Lung Cancer CT Screening May Be Helpful in Detecting COPD

Among men who were current or former heavy smokers, undergoing lung cancer screening with computed tomography (CT) scanning detected a considerable percentage who had chronic obstructive pulmonary disease (COPD), suggesting that this modality may be beneficial as an additional application in detecting COPD, according to recent research.

The study’s findings were published in the October 26, 2011, issue of the Journal of the American Medical Association (JAMA). “Smoking is annually projected to cause more than eight million deaths worldwide in the coming decades. Besides cardiovascular disease and cancer, chronic obstructive pulmonary disease is a major cause of death in heavy smokers. Nevertheless, COPD is considerably underdiagnosed. In spite of a decrease in cardiovascular mortality and stabilization of cancer mortality worldwide, mortality from COPD is increasing,” according to the authors. Early termination of smoking can prevent COPD progression, highlighting the importance of early detection. CT-based lung cancer screening may provide an opportunity to detect individuals with COPD at an early stage.

Onno M. Mets, MD, from the University Medical Center Utrecht (The Netherlands), and colleagues conducted a study to explore whether low-dose lung cancer screening CT scans could be utilized to identify participants with COPD. The study, performed within an ongoing lung cancer screening trial, included prebronchodilator pulmonary function testing with inspiratory and expiratory CT scans performed on the same day from 1,140 male study participants between July 2007 and September 2008. The pulmonary function tests were used as the reference standard in determining the COPD diagnostic accuracy of the CT scans.

The average age of participants was 62.5 years. Data for self-reported respiratory symptoms were available from 1,085 participants; a total of 566 participants were symptomatic, and 519 participants were asymptomatic. Forty-one participants (3.6%) reported physician-diagnosed emphysema and 93 (8.2%), bronchitis. Based on the results of pulmonary function testing, 437 participants (38%) were classified as having COPD.

The final diagnostic model for the study included five factors independently associated with obstructive pulmonary disease: CT emphysema, CT air trapping (an abnormal retention of air in the lungs), body mass index, pack-years (the number of packs of cigarettes smoked per day multiplied by the number of years the person has smoked), and smoking status. Using the point of optimal accuracy, the model identified 274 participants with COPD with 85 false-positives, a sensitivity of 63%, a specificity of 88%, and a positive predictive value of 76%, which corresponds to 63% (274 of 437) of all participants with COPD. These 274 participants comprised 54% (150 of 277) of all participants with mild obstruction, 73% (99 of 135) of all participants with moderate obstruction, and 100% (25 of 25) of all participants with severe obstruction.

“Our study findings suggest several practical considerations. If the results of this study are validated and confirmed and are found to be generalizable, it may be reasonable to consider adding an expiratory CT scan to the [baseline] inspiratory CT scan for additional evaluation of COPD because this would improve diagnostic accuracy. Although an additional ultralow-dose expiration CT scan increases the radiation dose, this exposure is limited. The additional scan can be obtained within the five minutes needed for lung cancer screening, so a substantial amount of extra scan time is not required,” the authors wrote.

The researchers added that this possible approach of using quantitative CT for detection of airflow limitation is not suggested as a primary screening method for COPD, for which pulmonary function testing is the preferred method. “A screening test should have a high sensitivity to identify most of the participants with unsuspected disease, and the performance of our strategy at optimal accuracy is not sufficient for CT to serve as a COPD screening test.”

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University Medical Center Utrecht