Analyzing 10 studies on ILA prognosis and 9 on cancer treatment complications, we found that ILA significantly increases the risk of overall mortality (RR 2.62, 95% CI 1.94-3.54; I2 = 90%) and lung cancer development (RR 3.85, 95% CI 2.64-5.62; I2 = 22%). Additionally, cancer patients with ILA had higher risks of grade 2 radiation pneumonitis (RR 2.28, 95% CI 1.71-3.03; I2 = 0%) and immune checkpoint inhibitor-related interstitial lung disease (RR 3.05, 95% CI 1.37-6.77; I2 = 83%) compared with those without ILA. In conclusion, ILA significantly associates with increased mortality, lung cancer risk, and cancer treatment-related complications, highlighting the necessity for vigilant patient management and monitoring.
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Affiliation(s)
- Jinwoo Seok
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, 04401, Republic of Korea
| | - Shinhee Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 14584, Republic of Korea
| | - Eun Chong Yoon
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, 04401, Republic of Korea
| | - Hee-Young Yoon
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, 04401, Republic of Korea.
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AKKAYA H, ERÇEN DİKEN Ö. Can lung semi-quantitative measurements and mediastinal adipose tissue volume predict prognosis in patients with idiopathic pulmonary fibrosis (IPF)? A CT-based preliminary study. Tuberk Toraks 2023; 71:203-214. [PMID: 37740624 PMCID: PMC10854059 DOI: 10.5578/tt.20239702] [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: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/24/2023] Open
Abstract
Introduction The aim of this study was to assess the potential of subcutaneous adipose tissue volume, mediastinal adipose tissue volume, lung density, and lung volume (as measured on high-resolution computed tomography) to predict disease progression in patients with idiopathic pulmonary fibrosis (IPF). Additionally, the study aimed to evaluate the changes in these semiquantitative measures over time. Materials and Methods The HRCT images of 57 patients diagnosed with IPF were retrospectively screened. Subcutaneous adipose tissue volume, mediastinal adipose tissue volume, and mean lung density and volume were measured at the time of diagnosis and at the 12th month. The ability of these parameters to predict progression was evaluated using the univariate and multivariate Cox regression analyses. Results Low mediastinal adipose tissue volume at diagnosis had a 0.991-fold effect [odds ratio (OR)= 0.991, 95% confidence interval (CI)= 0.984-0.997, p< 0.001] on progression. Low mediastinal adipose tissue volume at diagnosis had a 0.993-fold effect [odds ratio (OR)= 0.993, 95% confidence interval (CI)= 0.975-1.011, p< 0.001] and progression development at the 12th month had a 6.5-fold effect [odds ratio (OR)= 6.516, 95% confidence interval (CI)= 1.594-26.639, p< 0.009] on mortality. Conclusion This study indicate that the prognosis was better in those with a large mediastinal adipose tissue volume among the patients with IPF.
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Affiliation(s)
- H. AKKAYA
- Clinic of Radiology, University of Health Sciences, Adana City Training and
Research Hospital, Adana, Türkiye
- Clinic of Chest Diseases, University of Health Sciences, Adana City Training
and Research Hospital, Adana, Türkiye
| | - Ö. ERÇEN DİKEN
- Clinic of Chest Diseases, University of Health Sciences, Adana City Training
and Research Hospital, Adana, Türkiye
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Kreniske JS, Kaner RJ, Glesby MJ. Pathogenesis and management of emphysema in people with HIV. Expert Rev Respir Med 2023; 17:873-887. [PMID: 37848398 PMCID: PMC10872640 DOI: 10.1080/17476348.2023.2272702] [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: 03/04/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Since early in the HIV epidemic, emphysema has been identified among people with HIV (PWH) and has been associated with increased mortality. Smoking cessation is key to risk reduction. Health maintenance for PWH and emphysema should ensure appropriate vaccination and lung cancer screening. Treatment should adhere to inhaler guidelines for the general population, but inhaled corticosteroid (ICS) should be used with caution. Frontiers in treatment include targeted therapeutics. Major knowledge gaps exist in the epidemiology of and optimal care for PWH and emphysema, particularly in low and middle-income countries (LMIC). AREAS COVERED Topics addressed include risk factors, pathogenesis, current treatment and prevention strategies, and frontiers in research. EXPERT OPINION There are limited data on the epidemiology of emphysema in LMIC, where more than 90% of deaths from COPD occur and where the morbidity of HIV is most heavily concentrated. The population of PWH is aging, and age-related co-morbidities such as emphysema will only increase in salience. Over the next 5 years, the authors anticipate novel trials of targeted therapy for emphysema specific to PWH, and we anticipate a growing body of evidence to inform optimal clinical care for lung health among PWH in LMIC.
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Affiliation(s)
- Jonah S. Kreniske
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, USA
| | - Robert J. Kaner
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, USA
- Department of Genetic Medicine, Weill Cornell Medical College, USA
| | - Marshall J. Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, USA
- Department of Population Health Sciences, Weill Cornell Medical College, USA
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Lee JE, Chae KJ, Suh YJ, Jeong WG, Lee T, Kim YH, Jin GY, Jeong YJ. Prevalence and Long-term Outcomes of CT Interstitial Lung Abnormalities in a Health Screening Cohort. Radiology 2023; 306:e221172. [PMID: 36219115 DOI: 10.1148/radiol.221172] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The association between interstitial lung abnormalities (ILAs) and long-term outcomes has not been reported in Asian health screening populations. Purpose To investigate ILA prevalence in an Asian health screening cohort and determine rates and risks for ILA progression, lung cancer development, and mortality within the 10-year follow-up. Materials and Methods This observational, retrospective multicenter study included patients aged 50 years or older who underwent chest CT at three health screening centers over a 4-year period (2007-2010). ILA status was classified as none, equivocal ILA, and ILA (nonfibrotic or fibrotic). Progression was evaluated from baseline to the last follow-up CT examination, when available. The log-rank test was performed to compare mortality rates over time between ILA statuses. Multivariable Cox proportional hazards models were used to assess factors associated with hazards of ILA progression, lung cancer development, and mortality. Results Of the 2765 included patients (mean age, 59 years ± 7 [SD]; 2068 men), 94 (3%) had a finding of ILA (35 nonfibrotic and 59 fibrotic ILA) and 119 (4%) had equivocal ILA. The median time for CT follow-up and the entire observation was 8 and 12 years, respectively. ILA progression was observed in 80% (48 of 60) of patients with ILA over 8 years. Those with fibrotic and nonfibrotic ILA had a higher mortality rate than those without ILA (P < .001 and P = .01, respectively) over 12 years. Fibrotic ILA was independently associated with ILA progression (hazard ratio [HR], 10.3; 95% CI: 6.4, 16.4; P < .001), lung cancer development (HR, 4.4; 95% CI: 2.1, 9.1; P < .001), disease-specific mortality (HR, 6.7; 95% CI: 3.7, 12.2; P < .001), and all-cause mortality (HR, 2.5; 95% CI: 1.6, 3.8; P < .001) compared with no ILA. Conclusion The prevalence of interstitial lung abnormalities (ILAs) in an Asian health screening cohort was approximately 3%, and fibrotic ILA was an independent risk factor for ILA progression, lung cancer development, and mortality. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Hatabu and Hata in this issue.
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Affiliation(s)
- Jong Eun Lee
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Kum Ju Chae
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Young Ju Suh
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Won Gi Jeong
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Taebum Lee
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Yun-Hyeon Kim
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Gong Yong Jin
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
| | - Yeon Joo Jeong
- From the Departments of Radiology (J.E.L., Y.H.K.) and Pathology (T.L.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea (K.J.C., G.Y.J.); Department of Biomedical Sciences, School of Medicine, Inha University, Incheon, Korea (Y.J.S.); Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea (W.G.J.); and Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea (Y.J.J.)
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5
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Rose JA, Menon AA, Hino T, Hata A, Nishino M, Lynch DA, Rosas IO, El-Chemaly S, Raby BA, Ash SY, Choi B, Washko GR, Silverman EK, Cho MH, Hatabu H, Putman RK, Hunninghake GM. Suspected Interstitial Lung Disease in COPDGene Study. Am J Respir Crit Care Med 2023; 207:60-68. [PMID: 35930450 PMCID: PMC9952869 DOI: 10.1164/rccm.202203-0550oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: Although interstitial lung abnormalities (ILA), specific patterns of incidentally-detected abnormal density on computed tomography, have been associated with abnormal lung function and increased mortality, it is unclear if a subset with incidental interstitial lung disease (ILD) accounts for these adverse consequences. Objectives: To define the prevalence and risk factors of suspected ILD and assess outcomes. Methods: Suspected ILD was evaluated in the COPDGene (Chronic Obstructive Pulmonary Disease Genetic Epidemiology) study, defined as ILA and at least one additional criterion: definite fibrosis on computed tomography, FVC less than 80% predicted, or DLCO less than 70% predicted. Multivariable linear, longitudinal, and Cox proportional hazards regression models were used to assess associations with St. George's Respiratory Questionnaire, 6-minute-walk test, supplemental oxygen use, respiratory exacerbations, and mortality. Measurements and Main Results: Of 4,361 participants with available data, 239 (5%) had evidence for suspected ILD, whereas 204 (5%) had ILA without suspected ILD. In multivariable analyses, suspected ILD was associated with increased St. George's Respiratory Questionnaire score (mean difference [MD], 3.9 points; 95% confidence interval [CI], 0.6-7.1; P = 0.02), reduced 6-minute-walk test (MD, -35 m; 95% CI, -56 m to -13 m; P = 0.002), greater supplemental oxygen use (odds ratio [OR], 2.3; 95% CI, 1.1-5.1; P = 0.03) and severe respiratory exacerbations (OR, 2.9; 95% CI, 1.1-7.5; P = 0.03), and higher mortality (hazard ratio, 2.4; 95% CI, 1.2-4.6; P = 0.01) compared with ILA without suspected ILD. Risk factors associated with suspected ILD included self-identified Black race (OR, 2.0; 95% CI, 1.1-3.3; P = 0.01) and pack-years smoking history (OR, 1.2; 95% CI, 1.1-1.3; P = 0.0005). Conclusions: Suspected ILD is present in half of those with ILA in COPDGene and is associated with exercise decrements and increased symptoms, supplemental oxygen use, severe respiratory exacerbations, and mortality.
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Affiliation(s)
| | | | | | - Akinori Hata
- Department of Radiology, Osaka University, Osaka, Japan
| | | | | | - Ivan O. Rosas
- Pulmonary Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas; and
| | | | - Benjamin A. Raby
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Bina Choi
- Pulmonary and Critical Care Division
| | | | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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6
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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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7
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Sanders JL, Axelsson G, Putman R, Menon A, Dupuis J, Xu H, Wang S, Murabito J, Vasan R, Araki T, Nishino M, Washko GR, Hatabu H, O'Connor G, Gudmundsson G, Gudnason V, Hunninghake GM. The relationship between interstitial lung abnormalities, mortality, and multimorbidity: a cohort study. Thorax 2022; 78:559-565. [PMID: 35777957 DOI: 10.1136/thoraxjnl-2021-218315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Interstitial lung abnormalities (ILAs) are associated with increased mortality. It is unclear whether multimorbidity accounts for the mortality association or how strongly ILA is associated with mortality relative to other common age-associated diseases. We determined the association of ILA with all-cause mortality adjusted for multimorbidity, compared mortality associated with ILA and prevalent cardiovascular disease (CVD), diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease and cancer and also determined the association between ILA and these diseases. METHODS We measured ILA (none, indeterminant, definite) using blinded reads of CT images, prevalent chronic diseases and potential confounders in two observational cohorts, the Framingham Heart Study (FHS) (n=2449) and Age, Gene/Environment Susceptibility - Reykjavik Study (AGES-Reykjavik) (n=5180). We determined associations with mortality using Cox proportional hazards models and between ILA and diseases with multinomial logistic regression. RESULTS Over a median (IQR) follow-up of 8.8 (1.4) years in FHS and 12.0 (7.7) years in AGES-Reykjavik, in adjusted models, ILAs were significantly associated with increased mortality (HR, 95% CI 1.95, 1.23 to 3.08, p=0.0042, in FHS; HR 1.60, 1.41 to 1.82, p<0.0001, in AGES-Reykjavik) adjusted for multimorbidity. In both cohorts, the association of ILA with mortality was of similar magnitude to the association of most other diseases. In adjusted models, ILAs were associated only with prevalent kidney disease (OR, 95% CI 1.90, 1.01 to 3.57, p=0.0452) in FHS and with prevalent CVD (OR 1.42, 1.12 to 1.81, p=0.0040) in AGES-Reykjavik. CONCLUSIONS ILAs were associated with mortality adjusted for multimorbidity and were similarly associated with increased mortality compared with several common chronic diseases. ILAs were not consistently associated with the prevalence of these diseases themselves.
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Affiliation(s)
| | - Gisli Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Rachel Putman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aravind Menon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Josée Dupuis
- Biostatistics Department, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Hanfei Xu
- Biostatistics Department, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Joanne Murabito
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ramachandran Vasan
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Tetsuro Araki
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - George O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston University Medical Center, Boston, Massachusetts, USA
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Vilmundur Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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8
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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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9
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Quantitative inspiratory-expiratory chest CT findings in COVID-19 survivors at the 6-month follow-up. Sci Rep 2022; 12:7402. [PMID: 35513692 PMCID: PMC9070972 DOI: 10.1038/s41598-022-11237-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/19/2022] [Indexed: 12/15/2022] Open
Abstract
We evaluated pulmonary sequelae in COVID-19 survivors by quantitative inspiratory-expiratory chest CT (QCT) and explored abnormal pulmonary diffusion risk factors at the 6-month follow-up. This retrospective study enrolled 205 COVID-19 survivors with baseline CT data and QCT scans at 6-month follow-up. Patients without follow-up pulmonary function tests were excluded. All subjects were divided into group 1 (carbon monoxide diffusion capacity [DLCO] < 80% predicted, n = 88) and group 2 (DLCO ≥ 80% predicted, n = 117). Clinical characteristics and lung radiological changes were recorded. Semiquantitative total CT score (0-25) was calculated by adding five lobes scores (0-5) according to the range of lesion involvement (0: no involvement; 1: < 5%; 2: 5-25%; 3: 26-50%; 4: 51-75%; 5: > 75%). Data was analyzed by two-sample t-test, Spearman test, etc. 29% survivors showed air trapping by follow-up QCT. Semiquantitative CT score and QCT parameter of air trapping in group 1 were significantly greater than group 2 (p < 0.001). Decreased DLCO was negatively correlated with the follow-up CT score for ground-glass opacity (r = - 0.246, p = 0.003), reticulation (r = - 0.206, p = 0.002), air trapping (r = - 0.220, p = 0.002) and relative lung volume changes (r = - 0.265, p = 0.001). COVID-19 survivors with lung diffusion deficits at 6-month follow-up tended to develop air trapping, possibly due to small-airway impairment.
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10
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Zhang Y, Wan H, Richeldi L, Zhu M, Huang Y, Xiong X, Liao J, Zhu W, Mao L, Xu L, Ye D, Chen L, Liu J, Fu L, Li L, Lan L, Li P, Wang L, Tang X, Luo F. Reticulation is a Risk Factor of Progressive Subpleural non-Fibrotic Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2022; 206:178-185. [PMID: 35426779 DOI: 10.1164/rccm.202110-2412oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yuchen Zhang
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Huajing Wan
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Luca Richeldi
- Universita Cattolica del Sacro Cuore Sede di Roma, 96983, Pulmonary Medicine, Roma, Italy
| | - Min Zhu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Huang
- Department of Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofeng Xiong
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Junzhe Liao
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjun Zhu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingli Mao
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Linrui Xu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Dongfan Ye
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Chen
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Liu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Linxi Fu
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Liangyuan Li
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Lan Lan
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Li
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Lixia Wang
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Tang
- Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Fengming Luo
- West China Hospital, Sichuan University, Department of Respiratory Medicine, Chengdu, China
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11
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Pinsky PF, Lynch DA, Gierada DS. Incidental Findings on Low-Dose CT Scan Lung Cancer Screenings and Deaths From Respiratory Diseases. Chest 2022; 161:1092-1100. [PMID: 34838524 PMCID: PMC9005861 DOI: 10.1016/j.chest.2021.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Incidental respiratory disease-related findings are frequently observed on low-dose CT (LDCT) lung cancer screenings. This study analyzed data from the National Lung Screening Trial (NLST) to assess the relationship between such findings and respiratory disease mortality (RDM), excluding lung cancer. RESEARCH QUESTION Are incidental respiratory findings on LDCT scanning associated with increased RDM? STUDY DESIGN AND METHODS Subjects in the NLST LDCT arm received three annual screens. Trial radiologists noted findings related to possible lung cancer, as well as respiratory-related incidental findings. Demographic characteristics, smoking history, and medical history were captured in a baseline questionnaire. Kaplan-Meier curves were used to assess cumulative RDM. Multivariate proportional hazards models were used to assess risk factors for RDM; in addition to incidental CT scan findings, variables included respiratory disease history (COPD/emphysema, and asthma), smoking history, and demographic factors (age, race, sex, and BMI). RESULTS Of 26,722 subjects in the NLST LDCT arm, 25,002 received the baseline screen and a subsequent LDCT screen. Overall, 59% were male, 26.5% were aged ≥ 65 years at baseline, and 10.6% reported a history of COPD/emphysema. Emphysema on LDCT scanning was reported in 30.7% of subjects at baseline and in 44.2% at any screen. Of those with emphysema on baseline LDCT scanning, 18% reported a history of COPD/emphysema. Median mortality follow-up was 10.3 years. There were 3,639 deaths, and 708 were from respiratory diseases. Among subjects with no history of COPD/emphysema, 10-year cumulative RDM ranged from 3.9% for subjects with emphysema and reticular opacities to 1.1% for those with neither condition; the corresponding range among subjects with a COPD/emphysema history was 17.3% (both) to 3.7% (neither). Emphysema on LDCT imaging was associated with a significantly elevated RDM hazard ratio (2.27; 95% CI, 1.92-2.7) in the multivariate model. Reticular opacities (including honeycombing/fibrosis/scar) also had a significantly elevated hazard ratio (1.39; 95% CI, 1.19-1.62). INTERPRETATION Incidental respiratory disease-related findings observed on NLST LDCT screens were frequent and associated with increased mortality from respiratory diseases.
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Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - David S Gierada
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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12
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Hunninghake GM, Goldin JG, Kadoch MA, Kropski JA, Rosas IO, Wells AU, Yadav R, Lazarus HM, Abtin FG, Corte TJ, de Andrade JA, Johannson KA, Kolb MR, Lynch DA, Oldham JM, Spagnolo P, Strek ME, Tomassetti S, Washko GR, White ES. Detection and Early Referral of Patients With Interstitial Lung Abnormalities: An Expert Survey Initiative. Chest 2022; 161:470-482. [PMID: 34197782 PMCID: PMC10624930 DOI: 10.1016/j.chest.2021.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Interstitial lung abnormalities (ILA) may represent undiagnosed early-stage or subclinical interstitial lung disease (ILD). ILA are often observed incidentally in patients who subsequently develop clinically overt ILD. There is limited information on consensus definitions for, and the appropriate evaluation of, ILA. Early recognition of patients with ILD remains challenging, yet critically important. Expert consensus could inform early recognition and referral. RESEARCH QUESTION Can consensus-based expert recommendations be identified to guide clinicians in the recognition, referral, and follow-up of patients with or at risk of developing early ILDs? STUDY DESIGN AND METHODS Pulmonologists and radiologists with expertise in ILD participated in two iterative rounds of surveys. The surveys aimed to establish consensus regarding ILA reporting, identification of patients with ILA, and identification of populations that might benefit from screening for ILD. Recommended referral criteria and follow-up processes were also addressed. Threshold for consensus was defined a priori as ≥ 75% agreement or disagreement. RESULTS Fifty-five experts were invited and 44 participated; consensus was reached on 39 of 85 questions. The following clinically important statements achieved consensus: honeycombing and traction bronchiectasis or bronchiolectasis indicate potentially progressive ILD; honeycombing detected during lung cancer screening should be reported as potentially significant (eg, with the Lung CT Screening Reporting and Data System "S-modifier" [Lung-RADS; which indicates clinically significant or potentially significant noncancer findings]), recommending referral to a pulmonologist in the radiology report; high-resolution CT imaging and full pulmonary function tests should be ordered if nondependent subpleural reticulation, traction bronchiectasis, honeycombing, centrilobular ground-glass nodules, or patchy ground-glass opacity are observed on CT imaging; patients with honeycombing or traction bronchiectasis should be referred to a pulmonologist irrespective of diffusion capacity values; and patients with systemic sclerosis should be screened with pulmonary function tests for early-stage ILD. INTERPRETATION Guidance was established for identifying clinically relevant ILA, subsequent referral, and follow-up. These results lay the foundation for developing practical guidance on managing patients with ILA.
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Affiliation(s)
- Gary M Hunninghake
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Boston, MA.
| | - Jonathan G Goldin
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA
| | - Michael A Kadoch
- Department of Radiology, University of California at Davis, Davis, CA
| | | | - Ivan O Rosas
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Ruchi Yadav
- Imaging Institute, Cleveland Clinic, Cleveland, OH
| | | | - Fereidoun G Abtin
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA; Division of Interventional Radiology, University of California at Los Angeles, Los Angeles, CA
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, and University of Sydney, Sydney NSW, Australia
| | | | | | - Martin R Kolb
- Firestone Institute for Respiratory Health, Research Institute at St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Justin M Oldham
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California at Davis, Davis, CA; Department of Veterans Affairs Northern California, Sacramento, CA
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy
| | - Mary E Strek
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - George R Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Boston, MA
| | - Eric S White
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
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13
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Pompe E, Mohamed Hoesein FAA. Role of visual assessment of chronic obstructive pulmonary disease on chest CT: beauty is in the eye of the beholder. J Thorac Dis 2022; 13:6936-6939. [PMID: 35070377 PMCID: PMC8743402 DOI: 10.21037/jtd-21-1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Menon AA, Putman RK, Sanders JL, Hino T, Hata A, Nishino M, Ghosh AJ, Ash SY, Rosas IO, Cho MH, Lynch DA, Washko GR, Silverman EK, Hatabu H, Hunninghake GM. Interstitial Lung Abnormalities, Emphysema and Spirometry in Smokers. Chest 2021; 161:999-1010. [PMID: 34742688 DOI: 10.1016/j.chest.2021.10.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Most pulmonary conditions reduce forced vital capacity (FVC), but studies of patients with combined pulmonary fibrosis and emphysema demonstrate that reductions in FVC are less than expected when these two conditions coexist clinically. RESEARCH QUESTION Do interstitial lung abnormalities (ILA), chest computed tomography (CT) imaging findings that may suggest an early stage of pulmonary fibrosis in undiagnosed individuals, affect the association between emphysema and FVC? STUDY DESIGN AND METHODS Measures of ILA and emphysema were available in 9579 and 5277 participants from phases 1 (2007-2011) and 2 (2012-2016) of COPDGene, respectively. ILA were defined by Fleischner Society guidelines. Adjusted linear regression models were used to assess the associations and interactions between ILA, emphysema, measures of spirometry and lung function. RESULTS ILA were present in 528 (6%), and 580 (11%), of participants in phases 1 and 2 of COPDGene, respectively. ILA modified the association between emphysema and FVC (P<0.0001 for interaction) in both phases. In phase 1, in those without ILA, a 5% increase in emphysema was associated with a reduction in FVC (-110 cc, 95% confidence interval [CI] -121, -100; P<0.0001) however, in those with ILA it was not (-11cc, 95% CI -53,31; P=0.59). In contrast, there was no interaction between ILA and emphysema on total lung capacity (TLC) nor on diffusing capacity of carbon monoxide (DLCO). INTERPRETATION The presence of ILA attenuates the reduction in FVC associated with emphysema.
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Affiliation(s)
- Aravind A Menon
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Rachel K Putman
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Jason L Sanders
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Takuya Hino
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Akinori Hata
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Radiology, Osaka University, Osaka, Japan
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Auyon J Ghosh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Samuel Y Ash
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Ivan O Rosas
- Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - David A Lynch
- Department of Radiology, National Jewish Health, and University of Colorado at Denver Health Sciences Center, Denver, CO
| | - George R Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gary M Hunninghake
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA.
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15
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Hata A, Schiebler ML, Lynch DA, Hatabu H. Interstitial Lung Abnormalities: State of the Art. Radiology 2021; 301:19-34. [PMID: 34374589 DOI: 10.1148/radiol.2021204367] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The clinical importance of interstitial lung abnormality (ILA) is increasingly recognized. In July 2020, the Fleischner Society published a position paper about ILA. The purposes of this article are to summarize the definition, existing evidence, clinical management, and unresolved issues for ILA from a radiologic standpoint and to provide a practical guide for radiologists. ILA is a common incidental finding at CT and is often progressive and associated with worsened clinical outcomes. The hazard ratios for mortality range from 1.3 to 2.7 in large cohorts. Risk factors for ILA include age, smoking status, other inhalational exposures, and genetic factors (eg, gene encoding mucin 5B variant). Radiologists should systematically record the presence, morphologic characteristics, distribution, and subcategories of ILA (ie, nonsubpleural, subpleural nonfibrotic, and subpleural fibrotic), as these are informative for predicting progression and mortality. Clinically significant interstitial lung disease should not be considered ILA. Individuals with ILA are triaged into higher- and lower-risk groups depending on their risk factors for progression, and systematic follow-up, including CT, should be considered for the higher-risk group. Artificial intelligence-based automated analysis for ILA may be helpful, but further validation and improvement are needed. Radiologists have a central role in clinical management and research on ILA.
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Affiliation(s)
- Akinori Hata
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Mark L Schiebler
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - David A Lynch
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Hiroto Hatabu
- From the Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.H., H.H.); Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (A.H.); Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
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16
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Sanders JL, Putman RK, Dupuis J, Xu H, Murabito JM, Araki T, Nishino M, Benjamin EJ, Levy DL, Ramachandran VS, Washko GR, Curtis JL, Freeman CM, Bowler RP, Hatabu H, O’Connor GT, Hunninghake GM. The Association of Aging Biomarkers, Interstitial Lung Abnormalities, and Mortality. Am J Respir Crit Care Med 2021; 203:1149-1157. [PMID: 33080140 PMCID: PMC8314902 DOI: 10.1164/rccm.202007-2993oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/20/2020] [Indexed: 12/28/2022] Open
Abstract
Rationale: The association between aging and idiopathic pulmonary fibrosis has been established. The associations between aging-related biomarkers and interstitial lung abnormalities (ILA) have not been comprehensively evaluated.Objectives: To evaluate the associations among aging biomarkers, ILA, and all-cause mortality.Methods: In the FHS (Framingham Heart Study), we evaluated associations among plasma biomarkers (IL-6, CRP [C-reactive protein], TNFR [tumor necrosis factor α receptor II], GDF15 [growth differentiation factor 15], cystatin-C, HGBA1C [Hb A1C], insulin, IGF1 [insulin-like growth factor 1], and IGFBP1 [IGF binding protein 1] and IGFBP3]), ILA, and mortality. Causal inference analysis was used to determine whether biomarkers mediated age. GDF15 results were replicated in the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) Study.Measurements and Main Results: In the FHS, there were higher odds of ILA per increase in natural log-transformed GDF15 (odds ratio [95% confidence interval], 3.4 [1.8-6.4]; P = 0.0002), TNFR (3.1 [1.6-5.8]; P = 0.004), IL-6 (1.8 [1.4-2.4]; P < 0.0001), and CRP (1.7 [1.3-2.0]; P < 0.0001). In the FHS, after adjustment for multiple comparisons, no biomarker was associated with increased mortality, but the associations of GDF15 (hazard ratio, 2.0 [1.1-3.5]; P = 0.02), TNFR (1.8 [1.0-3.3]; P = 0.05), and IGFBP1 (1.3 [1.1-1.7]; P = 0.01) approached significance. In the COPDGene Study, higher natural log-transformed GDF15 was associated with ILA (odds ratio, 8.1 [3.1-21.4]; P < 0.0001) and mortality (hazard ratio, 1.6 [1.1-2.2]; P = 0.01). Causal inference analysis showed that the association of age with ILA was mediated by IL-6 (P < 0.0001) and TNFR (P = 0.002) and was likely mediated by GDF15 (P = 0.008) in the FHS and was mediated by GDF15 (P = 0.001) in the COPDGene Study.Conclusions: Some aging-related biomarkers are associated with ILA. GDF15, in particular, may explain some of the associations among age, ILA, and mortality.
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Affiliation(s)
| | | | - Josée Dupuis
- Department of Biostatistics, School of Public Health
| | - Hanfei Xu
- Department of Biostatistics, School of Public Health
| | - Joanne M. Murabito
- Department of Medicine, and
- Framingham Heart Study, Framingham, Massachusetts
| | - Tetsuro Araki
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Emelia J. Benjamin
- Department of Medicine, and
- Framingham Heart Study, Framingham, Massachusetts
| | - Daniel L. Levy
- Department of Medicine, and
- Framingham Heart Study, Framingham, Massachusetts
| | | | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
- Medical Service and
| | - Christine M. Freeman
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
- Research Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Russell P. Bowler
- Department of Medicine, National Jewish Health–Health Sciences Center, University of Colorado at Denver, Denver, Colorado
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital–Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - George T. O’Connor
- Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts
| | - Gary M. Hunninghake
- Division of Pulmonary and Critical Care Medicine and
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital–Harvard Medical School, Harvard University, Boston, Massachusetts; and
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17
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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: 296] [Impact Index Per Article: 74.0] [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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18
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Dept of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Dept of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Dept of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
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19
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
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20
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Putman RK, Gudmundsson G, Axelsson GT, Hida T, Honda O, Araki T, Yanagawa M, Nishino M, Miller ER, Eiriksdottir G, Gudmundsson EF, Tomiyama N, Honda H, Rosas IO, Washko GR, Cho MH, Schwartz DA, Gudnason V, Hatabu H, Hunninghake GM. Imaging Patterns Are Associated with Interstitial Lung Abnormality Progression and Mortality. Am J Respir Crit Care Med 2019; 200:175-183. [PMID: 30673508 PMCID: PMC6635786 DOI: 10.1164/rccm.201809-1652oc] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/23/2019] [Indexed: 11/16/2022] Open
Abstract
Rationale: Interstitial lung abnormalities (ILA) are radiologic abnormalities on chest computed tomography scans that have been associated with an early or mild form of pulmonary fibrosis. Although ILA have been associated with radiologic progression, it is not known if specific imaging patterns are associated with progression or risk of mortality. Objectives: To determine the role of imaging patterns on the risk of death and ILA progression. Methods: ILA (and imaging pattern) were assessed in 5,320 participants from the AGES-Reykjavik Study, and ILA progression was assessed in 3,167 participants. Multivariable logistic regression was used to assess factors associated with ILA progression, and Cox proportional hazards models were used to assess time to mortality. Measurements and Main Results: Over 5 years, 327 (10%) had ILA on at least one computed tomography, and 1,435 (45%) did not have ILA on either computed tomography. Of those with ILA, 238 (73%) had imaging progression, whereas 89 (27%) had stable to improved imaging; increasing age and copies of MUC5B genotype were associated with imaging progression. The definite fibrosis pattern was associated with the highest risk of progression (odds ratio, 8.4; 95% confidence interval, 2.7-25; P = 0.0003). Specific imaging patterns were also associated with an increased risk of death. After adjustment, both a probable usual interstitial pneumonia and usual interstitial pneumonia pattern were associated with an increased risk of death when compared with those indeterminate for usual interstitial pneumonia (hazard ratio, 1.7; 95% confidence interval, 1.2-2.4; P = 0.001; hazard ratio, 3.9; 95% confidence interval, 2.3-6.8;P < 0.0001), respectively. Conclusions: In those with ILA, imaging patterns can be used to help predict who is at the greatest risk of progression and early death.
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Affiliation(s)
| | - Gunnar Gudmundsson
- Department of Respiratory Medicine and Sleep, Faculty of Medicine, Landspital University Hospital and
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gisli Thor Axelsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Tomoyuki Hida
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | - Osamu Honda
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuro Araki
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mizuki Nishino
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | | | | | | | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan; and
| | | | - George R. Washko
- Pulmonary and Critical Care Division
- Center for Pulmonary Functional Imaging, and
| | - Michael H. Cho
- Pulmonary and Critical Care Division
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Hiroto Hatabu
- Department of Radiology
- Center for Pulmonary Functional Imaging, and
| | - Gary M. Hunninghake
- Pulmonary and Critical Care Division
- Center for Pulmonary Functional Imaging, and
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21
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Hatabu H, Hunninghake GM, Lynch DA. Interstitial Lung Abnormality: Recognition and Perspectives. Radiology 2019; 291:1-3. [DOI: 10.1148/radiol.2018181684] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroto Hatabu
- From the Department of Radiology (H.H.) and Pulmonary and Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215; and Department of Radiology, National Jewish Medical and Research Center, Denver, Colo (D.A.L.)
| | - Gary M. Hunninghake
- From the Department of Radiology (H.H.) and Pulmonary and Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215; and Department of Radiology, National Jewish Medical and Research Center, Denver, Colo (D.A.L.)
| | - David A. Lynch
- From the Department of Radiology (H.H.) and Pulmonary and Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215; and Department of Radiology, National Jewish Medical and Research Center, Denver, Colo (D.A.L.)
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22
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Janssen R, Piscaer I, Franssen FME, Wouters EFM. Emphysema: looking beyond alpha-1 antitrypsin deficiency. Expert Rev Respir Med 2019; 13:381-397. [DOI: 10.1080/17476348.2019.1580575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Rob Janssen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ianthe Piscaer
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F. M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
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23
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Hunninghake GM. Interstitial lung abnormalities: erecting fences in the path towards advanced pulmonary fibrosis. Thorax 2019; 74:506-511. [PMID: 30723182 PMCID: PMC6475107 DOI: 10.1136/thoraxjnl-2018-212446] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 01/01/2023]
Abstract
Interstitial lung abnormalities, when present in members of undiagnosed family members recruited on the basis of familial interstitial pneumonia, or in undiagnosed research participants, have been associated with a syndrome that includes distinct sets of imaging abnormalities, restrictive physiological and exercise impairments, and an increased prevalence of histopathological findings, and genetic predictors, that have been noted in patients with idiopathic pulmonary fibrosis. Recent longitudinal studies have demonstrated that qualitative and quantitative assessments of interstitial abnormalities are associated with accelerated lung function decline, an increased rate of clinical diagnoses of interstitial lung disease and an increased rate of mortality. In this perspective, in addition to reviewing the prior information, four major efforts that could help the field of early pulmonary fibrosis detection move forward are discussed. These efforts include: (1) developing standards for characterising and reporting imaging findings from patients with existing CTs; (2) developing consensus statements on when undiagnosed and asymptomatic imaging abnormalities should be considered a disease; (3) identifying populations for which screening efforts might be beneficial; and (4) considering approaches to developing effective secondary prevention trials.
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Mets OM, Chung K, Scholten ET, Veldhuis WB, Prokop M, van Ginneken B, Schaefer-Prokop CM, de Jong PA. Incidental perifissural nodules on routine chest computed tomography: lung cancer or not? Eur Radiol 2017; 28:1095-1101. [PMID: 28986629 PMCID: PMC5811588 DOI: 10.1007/s00330-017-5055-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/27/2017] [Accepted: 08/31/2017] [Indexed: 12/19/2022]
Abstract
Objectives Perifissural nodules (PFNs) are a common finding on chest CT, and are thought to represent non-malignant lesions. However, data outside a lung cancer-screening setting are currently lacking. Methods In a nested case-control design, out of a total cohort of 16,850 patients ≥ 40 years of age who underwent routine chest CT (2004-2012), 186 eligible subjects with incident lung cancer and 511 controls without were investigated. All non-calcified nodules ≥ 4 mm were semi-automatically annotated. Lung cancer location and subject characteristics were recorded. Results Cases (56 % male) had a median age of 64 years (IQR 59–70). Controls (60 % male) were slightly younger (p<0.01), median age of 61 years (IQR 51–70). A total of 262/1,278 (21 %) unique non-calcified nodules represented a PFN. None of these were traced to a lung malignancy over a median follow-up of around 4.5 years. PFNs were most often located in the lower lung zones (72 %, p<0.001). Median diameter was 4.6 mm (range: 4.0–8.1), volume 51 mm3 (range: 32–278). Some showed growth rates < 400 days. Conclusions Our data show that incidental PFNs do not represent lung cancer in a routine care, heterogeneous population. This confirms prior screening-based results. Key Points • One-fifth of non-calcified nodules represented a perifissural nodule in our non-screening population. • PFNs fairly often show larger size, and can show interval growth. • When morphologically resembling a PFN, nodules are nearly certainly not a malignancy. • The assumed benign aetiology of PFNs seems valid outside the screening setting.
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Affiliation(s)
- Onno M Mets
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Kaman Chung
- Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ernst Th Scholten
- Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - M Prokop
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Cornelia M Schaefer-Prokop
- Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
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Kauczor HU, Heussel CP, von Stackelberg O. Time to take CT screening to the next level? Eur Respir J 2017; 49:49/4/1700064. [PMID: 28424364 DOI: 10.1183/13993003.00064-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany .,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Dept of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
| | - Claus Peter Heussel
- Dept of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Dept of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Dept of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Medical Center Heidelberg, Heidelberg, Germany
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