Emphysema affects the number and appearance of solitary pulmonary nodules identified in chest low-dose computed tomography: a study on high risk lung cancer screenees recruited in Silesian District

Abstract

INTROduCTION Chest low-dose computed tomography (LDCT) has recently been proved effective in lung cancer screening. ObjECTIvEs We aimed to assess the association between the occurrence of emphysema and solitary pulmonary nodules (SPNs) in first-round screening with LDCT. PATIENTs ANd mEThOds A total of 601 asymptomatic volunteers with a smoking history underwent LDCT; 523 patients were assigned to one of the following groups: E, emphysema without nodules (n = 103); E + N, emphysema with coexisting nodules (n = 96); N, nodules without emphysema (n = 142); and NENN, no nodules and no emphysema (n = 182). The effect of emphysema and demographic factors on the profile of SPNs was assessed. REsuLTs Patients in the E + N group were older than those in the N group (median age, 65 vs 63 years; P = 0.001) and they smoked more (median pack-years, 37.8 vs 32; P = 0.01). Emphysema was detected in 199 of the 523 patients (38%), while nodules, in 238 (45.5%). The number of nodules in the E + N group was 390 (4.1 nodules per patient), and in the N group, 540 (3.8 nodules per patient). Multiple SPNs, of different size and morphology, constituted 93.3% of the nodules in the E + N group. Seven cases of cancer were detected among 238 patients with nodules, and their distribution was similar in the groups with and without emphysema (4.2 per 100 patients in the E + N group and 2.1 per 100 in the N group; P = 0.44). CONCLusIONs Emphysema was more frequently associated with multiple SPNs of different morphology among elderly patients with a higher number of smoking pack-years. EdITORIAL by Chilet-Rosell and Lumbreras, see p. 4

Association between visual emphysema and lung nodules on low-dose CT scan in a Chinese Lung Cancer Screening Program (Nelcin-B3)

“…When we focused on the participants with lung nodules, the presence of emphysema was related to larger nodules and participants with 2–3 nodules. This is consistent with findings of a study by Ewa et al, who found that emphysema is more frequently associated with larger and multiple lung nodules [ 11 ].…”

“…In addition, PM 2.5 could also induce changes in long-noncoding RNAs through reactive oxygen species, thereby promoting autophagy and proliferation of lung cells, further leading to the occurrence of emphysema and lung nodules [ 39 ]. Finally, the main pathological feature of emphysema is the permanent enlargement of airspaces distal to the terminal bronchioles, which will be the risk factor for neoplastic transformation [ 11 ].…”

“…Emphysema is a pathologic condition with enlargement of air spaces in the terminal bronchioles. It is one of the predictive risk factors for neoplastic transformation of the lining epithelium [ 11 ]. There are numerous studies on risk factors involving emphysema as a risk factor for lung cancer [ 12 , 13 ].…”

Possible Bias in Supervised Deep Learning Algorithms for CT Lung Nodule Detection and Classification

“…An example of such a case is shown in Figure 4 . Similarly, omitting the presence of other diseases like emphysema could also influence the number and characteristics of nodules [ 34 ] and so, the performance of that algorithm.…”

Tuberculosis diagnosed by thoracic surgeons

“…Screening programs using low-dose CT improve early detection of lung cancer in high-risk populations. Pulmonary nodules, also multiple, may be detected in a significant proportion of screenees [41]. Radiomics is a modality that may also enhance the effectiveness of lung cancer screening programs [42].…”