Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
BMJ Open Respir Res. 2023 Aug;10(1). doi: 10.1136/bmjresp-2022-001490.
Interstitial lung abnormalities (ILA) are relatively common incidental findings in participants undergoing low-dose CT screening for lung cancer. Some ILA are transient and inconsequential, but others represent interstitial lung disease (ILD). Lung cancer screening therefore offers the opportunity of earlier diagnosis and treatment of ILD for some screening participants.
The prevalence of ILA in participants in the baseline screening round of the Yorkshire Lung Screening Trial is reported, along with the proportion referred to a regional ILD service, eventual diagnoses, outcomes and treatments.
Of 6650 participants undergoing screening, ILA were reported in 169 (2.5%) participants. Following review in a screening review meeting, 56 participants were referred to the ILD service for further evaluation (0.8% of all screening participants). 2 participants declined referral, 1 is currently awaiting review and the remaining 53 were confirmed as having ILD. Eventual diagnoses were idiopathic pulmonary fibrosis (n=14), respiratory bronchiolitis ILD (n=4), chronic hypersensitivity pneumonitis (n=2), connective tissue disease/rheumatoid arthritis-related ILD (n=4), asbestosis (n=1), idiopathic non-specific interstitial pneumonia (n=1), sarcoidosis (n=1) and pleuroparenchymal fibroelastosis (n=1). Twenty five patients had unclassifiable idiopathic interstitial pneumonia. Overall, 10 people received pharmacotherapy (7 antifibrotics and 3 prednisolone) representing 18% of those referred to the ILD service and 0.15% of those undergoing screening. 32 people remain under surveillance in the ILD service, some of whom may require treatment in future.
Lung cancer screening detects clinically significant cases of ILD allowing early commencement of disease-modifying treatment in a proportion of participants. This is the largest screening cohort to report eventual diagnoses and treatments and provides an estimate of the level of clinical activity to be expected by ILD services as lung cancer screening is implemented. Further research is needed to clarify the optimal management of screen-detected ILD.
ISRCTN42704678.
在接受低剂量 CT 肺癌筛查的参与者中，间质性肺异常（ILA）是相对常见的偶然发现。一些 ILA 是短暂的、无关紧要的，但另一些则代表间质性肺疾病（ILD）。因此，肺癌筛查为一些筛查参与者提供了更早诊断和治疗ILD 的机会。
报告了在约克郡肺癌筛查试验的基线筛查轮次中参与者的 ILA 患病率，以及转诊到区域ILD 服务的比例、最终诊断、结果和治疗。
在接受筛查的 6650 名参与者中，有 169 名（2.5%）报告了 ILA。在筛查审查会议上进行审查后，有 56 名参与者被转诊到ILD 服务进行进一步评估（所有筛查参与者的 0.8%）。有 2 名参与者拒绝转诊，1 名正在等待审查，其余 53 名被确认为患有ILD。最终诊断为特发性肺纤维化（n=14）、呼吸性细支气管炎ILD（n=4）、慢性过敏性肺炎（n=2）、结缔组织病/类风湿关节炎相关ILD（n=4）、石棉肺（n=1）、特发性非特异性间质性肺炎（n=1）、结节病（n=1）和胸膜肺弹力纤维增生症（n=1）。25 名患者患有无法分类的特发性间质性肺炎。总体而言，有 10 人接受了药物治疗（7 种抗纤维化药物和 3 种泼尼松龙），占ILD 服务转诊人数的 18%和筛查人数的 0.15%。32 人仍在ILD 服务中接受监测，其中一些人将来可能需要治疗。
肺癌筛查检测到临床上有意义的ILD 病例，使一部分参与者能够早期开始使用疾病修饰治疗。这是报告最终诊断和治疗的最大筛查队列，并提供了ILD 服务在实施肺癌筛查时预计的临床活动水平的估计。需要进一步研究来阐明筛查发现的ILD 的最佳管理。
ISRCTN42704678。
