Incidental pulmonary emphysema and COPD cases in a national lung cancer screening program feasibility study.

Abstract

<b>Objective:</b> Lung cancer (LC) screening with low-dose CT (LDCT) is aimed to detect early-stage LC. However, besides LC, also other pulmonary and extrapulmonary findings are frequent. Aim of the study was to evaluate patients with incidental pulmonary emphysema and define cases of undiagnosed COPD. <b>Methods:</b> In three family physician practices, all 55–74-year-old patients with elevated LC risk either according to smoking status (&gt;20 pack-years; quit &lt;15 years ago) or LC risk score (PLCOm2012noRace &gt;1.5) were referred to LDCT, and the results were evaluated according to LungRADS version 1.1 protocol by two radiologists. Also, incidental findings were recorded. All radiologically verified emphysema cases were evaluated by study pneumologist, majority of the patients were invited to spirometry and out-patient visit. <b>Results:</b> Out of total 7035 patients, 495 (7.0%) were 55–74 years old current or previous smokers, 206 had elevated LC risk and were referred to LDCT. 201 ended up taking it and 186 of them (92.5%) had one or several incidental findings, most commonly coronary atherosclerosis (120 patients). 115 (57.2%) patients had pulmonary emphysema on CT. 20 (17.4%) patients had previously diagnosed COPD. 101 (87.8%) were referred to and 95 visited pneumologist. Eight new COPD cases were diagnosed (7.0% of patients with emphysema on CT), all but 1 had COPD symptoms. <b>Conclusions:</b> Incidental findings including emphysema were common on LC screening CT. While 17.4% of patients with radiologically evident emphysema had previous COPD diagnosis, 7.0% were undiagnosed. LC screening patients with radiologically detected emphysema and corresponding symptoms might have undiagnosed COPD.