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Obstructive Lung Diseases |

Significance of Emphysema in a Lung Cancer Screening Cohort

Vikramjit Mukherjee, MD; James Messina; Jun-Chieh Tsay, MD; John Munger, MD; William Rom, MD
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New York University Medical Center, New York, NY


Chest. 2015;148(4_MeetingAbstracts):698A. doi:10.1378/chest.2270085
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Abstract

SESSION TITLE: COPD Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: High risk smokers screened for lung cancer share epidemiological risk factors for COPD. Emphysema can be detected by reduced attenuation on Low Dose CT scans.

METHODS: High risk smokers who underwent LDCT scan Lung Cancer Screening at the New York University Lung Cancer Biomarker Center (NYU LCBC) in the last three years were identified. A retrospective chart review evaluated baseline demographics, respiratory symptoms, spirometry and comorbidities. Statistical analysis was done using SPSS software.

RESULTS: 458 consecutive high risk smokers underwent LDCT between 2012-2014 at NYU LCBC. The study population was 64±8 years (SD), Caucasian (92%) and heavy smokers (33% current, 59% ex-smokers, 38 ±22 pack years (SD)). 180 patients (39%) had CT evidence of emphysema. Study subjects with emphysema were more likely to be older (66 years vs. 64 years, p=0.003), heavier smokers (48.6 vs. 31.8 pack years, p=0.003) and current smokers (44.4% vs. 26.3%, p=0.002). They were more likely to have atelectasis (21.1% vs. 12.6%, p=0.018), small airways disease (22.8% vs. 15.1%, p=0.047), scarring (36.7% vs. 24.1%, p=0.004), aortic abnormalities (8.9% vs. 3.6%), aortic calcifications (46.1% vs. 30.6%, p=0.001) and coronary calcifications (48.9% vs. 36.0%, p=0.004). Patients with emphysema had a lower FEV1 as well (2.21L vs. 2.49L, p<0.001) and a lower FEV1/FVC ratio (72 vs. 68, p<0.001). There was no statistical significance between the two groups with regard to race, gender, respiratory symptoms or percent predicted FEV1.

CONCLUSIONS: There is a high prevalence of emphysema in our lung cancer screening cohort consisting of older, Caucasian high risk smokers with an extensive smoking history. Patients with emphysema were more likely to have more severe obstructive airways disease, as well as a higher prevalence of parenchymal and vascular abnormalities.

CLINICAL IMPLICATIONS: Patients with emphysema may be at higher risk for pulmonary and cardiovascular disease. Since current smokers are more likely to develop emphysema, this might be useful in counseling for smoking cessation. Future studies are required to study the use of LDCT emphysema as a tool to assess cardiovascular risk.

DISCLOSURE: The following authors have nothing to disclose: Vikramjit Mukherjee, James Messina, Jun-Chieh Tsay, John Munger, William Rom

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