鉴别肺癌筛查中重要临床间质性肺异常。

IF 3.4 3区 医学 Q1 RESPIRATORY SYSTEM
Brintha Selvarajah, Amyn Bhamani, Mehran Azimbagirad, Burcu Ozaltin, Ryoko Egashira, Daisuke Yamuda, John McCabe, Nicola Smallcombe, Priyam Verghese, Ruth Prendecki, Andrew Creamer, Jennifer L Dickson, Carolyn Horst, Sophie Tisi, Helen Hall, Chuen R Khaw, Monica L Mullin, Kylie Gyertson, Anne-Marie Hacker, Laura Farrelly, Anand Devaraj, Arjun Nair, Mariia Yuneva, Neal Navani, Daniel C Alexander, Rachel Clare Chambers, Joanna Porter, Allan Hackshaw, Gisli Jenkins, Sam M Janes, Joseph Jacob
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引用次数: 0

摘要

背景:肺间质性异常(ILAs)是肺癌筛查(LCS)中常见的偶然发现。然而,由欧洲呼吸学会(ERS)领导的欧洲多学科工作组在一份联合声明中强调,在确定临床相关的ILAs方面仍然存在挑战。为了应对这些挑战,我们分析了欧洲最大的LCS研究之一中确定的ILAs。方法:在11635例LCS患者中,使用新的视觉分类系统对417例筛查到的ILA进行评估,重点关注牵拉性细支气管扩张:非纤维化性ILA(无牵拉性细支气管扩张),纤维化性ILA(牵拉性细支气管扩张≤2叶);未确诊的间质性肺疾病(bbb20叶牵引性细支气管扩张)。使用Cohen’s Kappa将观察者协议与Fleischner Society ILA分类进行比较。年龄、性别和吸烟史匹配的对照组允许检查基线ILA/UILD与合并症、用力肺活量(FVC)、住院(学生t检验)和死亡率(单变量和多变量Cox比例风险模型)之间的关系。与Fleischner ILA分类(K=0.64)相比,我们的视觉ILA分类显示出更好的观察者间一致性(K=0.76)。ILA/ ild受试者的合并症更为普遍,在ILA/ ild诊断前约10年(与对照组相比)增加。与对照组相比,UILD参与者的死亡率高6倍,纤维化和非纤维化ILA亚型的死亡率高3倍。在多变量Cox回归分析中,ILA/UILD的存在(HR=4.90, 95% CI =2.36 ~ 10.10)。结论:我们展示了LCS人群中临床上重要的ILA/UILD的一种新的可重复分类。我们强调,在ILA/ ild受试者中,FVC与死亡率的关联有限。ILA/ ild患者多器官合并症的增加强调了早期综合多系统评估的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Differentiating clinically important interstitial lung abnormalities in lung cancer screening.

Background: Interstitial lung abnormalities (ILAs) are common incidental findings in lung cancer screening (LCS). However, challenges remain in identifying clinically relevant ILAs as highlighted in a joint statement by a European multidisciplinary task force led by the European Respiratory Society (ERS). To address these challenges, we analysed ILAs identified in one of Europe's largest LCS studies.

Methods: Of 11 635 LCS individuals, 417 screen-detected ILAs were evaluated using a new visual classification system focused on traction bronchiolectasis: non-fibrotic ILA (no traction bronchiolectasis), fibrotic ILA (traction bronchiolectasis in ≤2 lobes); undiagnosed interstitial lung disease (traction bronchiolectasis in >2 lobes). Observer agreement was compared with Fleischner Society ILA classification using Cohen's Kappa. An age, sex and smoking history-matched control group allowed the examination of associations between baseline ILA/UILD and comorbidities, forced vital capacity (FVC), hospitalisations (Student's t-tests) and mortality (univariable and multivariable Cox proportional hazards models).

Findings: Our visual ILA classification showed superior interobserver agreement (K=0.76) versus the Fleischner ILA classification (K=0.64). ILA/UILD subjects had more prevalent comorbidities, increasing (vs controls) approximately 10 years prior to ILA/UILD diagnosis. Compared with controls, mortality rates were 6-fold higher for UILD participants and 3-fold higher for fibrotic and non-fibrotic ILA subtypes. On multivariable Cox regression analysis, ILA/UILD presence (HR=4.90, 95% CI =2.36 to 10.10, p<0.001) showed stronger independent associations with mortality than baseline FVC (HR=0.98, 95% CI =0.96 to 1.00, p=0.04).

Conclusion: We demonstrate a new reproducible classification of clinically important ILA/UILDs in LCS populations. We highlight that FVC shows limited associations with mortality in ILA/UILD subjects. Increased multiorgan comorbidity in ILA/UILD subjects highlights a need for comprehensive early multisystem evaluation.

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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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