Identification of Chronic Obstructive Pulmonary Disease in Lung Cancer Screening Computed Tomographic Scans

Mets, Onno M.; Buckens, Constantinus F.; Zanen, Pieter; Išgum, Ivana; Ginneken, Bram van; Prokop, Mathias; Gietema, Hester A.; Lammers, Jan Willem J.; Vliegenthart, Rozemarijn; Oudkerk, Matthijs; Klaveren, Rob J. van; Koning, Harry J. de; Mali, Willem P.Th.M.; Jong, Pim A. de

doi:10.1001/jama.2011.1531

Cited by 127 publications

(100 citation statements)

References 35 publications

(36 reference statements)

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“…We also calculated the ratio of the mean lung density on the expiratory scan to the mean lung density on the inspiratory scan (CT/lung density ratio). This measurement has been reported previously by METS et al [19] as ''CT-air trapping''.…”

Section: Discussionsupporting

confidence: 74%

COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women

Camp

Ramírez‐Venegas

Sansores

et al. 2013

European Respiratory Journal

164

159

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We hypothesised that biomass smoke exposure is associated with an airway-predominant chronic obstructive pulmonary disease (COPD) phenotype, while tobacco-related COPD is associated with an emphysema-predominant phenotype.In this cross-sectional study, female never-smokers with COPD and biomass exposure (n521) and female ex-cigarette smokers with COPD without biomass exposure (n522) completed computed tomography (CT) at inspiration and expiration, pulmonary function, blood gas, exercise tolerance, and quality of life measures. Two radiologists scored the extent of emphysema and air trapping on CT. Quantitative emphysema severity and distribution and airway wall thickness were calculated using specialised software.Women in the tobacco group had significantly more emphysema than the biomass group (radiologist score 2.3 versus 0.7, p50.001; emphysema on CT 27% versus 19%, p50.046; and a larger size of emphysematous spaces, p50.006). Women in the biomass group had significantly more air trapping than the tobacco group (radiologist score 2.6 and 1.5, respectively; p50.02) and also scored lower on the symptom, activities and confidence domains of the quality of life assessment and had lower oxygen saturation at rest and during exercise (p,0.05).Biomass smoke exposure is associated with less emphysema but more air trapping than tobacco smoke exposure, suggesting an airway-predominant phenotype. @ERSpublications Biomass smoke causes less emphysema but more air trapping than tobacco smoke: airwaypredominant COPD phenotype?

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Section: Discussionsupporting

confidence: 74%

COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women

Camp

Ramírez‐Venegas

Sansores

et al. 2013

European Respiratory Journal

164

159

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“…The epidemiologic data linking reduced FEV 1 (airflow limitation) to an elevated risk of lung cancer is strongly supported by both cross-sectional and prospective data (1)(2)(3). Using data from the Pittsburgh and NELSON CT trials (3,4), simple spirometry identified COPD 89% and 84% of the time, respectively, compared with using CT-based emphysema which identified 49% and 67%, respectively (3, 4). More importantly, based on the Pittsburgh trial (3), 85% of lung cancer cases were identified among smokers with either airflow limitation and/or CT-based emphysema (see Fig.…”

Section: Robert P Young and Raewyn J Hopkinsmentioning

confidence: 99%

Lung Cancer Risk Prediction to Select Smokers for Screening CT—Letter

Young

2012

Cancer Prevention Research

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In a recent article, Maisonneuve and colleagues described risk models identifying smokers at greatest risk of lung cancer for computed tomographic (CT) screening (1). We agree that such an approach will help increase lung cancer detection rates, improve cost-effectiveness, and reduce harm from unnecessary follow-up to screening. However, we propose below an alternative approach based on the current literature.Among the risk models for lung cancer that they described (1), some were developed in populations including lifelong nonsmokers. As such, the relevance of these models in the context of CT screening, where exclusively current or former smokers are targeted, is not clear. Moreover, the model developed by Maisonneuve and colleagues (1) is based on age and smoking exposure (Bach model) and little comment is made of the sensitivity of such an approach. Using a representative sample of 446 lung cancer cases (2), we estimate that the eligibility criteria of the National Lung Screening Trial (NLST) and COSMOS trial would identify only 47% and 57% of cases, respectively. This means that approximately 40% to 50% of all lung cancer cases will occur outside these current screening programs.We strongly agree with the study of Maisonneuve and colleagues (1) that additional clinical variables such as chronic obstructive pulmonary disease (COPD; airflow limitation and/or emphysema) will contribute significantly to the risk-based approach to optimizing CT screening. The epidemiologic data linking reduced FEV 1 (airflow limitation) to an elevated risk of lung cancer is strongly supported by both cross-sectional and prospective data (1-3). Using data from the Pittsburgh and NELSON CT trials (3, 4), simple spirometry identified COPD 89% and 84% of the time, respectively, compared with using CT-based emphysema which identified 49% and 67%, respectively (3, 4). More importantly, based on the Pittsburgh trial (3), 85% of lung cancer cases were identified among smokers with either airflow limitation and/or CT-based emphysema (see Fig. 1). In these trials, this constitutes 46% to 48% of all CT screening participants. Conversely, only 15% of lung cancers were detected in those who had normal lungs (normal spirometry and no emphysema). Consistent with the recently published National Comprehensive Cancer Network (NCCN) recommendations for lung cancer screening (www.NCCN.org), we have developed a risk model for lung cancer that includes age, COPD, and genetic risk variables (family history and genetic markers) that has use in all smokers, including those with normal lung function (5). This is currently undergoing further validation in the NLST. We conclude that the optimal target population for CT screening of lung cancer can be identified by risk models that include clinical variables indicative of COPD (1,3,5). Disclosure of Potential Conflicts of InterestR.P. Young has commercial research grant (financial support) from Synergenz BioScience Ltd.; ownership interest (including patents) and patents related to genetic risk prediction a...

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“…Exposure settings were 30 mAs at 120 or 140 kVp, depending on the participant's weight. This low-dose CT protocol has previously been used to quantify emphysema in COPD patients and heavy smokers [8,15,16]. All quantifications were performed with CIRRUS Lung 12.03 (http://cirrus.diagnijmegen.nl).…”

Section: Pulmonary Function Testingmentioning

confidence: 99%

Airway wall thickness associated with forced expiratory volume in 1 second decline and development of airflow limitation

et al. 2015

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Airway wall thickness and emphysema contribute to airflow limitation.We examined their association with lung function decline and development of airflow limitation in 2021 male smokers with and without airflow limitation. Airway wall thickness and emphysema were quantified on chest computed tomography and expressed as the square root of wall area of a 10-mm lumen perimeter (Pi10) and the 15th percentile method (Perc15), respectively. Baseline and follow-up (median (interquartile range) 3 (2.9-3.1) years) spirometry was available.Pi10 and Perc15 correlated with baseline forced expiratory volume in 1 s (FEV1) (r= −0.49 and 0.11, respectively ( p<0.001)). Multiple linear regression showed that Pi10 and Perc15 at baseline were associated with a lower FEV1 after follow-up ( p<0.05). For each SD increase in Pi10 and decrease in Perc15 the FEV1 decreased by 20 mL and 30.2 mL, respectively. The odds ratio for developing airflow limitation after 3 years was 2.45 for a 1-mm higher Pi10 and 1.46 for a 10-HU lower Perc15 ( p<0.001).A greater degree of airway wall thickness and emphysema was associated with a higher FEV1 decline and development of airflow limitation after 3 years of follow-up. @ERSpublications Computed tomography airway wall thickness and emphysema are associated with lung function decline and COPD http://ow.ly/DMN4h

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Identification of Chronic Obstructive Pulmonary Disease in Lung Cancer Screening Computed Tomographic Scans

Abstract: Among men who are current and former heavy smokers, low-dose inspiratory and expiratory CT scans obtained for lung cancer screening can identify participants with COPD, with a sensitivity of 63% and a specificity of 88%.

Cited by 127 publications

References 35 publications

COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women

COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women

Lung Cancer Risk Prediction to Select Smokers for Screening CT—Letter

Airway wall thickness associated with forced expiratory volume in 1 second decline and development of airflow limitation

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