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European Radiology

, Volume 26, Issue 2, pp 487–494 | Cite as

Visual assessment of early emphysema and interstitial abnormalities on CT is useful in lung cancer risk analysis

  • Mathilde M. W. WilleEmail author
  • Laura H. Thomsen
  • Jens Petersen
  • Marleen de Bruijne
  • Asger Dirksen
  • Jesper H. Pedersen
  • Saher B. Shaker
Chest

Abstract

Objectives

Screening for lung cancer should be limited to a high-risk-population, and abnormalities in low-dose computed tomography (CT) screening images may be relevant for predicting the risk of lung cancer. Our aims were to compare the occurrence of visually detected emphysema and interstitial abnormalities in subjects with and without lung cancer in a screening population of smokers.

Methods

Low-dose chest CT examinations (baseline and latest possible) of 1990 participants from The Danish Lung Cancer Screening Trial were independently evaluated by two observers who scored emphysema and interstitial abnormalities. Emphysema (lung density) was also measured quantitatively.

Results

Emphysema was seen more frequently and its extent was greater among participants with lung cancer on baseline (odds ratio (OR), 1.8, p = 0.017 and p = 0.002) and late examinations (OR 2.6, p < 0.001 and p < 0.001). No significant difference was found using quantitative measurements. Interstitial abnormalities were more common findings among participants with lung cancer (OR 5.1, p < 0.001 and OR 4.5, p < 0.001).There was no association between presence of emphysema and presence of interstitial abnormalities (OR 0.75, p = 0.499).

Conclusions

Even early signs of emphysema and interstitial abnormalities are associated with lung cancer. Quantitative measurements of emphysema—regardless of type—do not show the same association.

Key Points

Visually detected emphysema on CT is more frequent in individuals who develop lung cancer.

Emphysema grading is higher in those who develop lung cancer.

Interstitial abnormalities, including discrete changes, are associated with lung cancer.

Quantitative lung density measurements are not useful in lung cancer risk prediction.

Early CT signs of emphysema and interstitial abnormalities can predict future risk.

Keywords

Computed tomography Lung cancer Emphysema Interstitial abnormalities Comorbidity 

Abbreviations

BMI

Body mass index

COPD

Chronic obstructive pulmonary disease

CT

Computed tomography

DLCST

Danish Lung Cancer Screening Trial

FEV1

Forced expiratory volume in one second

HU

Hounsfield units

ILD

Interstitial lung disease

IPF

Idiopathic pulmonary fibrosis

LAA%-910

Low attenuation area percentage under −910 HU

LAA%-950

Low attenuation area percentage under −950 HU

PD15

15th percentile density

pTLC

Predicted total lung capacity

Notes

Acknowledgements

We thank AstraZeneca, Sweden, for financial support. The scientific guarantor of this publication is Asger Dirksen. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in DLCST studies regarding nodule characteristics, lung function and lung density. Therefore an extensive overlap between study populations in these publications exists. We have previously published a study on the interobserver agreement and emphysema progression in visual assessments of DLCST scans [21]. The association of visual findings with lung cancer has, however, not previously been explored, and the data from the present study have not been published before. All relevant references are disclosed. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

Supplementary material

330_2015_3826_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 20 kb)

References

  1. 1.
    Aberle DR, Adams AM, Berg CD et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 5:395–409Google Scholar
  2. 2.
    Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 5:277–300CrossRefGoogle Scholar
  3. 3.
    Bach PB, Mirkin JN, Oliver TK et al (2012) Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 22:2418–29CrossRefGoogle Scholar
  4. 4.
    Field JK, van Klaveren R, Pedersen JH et al (2013) European randomized lung cancer screening trials: Post NLST. J Surg Oncol 5:280–6CrossRefGoogle Scholar
  5. 5.
    Humphrey LL, Deffebach M, Pappas M et al (2013) Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation. Ann Intern Med 6:411–20CrossRefGoogle Scholar
  6. 6.
    Field JK, Oudkerk M, Pedersen JH, Duffy SW (2013) Prospects for population screening and diagnosis of lung cancer. Lancet 9893:732–41CrossRefGoogle Scholar
  7. 7.
    McWilliams A, Tammemagi MC, Mayo JR et al (2013) Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 10:910–9CrossRefGoogle Scholar
  8. 8.
    Tammemagi CM, Pinsky PF, Caporaso NE et al (2011) Lung cancer risk prediction: Prostate, Lung, Colorectal And Ovarian Cancer Screening Trial models and validation. J Natl Cancer Inst 13:1058–68CrossRefGoogle Scholar
  9. 9.
    Spitz MR, Etzel CJ, Dong Q et al (2008) An expanded risk prediction model for lung cancer. Cancer Prev Res (Phila) 4:250–4CrossRefGoogle Scholar
  10. 10.
    Bach PB, Kattan MW, Thornquist MD et al (2003) Variations in lung cancer risk among smokers. J Natl Cancer Inst 6:470–8CrossRefGoogle Scholar
  11. 11.
    Tammemagi MC, Katki HA, Hocking WG et al (2013) Selection criteria for lung-cancer screening. N Engl J Med 8:728–36CrossRefGoogle Scholar
  12. 12.
    Kovalchik SA, Tammemagi M, Berg CD et al (2013) Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 3:245–54CrossRefGoogle Scholar
  13. 13.
    Mizuno S, Takiguchi Y, Fujikawa A et al (2009) Chronic obstructive pulmonary disease and interstitial lung disease in patients with lung cancer. Respirology 3:377–83CrossRefGoogle Scholar
  14. 14.
    Gierada DS, Guniganti P, Newman BJ et al (2011) Quantitative CT assessment of emphysema and airways in relation to lung cancer risk. Radiology 3:950–9CrossRefGoogle Scholar
  15. 15.
    Le Jeune I, Gribbin J, West J et al (2007) The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK. Respir Med 12:2534–40CrossRefGoogle Scholar
  16. 16.
    Hubbard R, Venn A, Lewis S, Britton J (2000) Lung cancer and cryptogenic fibrosing alveolitis. A population-based cohort study. Am J Respir Crit Care Med 1:5–8CrossRefGoogle Scholar
  17. 17.
    Harris JM, Johnston ID, Rudd R, Taylor AJ, Cullinan P (2010) Cryptogenic fibrosing alveolitis and lung cancer: the BTS study. Thorax 1:70–6CrossRefGoogle Scholar
  18. 18.
    Wells C, Mannino DM (1996) Pulmonary fibrosis and lung cancer in the United States: analysis of the multiple cause of death mortality data, 1979 through 1991. South Med J 5:505–10CrossRefGoogle Scholar
  19. 19.
    Jin GY, Lynch D, Chawla A et al (2013) Interstitial lung abnormalities in a CT lung cancer screening population: prevalence and progression rate. Radiology 2:563–71CrossRefGoogle Scholar
  20. 20.
    Pedersen JH, Ashraf H, Dirksen A et al (2009) The Danish randomized lung cancer CT screening trial–overall design and results of the prevalence round. J Thorac Oncol 5:608–14CrossRefGoogle Scholar
  21. 21.
    Wille MMW, Thomsen LH, Dirksen A, et al. (2014) Emphysema progression is visually detectable in low-dose CT scans in continuous but not in former smokers. European RadiologyGoogle Scholar
  22. 22.
    Ashraf H, Lo P, Shaker SB et al (2011) Short-term effect of changes in smoking behaviour on emphysema quantification by CT. Thorax 1:55–60CrossRefGoogle Scholar
  23. 23.
    Dirksen A (2008) Monitoring the progress of emphysema by repeat computed tomography scans with focus on noise reduction. Proc Am Thorac Soc 9:925–8CrossRefGoogle Scholar
  24. 24.
    de Torres JP, Bastarrika G, Wisnivesky JP et al (2007) Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest 6:1932–8CrossRefGoogle Scholar
  25. 25.
    Wilson DO, Weissfeld JL, Balkan A et al (2008) Association of radiographic emphysema and airflow obstruction with lung cancer. Am J Respir Crit Care Med 7:738–44CrossRefGoogle Scholar
  26. 26.
    Sverzellati N, Guerci L, Randi G et al (2011) Interstitial lung diseases in a lung cancer screening trial. Eur Respir J 2:392–400CrossRefGoogle Scholar
  27. 27.
    Kwak N, Park CM, Lee J et al (2014) Lung cancer risk among patients with combined pulmonary fibrosis and emphysema. Respir Med 3:524–30CrossRefGoogle Scholar
  28. 28.
    Camiciottoli G, Orlandi I, Bartolucci M et al (2007) Lung CT densitometry in systemic sclerosis: correlation with lung function, exercise testing, and quality of life. Chest 3:672–81CrossRefGoogle Scholar
  29. 29.
    Xu Y, van Beek EJ, Hwanjo Y et al (2006) Computer-aided classification of interstitial lung diseases via MDCT: 3D adaptive multiple feature method (3D AMFM). Acad Radiol 8:969–78CrossRefGoogle Scholar
  30. 30.
    Hartley PG, Galvin JR, Hunninghake GW et al (1985) (1994) High-resolution CT-derived measures of lung density are valid indexes of interstitial lung disease. J Appl Physiol 1:271–7Google Scholar
  31. 31.
    Shaker SB, Stavngaard T, Laursen LC, Stoel BC, Dirksen A (2011) Rapid fall in lung density following smoking cessation in COPD. COPD 1:2–7CrossRefGoogle Scholar
  32. 32.
    Shaker SB, Dirksen A, Lo P et al (2012) Factors influencing the decline in lung density in a Danish lung cancer screening cohort. Eur Respir J 5:1142–8CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Mathilde M. W. Wille
    • 1
    Email author
  • Laura H. Thomsen
    • 2
  • Jens Petersen
    • 3
  • Marleen de Bruijne
    • 3
    • 4
  • Asger Dirksen
    • 1
  • Jesper H. Pedersen
    • 5
  • Saher B. Shaker
    • 1
  1. 1.Department of Respiratory MedicineGentofte HospitalHellerupDenmark
  2. 2.Department of Respiratory MedicineHvidovre HospitalHvidovreDenmark
  3. 3.Department of Computer Science, DIKUUniversity of CopenhagenKøbenhavn ØDenmark
  4. 4.Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical InformaticsErasmus MC -University Medical Center RotterdamRotterdamThe Netherlands
  5. 5.Department of Thoracic Surgery, RigshospitaletCopenhagen University HospitalKøbenhavn ØDenmark

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