Results
interstitial lung abnormality, cancer, fibrosis, IPF, emphysema, lung cancer, infection, pneumoconiosis, interstitial lung abnormalities, interstitial lung diseaseFEVTwo
CANCER, FIBROSIS, EMPHYSEMA, LUNG CANCER, INFECTION, PLEURAL FIBROSIS, PNEUMOCONIOSIS, IDIOPATHIC PULMONARY FIBROSIS, RESPIRATORY BRONCHIOLITIS INTERSTITIAL LUNG DISEASE, HEART FAILURE, NON-SPECIFIC INTERSTITIAL PNEUMONIA
Baseline LDCT screening scans were performed on 6650 participants during the prevalent round of screening between November 2018 and February 2021. ILA were reported in 169 cases (2.5%) of which 153 cases were discussed in the SRM, usually because these cases were flagged as clinically significant, but occasionally at the discretion of the respiratory physician signing off the case.Of the 153 patients discussed in the SRM, 10 were known to the ILD service and no further action was needed and 87 were deemed to be not clinically significant and not referred. Thus, 56 patients (0.8% of the population undergoing prevalence LDCT screening) were identified as needing referral to the ILD service for initial discussion in the MDT meeting and subsequent review in the outpatient clinic. Demographic and clinical information is shown in Demographic and clinical information regarding participants with and without interstitial lung diseaseFEVTwo patients refused referral to the ILD clinic, and one patient is awaiting clinic review and a final diagnosis under the ILD team. A total of 53 patients have therefore received a final diagnosis and a consort diagram of diagnoses and treatments is shown in Flowchart for eventual diagnosis and treatment for participants with interstitial lung abnormalities reported on low-dose screening CT scans. ILA, interstitial lung abnormality; IPF, idiopathic pulmonary fibrosis; LDCT, low-dose CT; NSIP, non-specific interstitial pneumonia; RB-ILD, respiratory bronchiolitis interstitial lung disease.Thus, of 53 patients seen by the ILD service with a final diagnosis, 10 received pharmacotherapy (7 patients with antifibrotics, 3 patients with prednisolone) comprising 18% of those referred and 0.15% of all those undergoing prevalence LDCT screening. A total of 32 patients remain under active monitoring in the service with ongoing surveillance of lung function, 9 patients have now been discharged from the service after a period of stability and 2 patients died of unrelated causes.The most common reason for non-referral of cases to the ILD service was the trivial or mild nature of the ILA, as assessed by either the initial reporting radiologist or the radiologist reviewing the case in the SRM (n=42). In 33 cases, review in the SRM concluded that the LDCT findings were due to alternative causes (inflammatory change, infection or heart failure) rather than true ILA. Two cases were thought to represent classic RB-ILD but were not referred, as the patients had already engaged with the smoking cessation team on the mobile unit. In other cases, the reported ILA were thought to represent postradiation fibrosis, pleural fibrosis, pneumoconiosis or predominant emphysema, and thus patients were not referred to the service.Considering lung cancer diagnoses in the screening programme to date, a higher proportion of participants with ILD have been diagnosed with cancer compared with those without ILD (7.5% vs 2.4%, respectively, OR 3.16, 95% CI 1.25 to 7.94, p=0.015). Of the 103 participants with ILA mentioned in their LDCT reports who were not referred to the ILD service, 5 (4.9%) were subsequently diagnosed with lung cancer, thus considering the whole cohort with ILA/ILD 10 out of 169 participants (5.9%) were diagnosed with lung cancer.