<scp>COPD</scp> phenotypes in a lung cancer screening population

Balkan, Arzu; Bulut, Yasemin; Fuhrman, Carl R.; Fisher, Stephen N.; Wilson, David O.; Weissfeld, Joel L.; Sciurba, Frank C.

doi:10.1111/crj.12180

Cited by 11 publications

(7 citation statements)

References 43 publications

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“…Twenty-five to thirty percent of participants were discordant for FEV 1 /FVC-defined COPD and one of the qCT measures. This type of distinction was also reported in a population of current and ex-smokers involved in a lung screening program, where 17% of subjects had obstruction based on FEV 1 /FVC and no evidence of emphysema based on radiologist evaluation of the CT, 15% had no FEV 1 /FVC-defined obstruction but had evidence of emphysema based on radiologist evaluation of the CT, and 27% had findings of both (25). …”

Section: Discussionsupporting

confidence: 53%

Risk of Lung Cancer Associated with COPD Phenotype Based on Quantitative Image Analysis

Schwartz

Lusk

Wenzlaff

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background Chronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer. This study evaluates alternative measures of COPD based on spirometry and quantitative image analysis to better define a phenotype that predicts lung cancer risk. Methods Three-hundred-forty-one lung cancer cases and 752 volunteer controls age 21–89 years participated in a structured interview, standardized CT scan and spirometry. Logistic regression, adjusted for age, race, gender, pack-years, and inspiratory and expiratory total lung volume, was used to estimate the odds of lung cancer associated with FEV1/FVC, percent voxels less than -950 Hounsfield Units on the inspiratory scan (HUI) and percent voxels less than -856 HU on expiratory scan (HUE). Results The odds of lung cancer were increased 1.4- to 3.1-fold among those with COPD compared to those without, regardless of assessment method, however, in multivariable modeling, only percent voxels < -856 HUE as a continuous measure of air trapping (OR=1.04; 95% CI (1.03, 1.06)) and FEV1/FVC < 0.70 (OR=1.71; 95% CI (1.21, 2.41)) were independent predictors of lung cancer risk. Nearly 10% of lung cancer cases were negative on all objective measures of COPD. Conclusion Measures of air trapping using quantitative imaging, in addition to FEV1/FVC, can identify individuals at high risk of lung cancer and should be considered as supplemental measures at the time of screening for lung cancer. Impact Quantitative measures of air trapping based on imaging provide additional information for the identification of high risk groups who might benefit the most from lung cancer screening.

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Section: Discussionsupporting

confidence: 53%

Risk of Lung Cancer Associated with COPD Phenotype Based on Quantitative Image Analysis

Schwartz

Lusk

Wenzlaff

et al. 2016

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Although there is no validated score for daily clinical practice, the Bhalla score includes several elements that measure the extent and severity of bronchiectasis and other radiologic features associated with them [10].While other scales scarcely used in literature have some advantages in accuracy or good inter-observer variability, Bhalla score may show the severity of the disease more completely. The severity of bronchiectasis was significantly associated with age, smoking history, airflow limitation, lower FEV1, more frequent emphysema and coronary calcium, as previously seen in other studies [7,12,[28][29][30] Airflow limitation is quite common in patients with bronchiectasis [31][32][33] and was found in 55% of individuals with bronchiectasis in our cohort compared to 45% of the controls. In a study of 200 patients with bronchiectasis, airway obstruction was found in 43% and the presence and severity of airflow obstruction was proportional to the severity of bronchiectasis regardless of pack-years, sex or age [3].The finding of bronchiectasis in asymptomatic individuals, albeit mild in most instances, underlines the underdiagnosis of this condition.…”

Section: Burden Of Bronchiectasissupporting

confidence: 87%

Prevalence and burden of bronchiectasis in a lung cancer screening program

et al. 2020

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Introduction The prevalence of bronchiectasis in the general population and in individuals undergoing lung cancer screening with low dose computed tomography (LDCT) is unknown. The aim of this study is to estimate the prevalence and impact of bronchiectasis in a screening lung cancer program. Methods 3028 individuals participating in an international multicenter lung cancer screening consortium (I-ELCAP) were selected from 2000 to 2012. Patients with bronchiectasis on baseline CT were identified and compared to selected controls. Detection of nodules, need for additional studies and incidence of cancer were analyzed over the follow-up period. Results The prevalence of bronchiectasis was 11.6%(354/3028). On the baseline LDCT, the number of subjects with nodules identified was 189(53.4%) in patients with bronchiectasis compared to 63(17.8%) in controls (p<0.001). The occurrence of false positives was higher in subjects with bronchiectasis (26%vs17%;p = 0.003). During follow-up, new nodules were more common among subjects with bronchiectasis (17%vs.12%; p = 0.008). The total number of false positives during follow-up was 29(17.06%) for patients with bronchiectasis vs. 88(12.17%) for controls (p = 0.008).The incidence rate of lung cancer during follow-up was 6.8/1000 and 5.1/1000 person-years for each group respectively (p = 0.62) Conclusions Bronchiectasis are common among current and former smokers undergoing lung cancer screening with LDCT. The presence of bronchiectasis is associated with greater incidence

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“…Finally, since tumor nodules appear concave and mimic benign nodules when the surrounding parenchyma is emphysematous (23, 31, 32), as such, small pulmonary nodules likely have a greater probability of malignancy in the present of emphysema. This could be especially important since COPD phenotypes are highly prevalent in lung cancer screening populations (33). …”

Section: Discussionmentioning

confidence: 99%

Radiologic Features of Small Pulmonary Nodules and Lung Cancer Risk in the National Lung Screening Trial: A Nested Case-Control Study

Liu¹,

Wang²,

Li³

et al. 2018

Radiology

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Purpose Using data and images from the National Lung Screening Trial (NLST), we extracted radiological features from small pulmonary nodules (SPNs) that did not meet the original criteria to be considered a positive screen and identified features associated with lung cancer risk. Methods We extracted radiological features from SPNs of baseline low-dose computed tomography screens that did not meet NLST criteria to be considered a positive screen. SPNs were identified for 73 incidence case patients that were diagnosed with lung cancer at either the first or second follow-up screen and for 157 control subjects who had had three consecutive negative screens. Multivariable logistic regression was used to assess the association between radiological features and lung cancer risk. All statistical tests were two-sided. Results Nine features were significantly different between case patients and control subjects. Backward-elimination followed by bootstrap re-sampling identified a reduced model of highly informative radiological features with an under the ROC curve of 0.932 (95% C] 0.88–0.96), specificity of 92.38% (95% CI 52.22–84.91), and sensitivity of 76.55% (95% CI 87.50–95.35) that included total emphysema score (OR=1.71; 95% CI 1.39–2.01), attachment to vessel (OR=2.41; 95% CI 0.99–5.81), nodule location (OR=3.25; 95% CI 1.09–8.55), border definition (OR=7.56; 95% CI 1.89–30.8), and concavity (OR=2.58; 95% CI 0.89–5.64). Conclusion We identified a set of clinically relevant radiological features that that can be easily scored in the clinical setting and may be of use to determine lung cancer risk among participants presenting with SPNs.

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COPD phenotypes in a lung cancer screening population

Abstract: Combining LDCT with PFT and a comprehensive questionnaire allows subgroup classification of COPD phenotypes in a high-risk population and may lead to earlier intervention and an improved framework for future studies.

Cited by 11 publications

References 43 publications

Risk of Lung Cancer Associated with COPD Phenotype Based on Quantitative Image Analysis

Risk of Lung Cancer Associated with COPD Phenotype Based on Quantitative Image Analysis

Prevalence and burden of bronchiectasis in a lung cancer screening program

Radiologic Features of Small Pulmonary Nodules and Lung Cancer Risk in the National Lung Screening Trial: A Nested Case-Control Study

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