Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Takx, Richard A.P.; Vliegenthart, Rozemarijn; Hoesein, Firdaus A. A. Mohamed; Išgum, Ivana; Koning, Harry J. de; Mali, Willem P.Th.M.; Aalst, Carlijn M. van der; Zanen, Pieter; Lammers, Jan‐Willem J.; Groen, Harry J.M.; Rikxoort, Eva M. van; Schmidt, Michael A.; Ginneken, Bram van; Oudkerk, Matthijs; Leiner, Tim; Jong, Pim A. de

doi:10.1007/s00330-014-3384-6

Cited by 9 publications

(6 citation statements)

References 38 publications

(44 reference statements)

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“…Adding calcium volume and number of calcifications improved classification of risk, but not nearly as strongly as Agatston score. In a related study spirometric parameters were also associated with cardiovascular events but did not contain independent prognostic information (28).…”

Section: Europementioning

confidence: 99%

Coronary artery calcification in lung cancer screening

Ravenel¹,

Nance²

2018

Transl. Lung Cancer Res.

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Lung cancer screening has been shown in the National Lung Screening Trial (NLST) to result in a statistically significant decrease in lung cancer specific mortality. Also within that trial there was shown to be a 7% decrease in all-cause mortality. While the reasons for this benefit are not entirely clear, it may relate to the detection and treatment of other important findings. Smokers not only have a higher risk of lung cancer, but also increased risk of atherosclerosis. The latter can be detected by the discovery of aortic and/or coronary artery calcium on unenhanced CT. As coronary artery calcium scoring can be used as a screening tool to detect asymptomatic coronary artery atherosclerosis, its detection on lung cancer screening exams has the potential to provide both a teachable moment and treatment aimed at the reduction of major coronary artery events and mortality. In this review we will discuss the use of coronary artery calcium scoring for the detection of atherosclerotic disease and its potential application to lung cancer screening populations.

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Section: Europementioning

confidence: 99%

Coronary artery calcification in lung cancer screening

Ravenel¹,

Nance²

2018

Transl. Lung Cancer Res.

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“…Cases with unrealistic QCT values were assumed to be algorithm failures and therefore excluded, i.e. mean lung density >−300 HU (n=8), mean lung density <−1000 HU (n=3), Pi10 <0.8 (n=190) and Pi10 >6.5 (n=137) [3,27,28]. Five-fold multiple imputations were performed to deal with other missing data.…”

Section: Dataset Formationmentioning

confidence: 99%

Combining pulmonary and cardiac computed tomography biomarkers for disease-specific risk modelling in lung cancer screening

et al. 2021

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ObjectivesCombined assessment of cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), and lung cancer (LC) may improve the effectiveness of LC screening in smokers. The aims were to derive and assess risk models for predicting LC incidence, CVD mortality, and COPD mortality by combining quantitative CT measures from each disease, and to quantify the added predictive benefit of self-reported patient characteristics given the availability of a CT scan.MethodsA survey model (patient characteristics only), CT model (CT information only), and final model (all variables) were derived for each outcome using parsimonious Cox regression on a sample from the National Lung Screening Trial (n=15 000). Validation was performed using Multicentric Italian Lung Detection data (n=2287). Time-dependent measures of model discrimination and calibration are reported.ResultsAge, mean lung density, emphysema score, bronchial wall thickness, and aorta calcium volume are variables which contributed to all final models. Nodule features were crucial for LC incidence predictions but did not contribute to CVD and COPD mortality prediction. In the derivation cohort, the LC incidence CT model had a 5-year area under the receiver operating characteristic curve (AUC) of 82·5% (95% confidence interval=80·9–84·0%), significantly inferior to that of the final model (84·0%, 82·6–85·5%). However, the addition of patient characteristics did not improve the LC incidence model performance in the validation cohort (CT model=80·1%, 74·2–86·0%; final model=79·9, 73·9–85·8%). Similarly, the final CVD mortality model outperformed the other two models in the derivation cohort (survey model=74·9%, 72·7–77·1%; CT model=76·3%, 74·1–78·5%; final model=79·1%, 77·0–81·2%) but not the validation cohort (survey model=74·8%, 62·2–87·5%; CT model=72·1%, 61·1–83·2%; final model=72·2%, 60·4–84·0%). Combining patient characteristics and CT measures provided the largest increase in accuracy for the COPD mortality final model (92·3%, 90·1–94·5%) compared to either other model individually (survey model=87·5%, 84·3–90·6%; CT model=87·9%, 84·8–91·0%), but no external validation was performed due to a very low event frequency.ConclusionsCT measures of CVD and COPD provides small but reproducible improvements to nodule-based LC risk prediction accuracy from 3 years’ onwards. Self-reported patient characteristics may not be of added predictive value when CT information is available.

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“…As a gold standard, CT calcium score (Agatson score) is evaluated on ECG-gated acquisitions using structured reporting (CAC-RDS) [13]. However, CT calcium scores can also be obtained from non-gated lung cancer screening CTs and higher numbers of calcified lesions and scores of more than 400 may predict the likelihood of cardiovascular events in screening subjects with high confidence [14][15][16]. Smoking cessation interventions and modification of heart disease risk by using statins in those with high CAC scores may improve long-term improvements to quality of life for participants without lung cancer [17].…”

Section: Relevant Co-findingsmentioning

confidence: 99%

“…In the absence of lung function testing, lung cancer screening CTs allow identifying COPD with sensitivity 73.2%, specificity 88.8%, PPV 80.8% and NPV 84.2% [19]. In male asymptomatic lung cancer screening K Challenges in implementation of lung cancer screening-radiology requirements 167 short review [16]. However, the main beneficial role of emphysema quantification in lung cancer screening patients is an earlier diagnosis and therapy of COPD with smoking cessation strategies, inhaled bronchodilators with or without inhaled corticosteroids potentially leading to less exacerbations and hospitalizations for COPD.…”

Section: Relevant Co-findingsmentioning

confidence: 99%

Challenges in implementation of lung cancer screening—radiology requirements

Widmann

2019

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Implementation of lung cancer screening is a challenge for radiology. The present short review summarizes major requirements which are needed to ensure high rates of diagnostic accuracy and appropriate protocols for follow-up and invasive work-up. Standardization of procedures, structured reporting, assessment of quality metrics, close multidisciplinary collaboration, and continuous education are essential. Additional quantification of coronary artery calcium and emphysema may provide synergistic medical benefits for a lung cancer screening programme.

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Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study

Cited by 9 publications

References 38 publications

Coronary artery calcification in lung cancer screening

Coronary artery calcification in lung cancer screening

Combining pulmonary and cardiac computed tomography biomarkers for disease-specific risk modelling in lung cancer screening

Challenges in implementation of lung cancer screening—radiology requirements

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