title: Visual assessment of early emphysema and interstitial abnormalities on CT is useful in lung cancer risk analysis.
abstract: OBJECTIVE
  Screening for lung cancer should be limited to a high-risk-population, and abnormalities in low-dose computed tomography (CT) screening images may be relevant for predicting the risk of lung cancer. Our aims were to compare the occurrence of visually detected emphysema and interstitial abnormalities in subjects with and without lung cancer in a screening population of smokers.
  
  
  METHODS
  Low-dose chest CT examinations (baseline and latest possible) of 1990 participants from The Danish Lung Cancer Screening Trial were independently evaluated by two observers who scored emphysema and interstitial abnormalities. Emphysema (lung density) was also measured quantitatively.
  
  
  RESULTS
  Emphysema was seen more frequently and its extent was greater among participants with lung cancer on baseline (odds ratio (OR), 1.8, p = 0.017 and p = 0.002) and late examinations (OR 2.6, p < 0.001 and p < 0.001). No significant difference was found using quantitative measurements. Interstitial abnormalities were more common findings among participants with lung cancer (OR 5.1, p < 0.001 and OR 4.5, p < 0.001).There was no association between presence of emphysema and presence of interstitial abnormalities (OR 0.75, p = 0.499).
  
  
  CONCLUSIONS
  Even early signs of emphysema and interstitial abnormalities are associated with lung cancer. Quantitative measurements of emphysema-regardless of type-do not show the same association.
  
  
  CONCLUSIONS
  • Visually detected emphysema on CT is more frequent in individuals who develop lung cancer. • Emphysema grading is higher in those who develop lung cancer. • Interstitial abnormalities, including discrete changes, are associated with lung cancer. • Quantitative lung density measurements are not useful in lung cancer risk prediction. • Early CT signs of emphysema and interstitial abnormalities can predict future risk.
authors.affiliation: Department of Respiratory Medicine, Gentofte Hospital, Kildegårdsvej 28, opg. 1D, st.th, DK-2900, Hellerup, Denmark. mathilde.winkler@gmail.com.
authors.forename: Mathilde M W
authors.initials: MM
authors.lastname: Wille
authors.affiliation: Department of Respiratory Medicine, Hvidovre Hospital, Kettegård Alle 30, DK-2650, Hvidovre, Denmark.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Thomsen
authors.affiliation: Department of Computer Science, DIKU, University of Copenhagen, Universitetsparken 5, DK-2100, København Ø, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Petersen
authors.affiliation: Department of Computer Science, DIKU, University of Copenhagen, Universitetsparken 5, DK-2100, København Ø, Denmark.|Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus MC -University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: de Bruijne
authors.affiliation: Department of Respiratory Medicine, Gentofte Hospital, Kildegårdsvej 28, opg. 1D, st.th, DK-2900, Hellerup, Denmark.
authors.forename: Asger
authors.initials: A
authors.lastname: Dirksen
authors.affiliation: Department of Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, København Ø, Denmark.
authors.forename: Jesper H
authors.initials: JH
authors.lastname: Pedersen
authors.affiliation: Department of Respiratory Medicine, Gentofte Hospital, Kildegårdsvej 28, opg. 1D, st.th, DK-2900, Hellerup, Denmark.
authors.forename: Saher B
authors.initials: SB
authors.lastname: Shaker
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Comorbidity; Computed tomography; Emphysema; Interstitial abnormalities; Lung cancer