Paul F Pinsky1, David A Lynch2, David S Gierada3. 1. Division of Cancer Prevention, National Cancer Institute, Bethesda, MD. Electronic address: pp4f@nih.gov. 2. Department of Radiology, National Jewish Health, Denver, CO. 3. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
Abstract
BACKGROUND: Incidental respiratory disease-related findings are frequently observed on low-dose CT (LDCT) lung cancer screenings. This study analyzed data from the National Lung Screening Trial (NLST) to assess the relationship between such findings and respiratory disease mortality (RDM), excluding lung cancer. RESEARCH QUESTION: Are incidental respiratory findings on LDCT scanning associated with increased RDM? STUDY DESIGN AND METHODS: Subjects in the NLST LDCT arm received three annual screens. Trial radiologists noted findings related to possible lung cancer, as well as respiratory-related incidental findings. Demographic characteristics, smoking history, and medical history were captured in a baseline questionnaire. Kaplan-Meier curves were used to assess cumulative RDM. Multivariate proportional hazards models were used to assess risk factors for RDM; in addition to incidental CT scan findings, variables included respiratory disease history (COPD/emphysema, and asthma), smoking history, and demographic factors (age, race, sex, and BMI). RESULTS: Of 26,722 subjects in the NLST LDCT arm, 25,002 received the baseline screen and a subsequent LDCT screen. Overall, 59% were male, 26.5% were aged ≥ 65 years at baseline, and 10.6% reported a history of COPD/emphysema. Emphysema on LDCT scanning was reported in 30.7% of subjects at baseline and in 44.2% at any screen. Of those with emphysema on baseline LDCT scanning, 18% reported a history of COPD/emphysema. Median mortality follow-up was 10.3 years. There were 3,639 deaths, and 708 were from respiratory diseases. Among subjects with no history of COPD/emphysema, 10-year cumulative RDM ranged from 3.9% for subjects with emphysema and reticular opacities to 1.1% for those with neither condition; the corresponding range among subjects with a COPD/emphysema history was 17.3% (both) to 3.7% (neither). Emphysema on LDCT imaging was associated with a significantly elevated RDM hazard ratio (2.27; 95% CI, 1.92-2.7) in the multivariate model. Reticular opacities (including honeycombing/fibrosis/scar) also had a significantly elevated hazard ratio (1.39; 95% CI, 1.19-1.62). INTERPRETATION: Incidental respiratory disease-related findings observed on NLST LDCT screens were frequent and associated with increased mortality from respiratory diseases.
BACKGROUND: Incidental respiratory disease-related findings are frequently observed on low-dose CT (LDCT) lung cancer screenings. This study analyzed data from the National Lung Screening Trial (NLST) to assess the relationship between such findings and respiratory disease mortality (RDM), excluding lung cancer. RESEARCH QUESTION: Are incidental respiratory findings on LDCT scanning associated with increased RDM? STUDY DESIGN AND METHODS: Subjects in the NLST LDCT arm received three annual screens. Trial radiologists noted findings related to possible lung cancer, as well as respiratory-related incidental findings. Demographic characteristics, smoking history, and medical history were captured in a baseline questionnaire. Kaplan-Meier curves were used to assess cumulative RDM. Multivariate proportional hazards models were used to assess risk factors for RDM; in addition to incidental CT scan findings, variables included respiratory disease history (COPD/emphysema, and asthma), smoking history, and demographic factors (age, race, sex, and BMI). RESULTS: Of 26,722 subjects in the NLST LDCT arm, 25,002 received the baseline screen and a subsequent LDCT screen. Overall, 59% were male, 26.5% were aged ≥ 65 years at baseline, and 10.6% reported a history of COPD/emphysema. Emphysema on LDCT scanning was reported in 30.7% of subjects at baseline and in 44.2% at any screen. Of those with emphysema on baseline LDCT scanning, 18% reported a history of COPD/emphysema. Median mortality follow-up was 10.3 years. There were 3,639 deaths, and 708 were from respiratory diseases. Among subjects with no history of COPD/emphysema, 10-year cumulative RDM ranged from 3.9% for subjects with emphysema and reticular opacities to 1.1% for those with neither condition; the corresponding range among subjects with a COPD/emphysema history was 17.3% (both) to 3.7% (neither). Emphysema on LDCT imaging was associated with a significantly elevated RDM hazard ratio (2.27; 95% CI, 1.92-2.7) in the multivariate model. Reticular opacities (including honeycombing/fibrosis/scar) also had a significantly elevated hazard ratio (1.39; 95% CI, 1.19-1.62). INTERPRETATION: Incidental respiratory disease-related findings observed on NLST LDCT screens were frequent and associated with increased mortality from respiratory diseases.
Authors: Denise R Aberle; Christine D Berg; William C Black; Timothy R Church; Richard M Fagerstrom; Barbara Galen; Ilana F Gareen; Constantine Gatsonis; Jonathan Goldin; John K Gohagan; Bruce Hillman; Carl Jaffe; Barnett S Kramer; David Lynch; Pamela M Marcus; Mitchell Schnall; Daniel C Sullivan; Dorothy Sullivan; Carl J Zylak Journal: Radiology Date: 2010-11-02 Impact factor: 11.105
Authors: Emily B Tsai; Caroline Chiles; Brett W Carter; Myrna C B Godoy; Girish S Shroff; Reginald F Munden; Mylene T Truong; Carol C Wu Journal: Semin Ultrasound CT MR Date: 2018-03-01 Impact factor: 1.875
Authors: Esther Pompe; Pim A de Jong; David A Lynch; Nikolas Lessmann; Ivana Išgum; Bram van Ginneken; Jan-Willem J Lammers; Firdaus A A Mohamed Hoesein Journal: Eur Respir J Date: 2017-04-19 Impact factor: 16.671
Authors: Rachel K Putman; Gunnar Gudmundsson; Gisli Thor Axelsson; Tomoyuki Hida; Osamu Honda; Tetsuro Araki; Masahiro Yanagawa; Mizuki Nishino; Ezra R Miller; Gudny Eiriksdottir; Elías F Gudmundsson; Noriyuki Tomiyama; Hiroshi Honda; Ivan O Rosas; George R Washko; Michael H Cho; David A Schwartz; Vilmundur Gudnason; Hiroto Hatabu; Gary M Hunninghake Journal: Am J Respir Crit Care Med Date: 2019-07-15 Impact factor: 21.405
Authors: Denise R Aberle; Amanda M Adams; Christine D Berg; William C Black; Jonathan D Clapp; Richard M Fagerstrom; Ilana F Gareen; Constantine Gatsonis; Pamela M Marcus; JoRean D Sicks Journal: N Engl J Med Date: 2011-06-29 Impact factor: 91.245
Authors: Linda L Humphrey; Mark Deffebach; Miranda Pappas; Christina Baumann; Kathryn Artis; Jennifer Priest Mitchell; Bernadette Zakher; Rongwei Fu; Christopher G Slatore Journal: Ann Intern Med Date: 2013-09-17 Impact factor: 25.391
Authors: Tomoyuki Hida; Mizuki Nishino; Takuya Hino; Junwei Lu; Rachel K Putman; Elias F Gudmundsson; Tetsuro Araki; Vladimir I Valtchinov; Osamu Honda; Masahiro Yanagawa; Yoshitake Yamada; Akinori Hata; Masahiro Jinzaki; Noriyuki Tomiyama; Hiroshi Honda; Raul San Jose Estepar; George R Washko; Takeshi Johkoh; David C Christiani; David A Lynch; Vilmundur Gudnason; Gunnar Gudmundsson; Gary M Hunninghake; Hiroto Hatabu Journal: Eur J Radiol Date: 2020-05-18 Impact factor: 3.528
Authors: Rachel K Putman; Hiroto Hatabu; Tetsuro Araki; Gunnar Gudmundsson; Wei Gao; Mizuki Nishino; Yuka Okajima; Josée Dupuis; Jeanne C Latourelle; Michael H Cho; Souheil El-Chemaly; Harvey O Coxson; Bartolome R Celli; Isis E Fernandez; Oscar E Zazueta; James C Ross; Rola Harmouche; Raúl San José Estépar; Alejandro A Diaz; Sigurdur Sigurdsson; Elías F Gudmundsson; Gudny Eiríksdottír; Thor Aspelund; Matthew J Budoff; Gregory L Kinney; John E Hokanson; Michelle C Williams; John T Murchison; William MacNee; Udo Hoffmann; Christopher J O'Donnell; Lenore J Launer; Tamara B Harrris; Vilmundur Gudnason; Edwin K Silverman; George T O'Connor; George R Washko; Ivan O Rosas; Gary M Hunninghake Journal: JAMA Date: 2016-02-16 Impact factor: 56.272
Authors: Hunter G Lindsay; Frederick S Wamboldt; Kristen E Holm; Barry J Make; John Hokanson; James D Crapo; Elizabeth A Regan Journal: Chronic Obstr Pulm Dis Date: 2021-07-28