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Ueno M, Egashira R, Hashisako M, Fujimoto K, Fukuda T, Hayashida Y, Sumikawa H, Tominaga J, Tanaka T, Terasaki Y, Fukuoka J, Nishioka Y, Aoki T, Gabata T, Hatabu H, Johkoh T. Idiopathic dendriform pulmonary ossification as the phenotype of interstitial lung abnormalities: CT-pathologic correlation and prevalence. Jpn J Radiol 2024:10.1007/s11604-024-01590-8. [PMID: 38740642 DOI: 10.1007/s11604-024-01590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE Idiopathic dendriform pulmonary ossification (DPO) is mostly asymptomatic, and detected incidentally in lung CT. There have been no reports on the precise CT-pathologic correlation and the prevalence of idiopathic DPO. This study aimed to clarify the histological background and prevalence of idiopathic DPO. MATERIALS AND METHODS Sixteen patients with histologically confirmed idiopathic DPO (12 men and 4 women; mean age, 38.8 years; range 22-56 years) were identified in a nationwide epidemiological survey. Local HRCT findings of pre-biopsy examinations, such as branching, round, linear structures with or without high attenuation were compared side by side with histological findings. The attenuation of branching, round, and linear structures was classified into three-point levels on bone window images (width, 2500 HU; level, 500 HU). Furthermore, we collected continuous pulmonary CT images of 8111 cases for checking up metastasis from extrathoracic malignancy at a single institution, and evaluated the prevalence of interstitial lung abnormalities (ILAs) and DPO. RESULTS In all 16 cases, branching (n = 15, 93%), round (n = 5, 31%), or linear (n = 5, 31%) structures were identified, histologically corresponding to dendriform ossification and cicatricial organizing pneumonia (OP)/fibrosis. Histologically, ossification was confirmed in all the 16 patients. However, in two cases, a highly attenuated structure could not be detected on the pre-biopsy CT of the same area. Regarding the prevalence of idiopathic DPO, 283 (3.5%) of 8111 patients had ILAs, of which a total of 26 (0.3% of all cases, 9.2% of ILAs cases) had DPO. CONCLUSION Idiopathic DPO showed linear or branching structures with or without high attenuation on CT, corresponded to ossification, cicatricial OP/fibrosis. DPO was seen in 9.2% of ILAs cases. Idiopathic DPO is one of pathologic phenotypes of ILAs.
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Affiliation(s)
- Midori Ueno
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Kitakyushu City, Fukuoka, 807-8555, Japan.
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabesima, Saga City, Saga, 849-8501, Japan
| | - Mikiko Hashisako
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medicine Sciences, Kyushu University, 3-1-1, Maedashi, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka, 830-0011, Japan
| | - Taiki Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yoshiko Hayashida
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Hiromitsu Sumikawa
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180, Nagasonecyo, Kita-Ku, Sakai City, Osaka, 591-8555, Japan
| | - Junya Tominaga
- Department of Diagnostic Radiology, Tohoku University School of Medicine, 1-1, Seiryoucyo, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan
| | - Tomonori Tanaka
- Department of Diagnostic Pathology, Kobe University Hospital, 7-5-2, Kusumachi, Cyuoh-Ku, Kobe City, Hyogo, 65017, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School Hospital, 1-1-5, Sendaki, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Junya Fukuoka
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, 2-50-1, Kuramotocyo, Tokushima City, Tokusima, 770-0042, Japan
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Kitakyushu City, Fukuoka, 807-8555, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa City, Isihikawa, 920-8641, Japan
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75, Francis Street, Boston, 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo, 660-0064, Japan
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Hata A, Yanagawa M, Miyata T, Hiraoka Y, Shirae M, Ninomiya K, Doi S, Yamagata K, Yoshida Y, Kikuchi N, Ogawa R, Hatabu H, Tomiyama N. Association between interstitial lung abnormality and mortality in patients with esophageal cancer. Jpn J Radiol 2024:10.1007/s11604-024-01563-x. [PMID: 38658500 DOI: 10.1007/s11604-024-01563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To investigate the relationship between interstitial lung abnormalities (ILAs) and mortality in patients with esophageal cancer and the cause of mortality. MATERIALS AND METHODS This retrospective study investigated patients with esophageal cancer from January 2011 to December 2015. ILAs were visually scored on baseline CT using a 3-point scale (0 = non-ILA, 1 = indeterminate for ILA, and 2 = ILA). ILAs were classified into subcategories of non-subpleural, subpleural non-fibrotic, and subpleural fibrotic. Five-year overall survival (OS) was compared between patients with and without ILAs using the multivariable Cox proportional hazards model. Subgroup analyses were performed based on cancer stage and ILA subcategories. The prevalences of treatment complications and death due to esophageal cancer and pneumonia/respiratory failure were analyzed using Fisher's exact test. RESULTS A total of 478 patients with esophageal cancer (age, 66.8 years ± 8.6 [standard deviation]; 64 women) were evaluated in this study. Among them, 267 patients showed no ILAs, 125 patients were indeterminate for ILAs, and 86 patients showed ILAs. ILAs were a significant factor for shorter OS (hazard ratio [HR] = 1.68, 95% confidence interval [CI] 1.10-2.55, P = 0.016) in the multivariable Cox proportional hazards model adjusting for age, sex, smoking history, clinical stage, and histology. On subgroup analysis using patients with clinical stage IVB, the presence of ILAs was a significant factor (HR = 3.78, 95% CI 1.67-8.54, P = 0.001). Subpleural fibrotic ILAs were significantly associated with shorter OS (HR = 2.22, 95% CI 1.25-3.93, P = 0.006). There was no significant difference in treatment complications. Patients with ILAs showed a higher prevalence of death due to pneumonia/respiratory failure than those without ILAs (non-ILA, 2/95 [2%]; ILA, 5/39 [13%]; P = 0.022). The prevalence of death due to esophageal cancer was similar in patients with and without ILA (non-ILA, 82/95 [86%]; ILA 32/39 [82%]; P = 0.596). CONCLUSION ILAs were significantly associated with shorter survival in patients with esophageal cancer.
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Affiliation(s)
- Akinori Hata
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
| | - Masahiro Yanagawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Tomo Miyata
- Department of Radiology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, 5938304, Japan
| | - Yu Hiraoka
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Motohiro Shirae
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Keisuke Ninomiya
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Shuhei Doi
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Kazuki Yamagata
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Yuriko Yoshida
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Noriko Kikuchi
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Ryo Ogawa
- Future Diagnostic Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan
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Iwashita H, Kawabata Y, Hayashi H, Matsushita S, Yamashiro T, Matsumura M, Yoshimura Y, Kataoka T, Mitsui H, Suzuki T, Misumi T, Tanaka T, Ishijima S, Fukuoka J, Iwasawa T, Ogura T, Okudela K. Frequency of subclinical interstitial lung disease in COVID-19 autopsy cases: potential risk factors of severe pneumonia. BMC Pulm Med 2023; 23:408. [PMID: 37891495 PMCID: PMC10612296 DOI: 10.1186/s12890-023-02692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Risk factors of severe coronavirus disease 2019 (COVID-19) have been previously reported; however, histological risk factors have not been defined thus far. The aim of this study was to clarify subclinical hidden interstitial lung disease (ILD) as a risk factor of severe pneumonia associated with COVID-19. We carefully examined autopsied lungs and chest computed tomography scanning (CT) images from patients with COVID-19 for interstitial lesions and then analyzed their relationship with disease severity. Among the autopsy series, subclinical ILD was found in 13/27 cases (48%) in the COVID-19 group, and in contrast, 8/65 (12%) in the control autopsy group (p = 0.0006; Fisher's exact test). We reviewed CT images from the COVID-19 autopsy cases and verified that subclinical ILD was histologically detectable in the CT images. Then, we retrospectively examined CT images from another series of COVID-19 cases in the Yokohama, Japan area between February-August 2020 for interstitial lesions and analyzed the relationship to the severity of COVID-19 pneumonia. Interstitial lesion was more frequently found in the group with the moderate II/severe disease than in the moderate I/mild disease (severity was evaluated according to the COVID-19 severity classification system of the Ministry of Health, Labor, and Welfare [Japan]) (moderate II/severe, 11/15, 73.3% versus moderate I/mild, 108/245, 44.1%; Fisher exact test, p = 0.0333). In conclusion, it was suggested that subclinical ILD could be an important risk factor for severe COVID-19 pneumonia. A benefit of these findings could be the development of a risk assessment system using high resolution CT images for fatal COVID-19 pneumonia.
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Affiliation(s)
- Hiromichi Iwashita
- Department of Pathology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Yoshinori Kawabata
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, 1696, Itai, Kumagaya-shi, Saitama, 360-0197, Japan
| | - Hiroyuki Hayashi
- Division of Pathology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama-shi, Kanagawa, 221-0855, Japan
| | - Shoichiro Matsushita
- Department of Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Mai Matsumura
- Department of Pathology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Yukihiro Yoshimura
- Division of Infectious disease, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama-shi, Kanagawa, 221-0855, Japan
| | - Toshiaki Kataoka
- Department of Pathology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Hideaki Mitsui
- Department of Pathology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Takehisa Suzuki
- Department of Pathology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan
| | - Tomonori Tanaka
- Department of Diagnostic Pathology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi, Hyogo, 650-0017, Japan
| | - Sosuke Ishijima
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-14 Bunkyo-machi, Nagasaki-shi, Nagasaki, 852-8521, Japan
| | - Junya Fukuoka
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-14 Bunkyo-machi, Nagasaki-shi, Nagasaki, 852-8521, Japan
| | - Tae Iwasawa
- Division of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka- higashi, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0051, Japan
| | - Takashi Ogura
- Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0051, Japan
| | - Koji Okudela
- Department of Pathology, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0004, Japan.
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Menon AA, Lee M, Ke X, Putman RK, Hino T, Rose JA, Duan F, Ash SY, Cho MH, O'Connor GT, Dupuis J, Hatabu H, Lenburg ME, Billatos ES, Hunninghake GM. Bronchial epithelial gene expression and interstitial lung abnormalities. Respir Res 2023; 24:245. [PMID: 37817229 PMCID: PMC10566143 DOI: 10.1186/s12931-023-02536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Interstitial lung abnormalities (ILA) often represent early fibrotic changes that can portend a progressive fibrotic phenotype. In particular, the fibrotic subtype of ILA is associated with increased mortality and rapid decline in lung function. Understanding the differential gene expression that occurs in the lungs of participants with fibrotic ILA may provide insight into development of a useful biomarker for early detection and therapeutic targets for progressive pulmonary fibrosis. METHODS Measures of ILA and gene expression data were available in 213 participants in the Detection of Early Lung Cancer Among Military Personnel (DECAMP1 and DECAMP2) cohorts. ILA was defined using Fleischner Society guidelines and determined by sequential reading of computed tomography (CT) scans. Primary analysis focused on comparing gene expression in ILA with usual interstitial pneumonia (UIP) pattern with those with no ILA. RESULTS ILA was present in 51 (24%) participants, of which 16 (7%) were subtyped as ILA with a UIP pattern. One gene, pro platelet basic protein (PPBP) and seventeen pathways (e.g. TNF-α signalling) were significantly differentially expressed between those with a probable or definite UIP pattern of ILA compared to those without ILA. 16 of these 17 pathways, but no individual gene, met significance when comparing those with ILA to those without ILA. CONCLUSION Our study demonstrates that abnormal inflammatory processes are apparent in the bronchial airway gene expression profiles of smokers with and without lung cancer with ILA. Future studies with larger and more diverse populations will be needed to confirm these findings.
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Affiliation(s)
- Aravind A Menon
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Minyi Lee
- Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Xu Ke
- Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Takuya Hino
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan A Rose
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc E Lenburg
- Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Ehab S Billatos
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Fukuda K, Katsurada N, Kawa Y, Satouchi M, Kaneshiro K, Matsumoto M, Takamiya R, Hatakeyama Y, Dokuni R, Matsumura K, Katsurada M, Nakata K, Yoshimura S, Tachihara M. Drug-induced interstitial lung disease after chemoimmunotherapy for extensive-stage small cell lung cancer. Heliyon 2023; 9:e20463. [PMID: 37822623 PMCID: PMC10562781 DOI: 10.1016/j.heliyon.2023.e20463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives The combination of chemotherapy and immune checkpoint inhibitors (chemo-ICI) has become the new standard of treatment for extensive-stage small cell lung cancer (ES-SCLC). Recently, slight changes in interstitial shadows, defined as interstitial lung abnormalities (ILA), have been identified. In patients with ES-SCLC who received chemo-ICI, there are limited data on the incidence of drug-induced interstitial lung disease (D-ILD) in daily practice and the association between the development of D-ILD and ILA in the baseline computed tomography (CT). Materials and methods A multicenter, retrospective study was conducted to investigate the incidence of D-ILD, the risk factors for developing D-ILD, progression-free survival (PFS), and overall survival (OS) in patients with ES-SCLC who received chemo-ICI between August 2019 and November 2021. Results This study enrolled 70 patients (median age, 71 years; including 58 men) from nine institutions in Japan. There were 62 patients (89%) treated with carboplatin/etoposide/atezolizumab and 8 patients treated with carboplatin or cisplatin/etoposide/durvalumab. Twenty-nine patients (41.4%) were found to have ILA at baseline CT. Eleven patients (15.7%) developed D-ILD. The proportion of patients with ILA was significantly higher in the group who developed D-ILD than in the group who did not (9/11 (81.8%) vs. 20/59 (33.9%), respectively, P = 0.0057). In addition, the frequency of ground glass attenuation (GGA) and reticulation was higher in patients who developed D-ILD. There was no significant difference in PFS and OS between patients who developed D-ILD and those who did not (median PFS, 8.0 (95% confidence interval (CI), 5.5-9.5) months vs. 5.0 (95% CI, 4.5-5.6) months, respectively, P = 0.11 and median OS, not reached (NR) (95% CI, 8.7-NR) vs. 18.2 (95% CI, 13.2-NR) months, respectively, P = 0.20). Conclusion The incidence of D-ILD in patients with ES-SCLC who received chemo-ICI in clinical practice was higher than that in clinical trials. Patients with pre-existing ILA were more likely to develop D-ILD.
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Affiliation(s)
- Kiyoko Fukuda
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Naoko Katsurada
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Yoshitaka Kawa
- Department of Thoracic Oncology, Hyogo Cancer Center, Japan
| | | | - Kazumi Kaneshiro
- Department of Respiratory Medicine, Kita-harima Medical Center, Japan
| | | | - Rei Takamiya
- Department of Respiratory Medicine, Akashi Medical Center, Japan
| | | | - Ryota Dokuni
- Department of Respiratory Medicine, Hyogo Prefectural Awaji Medical Center, Japan
| | - Kanoko Matsumura
- Department of Respiratory Medicine, Takatsuki General Hospital, Japan
| | - Masahiro Katsurada
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Japan
| | - Kyosuke Nakata
- Department of Respiratory Medicine, Konan Medical Center, Japan
| | - Sho Yoshimura
- Department of Respiratory Medicine, Steel Memorial Hirohata Hospital, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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Cho EJ, Hong J, Hyun J, Lee W, Kim HS, Chun S, Min WK. Usefulness and performance evaluation of serum KL-6 and SP-A assays in healthy individuals and patients with interstitial lung disease. Clin Biochem 2023:110609. [PMID: 37414329 DOI: 10.1016/j.clinbiochem.2023.110609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Interstitial lung abnormalities (ILAs) are associated with the risk of progression to interstitial lung diseases (ILDs). Krebs von den Lungen 6 (KL-6) and surfactant protein (SP)-A have been used as biomarkers of ILDs. In this study, we evaluated the levels of these biomarkers and identified their clinical correlations in healthy individuals to assess their usefulness in the diagnosis of ILAs. METHODS The patient samples were categorized into three groups: healthy, disease, and ILD groups. We used the automated immunoassay HISCL KL-6 and SP-A assay kits. The analytical performance evaluation involved precision, linearity, comparison, establishment of reference intervals, and determination of the cutoff points. We also analyzed the correlations between presence of abnormalities on chest radiography and computed tomography (CT) or pulmonary function test (PFT) and serum levels in the healthy group. RESULTS KL-6 and SP-A assays showed good analytical performance. The KL-6 and SP-A cutoff values were 304 U/mL and 43.5 ng/mL between the ILD and healthy groups, respectively, which were lower than the values recommended by the manufacturer. In the clinical correlations with radiological findings, SP-A values in subjects with lung abnormalities on CT scans were significantly higher than those in normal scans. There was no significant difference in KL-6 and SP-A levels among PFT patterns; however, both serum levels in the mixed pattern showed higher values than those in the other patterns. CONCLUSIONS The results revealed a positive association between increased serum levels of SP-A and KL-6 and clinical characteristics as incidental findings on chest imaging and reduced lung function.
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Affiliation(s)
- Eun-Jung Cho
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jinyoung Hong
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jungwon Hyun
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Woochang Lee
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Soo Kim
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sail Chun
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Won-Ki Min
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chai DD, Ye Q. [A concise review of diagnosis and evaluation of interstitial lung abnormalities]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2023; 41:396-400. [PMID: 37248090 DOI: 10.3760/cma.j.cn121094-20220216-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Interstitial lung abnormalities (ILAs) refer to the subtle or mild signs of ILAs pulmonary parenchyma on chest HRCT scans, which are not yet sufficient to diagnose a certain interstitial lung disease, may be potentially compatible an early stage of the diseases. The signs of ILAs usually includes ground-glass opacities, reticular abnormakicies, honeycombing, traction bronchiectasis or non-emphysematous cysts. This article reviews the research progreses in the definition and classification, risk factors, prognosis, comorbidities and management of ILAs in combination with domestic and foreign literatures.
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Affiliation(s)
- D D Chai
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Q Ye
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China
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Rôlo Silvestre C, Custódio C, Clemente S, Rodrigues S, Furtado ST, Maio R. Interstitial lung abnormalities: Real-world evidence. Health Sci Rep 2023; 6:e1216. [PMID: 37091361 PMCID: PMC10120401 DOI: 10.1002/hsr2.1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
| | | | | | | | | | - Rui Maio
- Hospital Beatriz ÂngeloLouresPortugal
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9
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Patel AS, Miller E, Regis SM, Hunninghake GM, Price LL, Gawlik M, McKee AB, Rieger-Christ KM, Pinto-Plata V, Liesching TN, Wald C, Hashim J, McKee BJ, Gazourian L. Interstitial lung abnormalities in a large clinical lung cancer screening cohort: association with mortality and ILD diagnosis. Respir Res 2023; 24:49. [PMID: 36782326 PMCID: PMC9926562 DOI: 10.1186/s12931-023-02359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Interstitial lung abnormalities (ILA) are CT findings suggestive of interstitial lung disease in individuals without a prior diagnosis or suspicion of ILD. Previous studies have demonstrated that ILA are associated with clinically significant outcomes including mortality. The aim of this study was to determine the prevalence of ILA in a large CT lung cancer screening program and the association with clinically significant outcomes including mortality, hospitalizations, cancer and ILD diagnosis. METHODS This was a retrospective study of individuals enrolled in a CT lung cancer screening program from 2012 to 2014. Baseline and longitudinal CT scans were scored for ILA per Fleischner Society guidelines. The primary analyses examined the association between baseline ILA and mortality, all-cause hospitalization, and incidence of lung cancer. Kaplan-Meier plots were generated to visualize the associations between ILA and lung cancer and all-cause mortality. Cox regression proportional hazards models were used to test for this association in both univariate and multivariable models. RESULTS 1699 subjects met inclusion criteria. 41 (2.4%) had ILA and 101 (5.9%) had indeterminate ILA on baseline CTs. ILD was diagnosed in 10 (24.4%) of 41 with ILA on baseline CT with a mean time from baseline CT to diagnosis of 4.47 ± 2.72 years. On multivariable modeling, the presence of ILA remained a significant predictor of death, HR 3.87 (2.07, 7.21; p < 0.001) when adjusted for age, sex, BMI, pack years and active smoking, but not of lung cancer and all-cause hospital admission. Approximately 50% with baseline ILA had progression on the longitudinal scan. CONCLUSIONS ILA identified on baseline lung cancer screening exams are associated with all-cause mortality. In addition, a significant proportion of patients with ILA are subsequently diagnosed with ILD and have CT progression on longitudinal scans. TRIAL REGISTRATION NUMBER ClinicalTrials.gov; No.: NCT04503044.
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Affiliation(s)
- Avignat S. Patel
- grid.415731.50000 0001 0725 1353Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805 USA ,grid.67033.310000 0000 8934 4045Tufts University School of Medicine, Boston, MA 02111 USA
| | - Ezra Miller
- grid.415731.50000 0001 0725 1353Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805 USA ,grid.67033.310000 0000 8934 4045Tufts University School of Medicine, Boston, MA 02111 USA
| | - Shawn M. Regis
- grid.415731.50000 0001 0725 1353Division of Radiation Oncology, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805 USA
| | - Gary M. Hunninghake
- grid.62560.370000 0004 0378 8294Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115 USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA 02115 USA
| | - Lori Lyn Price
- grid.67033.310000 0000 8934 4045Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111 USA ,grid.429997.80000 0004 1936 7531Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA 02111 USA
| | - Melissa Gawlik
- grid.415731.50000 0001 0725 1353Quality and Safety, Lahey Hospital and Medical Center, Burlington, MA 01805 USA
| | - Andrea B. McKee
- grid.415731.50000 0001 0725 1353Division of Radiation Oncology, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805 USA
| | - Kimberly M. Rieger-Christ
- grid.415731.50000 0001 0725 1353Translational Research, Lahey Hospital and Medical Center, Burlington, MA 01805 USA
| | - Victor Pinto-Plata
- grid.415731.50000 0001 0725 1353Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805 USA ,grid.67033.310000 0000 8934 4045Tufts University School of Medicine, Boston, MA 02111 USA
| | - Timothy N. Liesching
- grid.415731.50000 0001 0725 1353Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805 USA ,grid.67033.310000 0000 8934 4045Tufts University School of Medicine, Boston, MA 02111 USA
| | - Christoph Wald
- grid.415731.50000 0001 0725 1353Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA 01805 USA
| | - Jeffrey Hashim
- grid.415731.50000 0001 0725 1353Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA 01805 USA
| | - Brady J. McKee
- grid.415731.50000 0001 0725 1353Department of Radiology, Lahey Hospital and Medical Center, Burlington, MA 01805 USA
| | - Lee Gazourian
- grid.415731.50000 0001 0725 1353Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805 USA ,grid.67033.310000 0000 8934 4045Tufts University School of Medicine, Boston, MA 02111 USA
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10
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Hoffman TW, van Es HW, Biesma DH, Grutters JC. Potential interstitial lung abnormalities on chest X-rays prior to symptoms of idiopathic pulmonary fibrosis. BMC Pulm Med 2022; 22:329. [PMID: 36038862 PMCID: PMC9426013 DOI: 10.1186/s12890-022-02122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) often has significant diagnostic delay. At present it is not well-known what factors associate with time to diagnosis and if this is associated with survival after the diagnosis. There has also been increasing attention for interstitial lung abnormalities on chest CT-scans. In this study we assessed what factors associate with time to diagnosis in patients with IPF, and whether early stages of pulmonary fibrosis can be seen on chest X-rays prior to the start of symptoms. Methods In this retrospective study, 409 Dutch patients with IPF were included. Clinical characteristics, including patient demographics, medical history, time of start of symptoms, time of first visit to pulmonologist, and any previous radiographic imaging reports were collected from patient records. Results In 96 patients (23%) a chest X-ray was available that had been made prior to the start of symptoms (median of 50.5 months (IQR 26.3–83.3 months)), and this showed potential interstitial lung abnormalities in 56 patients (58%). The median time from the start of symptoms to the final diagnosis was 24.0 months (interquartile range 9.0–48.0 months). In a multivariate model that corrected for diffusion capacity of the lung for carbon monoxide, forced vital capacity, sex, and age at diagnosis, time to diagnosis did not associate with survival (hazard ratio 1.051 (95% CI 0.800–1.380; p = 0.72)). Conclusions There is a significant diagnostic delay for patients with IPF, but longer time to diagnosis did not associate with survival. Interstitial lung abnormalities were seen in more than half of the patients in whom a chest X-ray had been made prior to the start of symptoms. This illustrates that a computed tomography scan should be strongly considered for analysis of unexplained abnormalities on a chest X-ray. This could facilitate early detection and possibly prevention of disease progression for patients with pulmonary fibrosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02122-8.
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Affiliation(s)
- T W Hoffman
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - H W van Es
- Department of Radiology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - D H Biesma
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J C Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
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11
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Sangani RG, Deepak V, Ghio AJ, Forte MJ, Zulfikar R, Patel Z, King A, Alshaikhnassir E, Abbas G, Vos J. Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection. BMC Pulm Med 2022; 22:172. [PMID: 35488260 DOI: 10.1186/s12890-022-01961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality. Methods Patients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis. Results In the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84–9.25]). Conclusions In a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01961-9.
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12
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Choi JY, Song JW, Rhee CK. Chronic obstructive pulmonary disease combined with interstitial lung disease. Tuberc Respir Dis (Seoul) 2022:trd.2021.0104. [PMID: 35081692 DOI: 10.4046/trd.2021.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.
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Affiliation(s)
- Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06649, Republic of Korea
| | - Jin Woo Song
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06649, Republic of Korea
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13
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Ledda RE, Milanese G, Milone F, Leo L, Balbi M, Silva M, Sverzellati N. Interstitial lung abnormalities: new insights between theory and clinical practice. Insights Imaging 2022; 13:6. [PMID: 35032230 DOI: 10.1186/s13244-021-01141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022] Open
Abstract
Interstitial lung abnormalities (ILAs) represent radiologic abnormalities incidentally detected on chest computed tomography (CT) examination, potentially related to interstitial lung diseases (ILD). Numerous studies have demonstrated that ILAs are associated with increased risk of progression toward pulmonary fibrosis and mortality. Some radiological patterns have been proven to be at a higher risk of progression. In this setting, the role of radiologists in reporting these interstitial abnormalities is critical. This review aims to discuss the most recent advancements in understanding this radiological entity and the open issues that still prevent the translation from theory to practice, emphasizing the importance of ILA recognition and adequately reporting in clinical practice.
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14
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Liu Q, Zhang H, Han B, Jiang H, Chung KF, Li F. Interstitial lung abnormalities: What do we know and how do we manage? Expert Rev Respir Med 2021; 15:1551-1561. [PMID: 34689661 DOI: 10.1080/17476348.2021.1997598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Interstitial lung abnormalities (ILAs), which refer to mild or subtle nongravity-dependent interstitial changes, may be neglected by some clinicians due to many reasons, such as lack of diagnostic criteria for ILAs and absence of available treatments and surveillance strategies. However, without intervention, some ILAs may progress to interstitial lung disease (ILD). This review summarizes our current knowledge of this condition and ways of diagnosing it together with current management. We hope that this will lead to better recognition of ILAs. AREAS COVERED We reviewed the literature on PubMed between 2008 and 2020 focusing on prevalence, etiology, symptoms, diagnostic biomarkers, clinical associations, and management of ILAs. EXPERT OPINION Timely diagnosis with close monitoring of ILAs and appropriate intervention should be recognized as the management approach to ILAs. Research into ILAs should continue to improve its management.
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Affiliation(s)
- Qi Liu
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Hai Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Baohui Han
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Handong Jiang
- Department of Respiratory and Critical Care Medicine, Shanghai Renji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, P.R. China
| | - Kian Fan Chung
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, UK
| | - Feng Li
- Department of Pulmonary and Critical Care Medicine, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, P.R. China
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15
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Abstract
Cellular level changes that lead to interstitial lung disease (ILD) may take years to become clinically apparent and have been termed preclinical ILD. Incidentally identified interstitial lung abnormalities (ILA) are increasingly being recognized on chest computed tomographic scans done as part of lung cancer screening and for other purposes. Many individuals found to have ILA will progress to clinically significant ILD. ILA are independently associated with greater risk of death, lung function decline, and incident lung cancer. Current management recommendations focus on identifying individuals with ILA at high risk of progression, through a combination of clinical and radiological features.
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Affiliation(s)
- Anna J Podolanczuk
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, 1305 York Avenue, Y-1053, Box 96, New York, NY 10021, USA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Thorn 908D, Boston, MA 02115, USA.
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16
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Lago VC, Prudente RA, Luzia DA, Franco ET, Cezare TJ, Peralta A, Ferreira EVM, Albuquerque ALP, Okoshi MP, Baldi BG, Tanni SE. Persistent interstitial lung abnormalities in post-COVID-19 patients: a case series. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200157. [PMID: 33907556 PMCID: PMC8047717 DOI: 10.1590/1678-9199-jvatitd-2020-0157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
A new concept of multisystem disease has emerged as a long-term condition following mild-severe COVID-19 infection. The main symptoms of this affection are breathlessness, chest pain, and fatigue. We present here the clinical case of four COVID-19 patients during hospitalization and 60 days after hospital discharge. Physiological impairment of all patients was assessed by spirometry, dyspnea score, arterial blood gas, and 6-minute walk test 60 days after hospital discharge, and computed tomographic scan 90 days after discharge. All patients had fatigue, which was not related to hypoxemia or impaired spirometry values, and interstitial lung alterations, which occurred in both mechanically ventilated and non-mechanically ventilated patients. In conclusion, identifying the prevalence and patterns of permanent lung damage is paramount in preventing and treating COVID-19-induced fibrotic lung disease. Additionally, and based on our preliminary results, it will be also relevant to establish long-term outpatient programs for these individuals.
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Affiliation(s)
- Vanessa Carvalho Lago
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
| | - Robson Aparecido Prudente
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
| | - Dayane Araujo Luzia
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
| | - Estefânia Thomé Franco
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
| | - Talita Jacon Cezare
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
| | - Amanda Peralta
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
| | - Eloara Vieira M. Ferreira
- Paulista School of Medicine (EPM), Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil.Paulista School of MedicineFederal University of São PauloSão PauloSPBrazil
| | | | - Marina Politi Okoshi
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
| | - Bruno Guedes Baldi
- Heart Institute (InCor), University of São Paulo (USP), São Paulo, SP, Brazil.University of São PauloSão PauloSPBrazil
| | - Suzana Erico Tanni
- Department of Internal Medicine, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.Department of Internal MedicineBotucatu Medical SchoolSão Paulo State UniversityBotucatuSPBrazil
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17
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Kobayashi H, Wakuda K, Naito T, Mamesaya N, Omori S, Ono A, Kenmotsu H, Murakami H, Endo M, Harada H, Gon Y, Takahashi T. Chemoradiotherapy for limited-stage small-cell lung cancer and interstitial lung abnormalities. Radiat Oncol 2021; 16:52. [PMID: 33731123 PMCID: PMC7972232 DOI: 10.1186/s13014-021-01780-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 03/10/2021] [Indexed: 12/04/2022] Open
Abstract
Background Patients with lung cancer and interstitial lung disease treated with radiotherapy are at risk of developing radiation pneumonitis. However, the association between interstitial lung abnormalities (ILAs) and radiation pneumonitis in patients with limited-stage small-cell lung cancer (LS-SCLC) remains unclear. Furthermore, the prognosis is uncertain for patients with SCLC and ILAs treated with chemoradiotherapy. We investigated the impact of ILAs on radiation pneumonitis and assessed the prognosis of patients with LS-SCLC and ILAs treated with chemoradiotherapy. Methods We retrospectively reviewed the medical records of 149 patients with LS-SCLC who received first-line treatment between January 2009 and December 2016. Results In the univariate analysis, the patients with ILAs showed a higher incidence rate of radiation pneumonitis compared with those without ILAs (64% vs. 10%, P < 0.001). Multivariate analysis confirmed that ILAs were significantly associated with the incidence of radiation pneumonitis. In the univariate analysis, patients with ILAs showed poorer overall survival than those without ILAs (median, 18.9 vs. 67.9 months, P = 0.0338). Multivariate analysis showed that ILAs were a significant independent negative prognostic factor. However, the 2-year and 5-year survival rates for the patients with ILAs treated with chemoradiotherapy were 36% and 26%, respectively, and 8% and 0%, respectively, for those treated with chemotherapy alone. Conclusions ILAs were found to be a predictive factor for radiation pneumonitis in patients with LS-SCLC treated with chemoradiotherapy. Patients with LS-SCLC and ILAs who were treated with chemoradiotherapy had both the possibility of long-term survival and risk of radiation pneumonitis. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01780-y.
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Affiliation(s)
- Haruki Kobayashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. .,Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Kazushige Wakuda
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Shota Omori
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Akira Ono
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Harada
- Division of Radiation and Proton Therapy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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18
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Mori Y, Kondoh Y. What parameters can be used to identify early idiopathic pulmonary fibrosis? Respir Investig 2021; 59:53-65. [PMID: 33277230 DOI: 10.1016/j.resinv.2020.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 06/12/2023]
Abstract
Elucidating the disease process of early idiopathic pulmonary fibrosis (IPF) will help clinicians in addressing the contentious issues of when and in which patients, therapeutic intervention should be initiated. Here, we discuss several possible parameters for diagnosing early IPF and their clinical impacts. Physiologically, early IPF can be considered as IPF with normal or mild impairment in pulmonary function. Radiologically, early IPF can be considered as IPF with a small extent and/or early features of fibrosis. Symptomatically, early IPF can be considered as asymptomatic or less symptomatic IPF. IPF at Gender-Age-Physiology index stage I can be considered early IPF. Interstitial lung abnormalities are defined as parenchymal abnormalities in more than 5% of the lung in patients with no prior history of interstitial lung disease, and in some cases, this seems to be equivalent to early IPF. Previous clinical trials showed the effect of antifibrotic therapies in early IPF, but the effects of therapy are uncertain in early IPF outside of clinical trials, such as in cases of IPF with normal pulmonary function, IPF without honeycombing or traction bronchiectasis, and asymptomatic IPF. Moreover, little has been reported on disease progression in such conditions. Because the conceptual framework of early IPF may vary depending on its definition, not only is a diagnosis of early IPF important but prediction of disease progression is also crucial. Further investigations are needed to identify biomarkers that can detect patients who may experience greater degrees of disease progression and require treatment even with those forms of early IPF.
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Affiliation(s)
- Yuta Mori
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan; Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
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19
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Chae KJ, Jin GY, Goo JM, Chung MJ. Interstitial Lung Abnormalities: What Radiologists Should Know. Korean J Radiol 2020; 22:454-463. [PMID: 33169548 PMCID: PMC7909860 DOI: 10.3348/kjr.2020.0191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023] Open
Abstract
Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentally on chest CT that are potentially related to interstitial lung diseases. Several articles have reported that ILAs are associated with increased mortality, and they can show radiologic progression. With the increased recognition of ILAs on CT, the role of radiologists in reporting them is critical. This review aims to discuss the clinical significance and radiologic characteristics of ILAs to facilitate and enhance their management.
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Affiliation(s)
- Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung Ja Chung
- Department of Pathology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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20
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Araki T, Washko GR, Schiebler ML, O'Connor GT, Hatabu H. The Framingham Heart Study: Populational CT-based phenotyping in the lungs and mediastinum. Eur J Radiol Open 2020; 7:100260. [PMID: 32984450 PMCID: PMC7495061 DOI: 10.1016/j.ejro.2020.100260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023] Open
Abstract
The Framingham Heart Study (FHS) is one of the largest and established longitudinal populational cohorts. CT cohorts of the FHS since 2002 provided a unique opportunity to assess non-cardiac thoracic imaging findings. This review deals with image-based phenotyping studies from recent major publications regarding interstitial lung abnormalities (ILAs), pulmonary cysts, emphysema, pulmonary nodules, pleural plaques, normal spectrum of the thymus, and anterior mediastinal masses, concluding with the discussion of future directions of FHS CT cohorts studies in the era of radiomics and artificial intelligence.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George R Washko
- Department of Pulmonology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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21
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Nakanishi Y, Masuda T, Yamaguchi K, Sakamoto S, Horimasu Y, Nakashima T, Miyamoto S, Tsutani Y, Iwamoto H, Fujitaka K, Miyata Y, Hamada H, Okada M, Hattori N. Pre-existing interstitial lung abnormalities are risk factors for immune checkpoint inhibitor-induced interstitial lung disease in non-small cell lung cancer. Respir Investig 2019; 57:451-459. [PMID: 31248832 DOI: 10.1016/j.resinv.2019.05.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/28/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Approximately 5% of non-small cell lung cancer (NSCLC) patients develop immune checkpoint inhibitor (ICI)-induced interstitial lung disease (ICI-ILD), 10% of whom die. However, there are no established risk factors for its occurrence. Interstitial lung abnormalities (ILA) are areas of increased lung density on lung computed tomography (CT) in individuals with no known ILD. This study retrospectively investigated whether any patient characteristics, including ILA, were risk factors for ICI-ILD in patients with NSCLC. METHODS NSCLC patients who received anti-programmed death (PD)-1 antibody treatment at our hospital between September 2015 and December 2017 were enrolled. Information on patient characteristics before anti-PD-1 antibody administration, including chest CT findings and laboratory data, were obtained. RESULTS Among 83 enrolled patients, the incidence of ICI-ILD was 16.9% (14/83). All ICI-ILD cases developed by the third line of treatment. The incidence of ICI-ILD was significantly higher in patients with pre-existing ILA than that in those without (p = 0.007). Furthermore, patients with ground glass attenuation (GGA) in ILA had a higher incidence of ICI-ILD than that in those without (p < 0.001). In univariate logistic analysis, ILA were significant risk factors for ICI-ILD (p = 0.005). Multivariate logistic analysis revealed that only GGA in ILA was a significant risk factor for ICI-ILD (p < 0.001). CONCLUSIONS Pre-existing ILA are risk factors for ICI-ILD and GGA in ILA is an independent risk factor for ICI-ILD. Therefore, we should be more aware of the development of ICI-ILD in patients with ILA, especially those with GGA.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Carcinoma, Non-Small-Cell Lung/complications
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Female
- Humans
- Lung/diagnostic imaging
- Lung/pathology
- Lung Diseases, Interstitial/chemically induced
- Lung Diseases, Interstitial/diagnostic imaging
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/pathology
- Lung Neoplasms/complications
- Lung Neoplasms/drug therapy
- Male
- Middle Aged
- Nivolumab/adverse effects
- Nivolumab/therapeutic use
- Programmed Cell Death 1 Receptor/immunology
- Retrospective Studies
- Risk Factors
- Tomography, X-Ray Computed
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Affiliation(s)
- Yu Nakanishi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuhiro Tsutani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Araki T, Dahlberg SE, Hida T, Lydon CA, Rabin MS, Hatabu H, Johnson BE, Nishino M. Interstitial lung abnormality in stage IV non-small cell lung cancer: A validation study for the association with poor clinical outcome. Eur J Radiol Open 2019; 6:128-131. [PMID: 30984804 PMCID: PMC6444119 DOI: 10.1016/j.ejro.2019.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/17/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose The presence of interstitial lung abnormality (ILA) at diagnosis of stage IV non-small cell lung cancer (NSCLC) patients has previously shown to be associated with shorter overall survival (OS). The present study aimed to validate the association between ILA and shorter OS in a larger cohort of treatment-naïve stage IV NSCLC patients. Materials and methods This study includes 484 patients (205 men and 279 women) with a pathological diagnosis of stage IV NSCLC with pretreatment baseline CT available for review. ILA was visually scored on the baseline chest CT with a 3-point scale (0=no ILA, 1=indeterminate for ILA, 2 = ILA) as published previously. Clinical characteristics and overall survival (OS) were compared in patients with ILA score 2 vs. those with ILA score 0 or 1. Results ILA was present (score 2) on baseline CT in 19 of 484 patients (3.9%, 95%CI2.4-6.1%). Patients with ILA were significantly older (p = 0.0008) and more commonly male (p = 0.03) compared to those with ILA score 0 or 1. Patients with ILA score 2 showed significantly shorter OS compared to those with ILA score 0 or 1 (median OS 9.95 months vs. 16.95 months; p = 0.0002). In multivariate analyses, baseline ILA score 2 remained significant as a marker for shorter OS (HR = 2.09, p = 0.004) after adjustments for age (HR = 1.48; p = 0.001), gender (HR = 1.22, p = 0.06), and smoking (HR = 0.79; p = 0.051). Conclusions ILA on baseline CT at diagnosis of stage IV NSCLC patients was associated with shorter OS (HR = 2.09, p = 0.004), validating ILA as an independent marker for poor clinical outcome.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, Brigham and Women's Hospital, 73 Francis St., Boston, MA, 02115 USA.,Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Suzanne E Dahlberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Tomoyuki Hida
- Department of Radiology, Brigham and Women's Hospital, 73 Francis St., Boston, MA, 02115 USA
| | - Christine A Lydon
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Michael S Rabin
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, 73 Francis St., Boston, MA, 02115 USA
| | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, 73 Francis St., Boston, MA, 02115 USA.,Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
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23
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Araki T, Nishino M, Zazueta OE, Gao W, Dupuis J, Okajima Y, Latourelle JC, Rosas IO, Murakami T, O'Connor GT, Washko GR, Hunninghake GM, Hatabu H. Paraseptal emphysema: Prevalence and distribution on CT and association with interstitial lung abnormalities. Eur J Radiol 2015; 84:1413-8. [PMID: 25868675 DOI: 10.1016/j.ejrad.2015.03.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/26/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities. MATERIALS AND METHODS We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of the participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated. RESULTS Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, P<0.001) and had significantly decreased FEV1/FVC% (P=0.002), and diffusion capacity of carbon monoxide (DLCO) (P=0.002). There was a significant association between pure paraseptal emphysema and interstitial lung abnormalities (P<0.001). CONCLUSIONS The prevalence of pure paraseptal emphysema was 3% in the FHS population, predominantly affects the upper lung zone, and contributes to decreased pulmonary function. Cigarette smoking, aging, and male gender were the factors associated with the presence of paraseptal emphysema. Significant association between paraseptal emphysema and interstitial lung abnormalities was observed.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA; Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
| | - Mizuki Nishino
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA
| | - Oscar E Zazueta
- The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Gao
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | - Yuka Okajima
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA
| | - Jeanne C Latourelle
- Department of Medicine and Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Ivan O Rosas
- The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Takamichi Murakami
- Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - George T O'Connor
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA, USA; Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - George R Washko
- The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gary M Hunninghake
- The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215, USA
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