{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK",
        "Oncogenes and Tumour Metabolism Lab, The Francis Crick Institute, London, UK",
        "University College London Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Brintha Selvarajah"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Amyn Bhamani"
    },
    {
      "affiliations": [
        "Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK"
      ],
      "name": "Mehran Azimbagirad"
    },
    {
      "affiliations": [
        "Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK",
        "Vocational School of Health Services, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey"
      ],
      "name": "Burcu Ozaltin"
    },
    {
      "affiliations": [
        "Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan"
      ],
      "name": "Ryoko Egashira"
    },
    {
      "affiliations": [
        "Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK"
      ],
      "name": "Daisuke Yamada"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "John McCabe"
    },
    {
      "affiliations": [
        "Royal London Hospital, Barts Health NHS Trust, London, UK"
      ],
      "name": "Nicola Smallcombe"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Priyam Verghese"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Ruth Prendecki"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Andrew Creamer"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Jennifer L Dickson"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Carolyn Horst"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Sophie Tisi"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Helen Hall"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Chuen R Khaw"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK",
        "The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Monica L Mullin"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Kylie Gyertson"
    },
    {
      "affiliations": [
        "Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK"
      ],
      "name": "Anne-Marie Hacker"
    },
    {
      "affiliations": [
        "Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK"
      ],
      "name": "Laura Farrelly"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, London, UK",
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Anand Devaraj"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Arjun Nair"
    },
    {
      "affiliations": [
        "Oncogenes and Tumour Metabolism Lab, The Francis Crick Institute, London, UK"
      ],
      "name": "Mariia Yuneva"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust, London, UK",
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Neal Navani"
    },
    {
      "affiliations": [
        "UCL Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK"
      ],
      "name": "Daniel C Alexander"
    },
    {
      "affiliations": [
        "Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Rachel Clare Chambers"
    },
    {
      "affiliations": [
        "Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK",
        "University College London Hospitals NHS Foundation Trust, London, UK"
      ],
      "name": "Joanna Porter"
    },
    {
      "affiliations": [
        "Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK"
      ],
      "name": "Allan Hackshaw"
    },
    {
      "affiliations": [
        "Royal Brompton and Harefield Hospitals, London, UK",
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Gisli Jenkins"
    },
    {
      "affiliations": [
        "Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK",
        "Oncogenes and Tumour Metabolism Lab, The Francis Crick Institute, London, UK",
        "University College London Hospitals NHS Foundation Trust, London, UK",
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK",
        "Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK",
        "Vocational School of Health Services, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey",
        "Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan",
        "Royal London Hospital, Barts Health NHS Trust, London, UK",
        "The University of British Columbia, Vancouver, British Columbia, Canada",
        "Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK",
        "Royal Brompton and Harefield Hospitals, London, UK",
        "National Heart and Lung Institute, Imperial College London, London, UK",
        "UCL Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK"
      ],
      "name": "The SUMMIT Consortium"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust, London, UK",
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK"
      ],
      "name": "Sam M Janes"
    },
    {
      "affiliations": [
        "Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK",
        "Satsuma Lab, Centre for Medical Image Computing, University College London, London, UK"
      ],
      "name": "Joseph Jacob"
    }
  ],
  "title": "Differentiating clinically important interstitial lung abnormalities in lung cancer screening",
  "uid": "c2d25bbc-7bbd-50ef-9425-557621a5f80f"
}