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Related Experiment Video

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Differentiating clinically important interstitial lung abnormalities in lung cancer screening.

Brintha Selvarajah1,2,3, Amyn Bhamani4, Mehran Azimbagirad5

  • 1Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK.

BMJ Open Respiratory Research
|September 11, 2025
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Summary

A new classification system for interstitial lung abnormalities (ILAs) in lung cancer screening (LCS) improves accuracy. ILAs, including undiagnosed interstitial lung disease (UILD), are linked to higher mortality and comorbidity risks.

Keywords:
Idiopathic Pulmonary FibrosisImaging/CT MRI etcInterstitial Fibrosis

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Area of Science:

  • Pulmonary Medicine
  • Radiology
  • Epidemiology

Background:

  • Interstitial lung abnormalities (ILAs) are frequent incidental findings in lung cancer screening (LCS).
  • Accurate identification of clinically significant ILAs remains a challenge, as noted by the European Respiratory Society (ERS).
  • This study analyzes ILAs from a large European LCS cohort to address these challenges.

Purpose of the Study:

  • To evaluate a novel visual classification system for ILAs based on traction bronchiolectasis.
  • To compare the interobserver agreement of the new system with the Fleischner Society ILA classification.
  • To assess the association of ILAs/undiagnosed interstitial lung disease (UILD) with comorbidities, lung function, and mortality.

Main Methods:

  • A new visual classification system was applied to 417 screen-detected ILAs in 11,635 LCS individuals.
  • The system categorizes ILAs into non-fibrotic ILA, fibrotic ILA, and UILD based on traction bronchiolectasis extent.
  • Observer agreement was assessed using Cohen's Kappa, and associations with clinical outcomes were analyzed using matched controls and Cox regression models.

Main Results:

  • The new visual ILA classification demonstrated superior interobserver agreement (Kappa=0.76) compared to the Fleischner classification (Kappa=0.64).
  • Individuals with ILA/UILD exhibited higher comorbidity prevalence, appearing approximately 10 years earlier than diagnosis.
  • Mortality rates were significantly higher for UILD (6-fold) and ILA subtypes (3-fold) compared to controls. ILA/UILD presence was a stronger predictor of mortality than FVC.

Conclusions:

  • A reproducible classification for clinically significant ILAs/UILDs in LCS populations was established.
  • Forced vital capacity (FVC) showed limited association with mortality in ILA/UILD patients.
  • The high prevalence of multiorgan comorbidity in ILA/UILD underscores the need for early, comprehensive multisystem evaluation.