Diagnoses and treatments for participants with interstitial lung abnormalities detected in the Yorkshire Lung Screening Trial

Our plain-English summary of Diagnoses and treatments for participants with interstitial lung abnormalities detected in the Yorkshire Lung Screening Trial, by S. Upperton, P. Beirne, B. Bhartia, et al (BMJ Open Respiratory Research, 2023).

The study

• Authors: S. Upperton, P. Beirne, B. Bhartia, A. Boland, C. Bradley, P.A.J. Crosbie, M. Darby, C. Eckert, R. Gabe, N. Hancock, M.P.T. Kennedy, J. Lindop, S. Rogerson, B. Shinkins, I. Simmonds, T.J.T. Sutherland, M.E.J. Callister
• Journal: BMJ Open Respiratory Research
• Published: 2023;10(1)
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Interstitial lung abnormalities (ILA) are relatively common incidental findings in participants undergoing low-dose CT screening for lung cancer. Some ILA are transient and inconsequential, but others represent interstitial lung disease (ILD). Lung cancer screening therefore offers the opportunity of earlier diagnosis and treatment of ILD for some screening participants.

Methods: The prevalence of ILA in participants in the baseline screening round of the Yorkshire Lung Screening Trial is reported, along with the proportion referred to a regional ILD service, eventual diagnoses, outcomes and treatments.

Results: Of 6650 participants undergoing screening, ILA were reported in 169 (2.5%) participants. Following review in a screening review meeting, 56 participants were referred to the ILD service for further evaluation (0.8% of all screening participants). 2 participants declined referral, 1 is currently awaiting review and the remaining 53 were confirmed as having ILD. Eventual diagnoses were idiopathic pulmonary fibrosis (n=14), respiratory bronchiolitis ILD (n=4), chronic hypersensitivity pneumonitis (n=2), connective tissue disease/rheumatoid arthritis-related ILD (n=4), asbestosis (n=1), idiopathic non-specific interstitial pneumonia (n=1), sarcoidosis (n=1) and pleuroparenchymal fibroelastosis (n=1). Twenty five patients had unclassifiable idiopathic interstitial pneumonia. Overall, 10 people received pharmacotherapy (7 antifibrotics and 3 prednisolone) representing 18% of those referred to the ILD service and 0.15% of those undergoing screening. 32 people remain under surveillance in the ILD service, some of whom may require treatment in future.

Discussion: Lung cancer screening detects clinically significant cases of ILD allowing early commencement of disease-modifying treatment in a proportion of participants. This is the largest screening cohort to report eventual diagnoses and treatments and provides an estimate of the level of clinical activity to be expected by ILD services as lung cancer screening is implemented. Further research is needed to clarify the optimal management of screen-detected ILD.

Trial Registration Number: ISRCTN42704678.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

In plain English

This study reported on interstitial lung abnormalities (ILA), a variety of incidental findings on CT scans, in the first (baseline) round of the Yorkshire Lung Screening Trial. People aged 55 to 80 who had ever smoked and were at higher risk of lung cancer were offered low-dose CT scans between November 2018 and February 2021. Of 6650 people scanned, ILA were reported in 169 (2.5%). After review, 56 (0.8% of those screened) were referred to a regional interstitial lung disease (ILD) service. Two declined, one was awaiting review, and 53 were confirmed as having ILD. The most common specific diagnosis was idiopathic pulmonary fibrosis (14 people). Twenty-five had unclassifiable idiopathic interstitial pneumonia, and one had asbestosis. Ten people received drug treatment: seven received antifibrotics and three received prednisolone. People with ILD were older and more often male than those without. Screen-detected lung cancer was more common among them (7.5% vs 2.4%). The authors concluded that screening can detect clinically significant ILD. They noted that their results cover only the baseline round of screening.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Analysis of participants in the baseline round of a lung cancer screening trial. Cases discussed at review meetings were logged prospectively, and health records were reviewed retrospectively.
• Who was studied: 6650 people who had baseline low-dose CT screening in the Yorkshire Lung Screening Trial between November 2018 and February 2021. They were aged 55 to 80, had ever smoked, and were at higher risk of lung cancer.
• Exposure: The study did not measure asbestos or other occupational exposure. It concerned ILA found on low-dose CT lung cancer screening in people who had ever smoked. Asbestosis appears only as one of the final diagnoses.
• Main results:
  • ILA were reported in 169 of the 6650 participants scanned (2.5%).
  • 56 participants (0.8% of those screened) were identified as needing referral to the ILD service.
  • Of the 56 referred, 2 declined referral, 1 was awaiting review, and 53 were confirmed as having ILD.
  • Among the 53 with a final diagnosis, idiopathic pulmonary fibrosis was diagnosed in 14 people.
  • Among the 53 with a final diagnosis, 25 had unclassifiable idiopathic interstitial pneumonia.
  • Among the 53 with a final diagnosis, one person was diagnosed with asbestosis.
  • Of the 53 people with a final diagnosis, 10 received drug treatment: 7 patients received antifibrotics and 3 patients received prednisolone. The authors give this as 18% of those referred and 0.15% of all those screened.
  • 32 patients remained under monitoring in the ILD service, 9 were discharged after a period of stability, and 2 died of unrelated causes.
  • Participants with ILD (66: 10 already known, 56 newly referred) were older than those without ILD (6584), mean 72.6 vs 68.4 years. They were also more often male (76% vs 55%, p=0.001).
  • The proportion still smoking was similar in those with and without ILD (30% vs 35%, p=0.491).
  • Lung cancer was diagnosed in a higher proportion of participants with ILD than without ILD: 7.5% vs 2.4%, odds ratio 3.16, 95% CI 1.25 to 7.94, p=0.015.
  • Of the 103 participants with ILA mentioned in their reports who were not referred, 5 (4.9%) were later diagnosed with lung cancer.
  • Some cases were not referred because the reported ILA were thought to represent postradiation fibrosis, pleural fibrosis, pneumoconiosis or predominant emphysema. No counts were given for these.
• The authors' conclusion: The authors concluded that low-dose CT lung cancer screening can detect clinically significant cases of ILD in participants who meet criteria for starting treatment.
• Limitations the authors state:
  • Findings were available only from the baseline screening round. The authors expected the proportions needing referral and treatment to rise over time.
  • Radiologists may not have recorded milder ILA as instructed, which may have lowered the reported prevalence.
  • The 10% reticulation threshold used was higher than in the Fleischner Society statement. The authors said this may have contributed to lower prevalence and referral rates.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Interstitial, Low-Dose CT Screening, Lung Cancer, Interstitial Lung Disease, Idiopathic, Pulmonary Fibrosis, Pneumonitis.

Related studies

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• Differential diagnosis of usual interstitial pneumonia: when is it truly idiopathic? — W.A. Wuyts, A. Cavazza, et al. (2014)
• Comprehensive characterisation of individuals with fibrotic interstitial lung disease: baseline insights from the INJUSTIS study — F. Khan, I. Stewart, et al. (2026)
• Interstitial Lung Abnormalities Detected by CT in Asbestos-Exposed Subjects Are More Likely Associated to Age — F. Laurent, I. Benlala, et al. (2021)
• Prognosis and causes of death of patients with acute exacerbation of fibrosing interstitial lung diseases — J. Salonen, M. Purokivi, et al. (2020)
• Usual interstitial pneumonia in asbestos-exposed cohorts - concurrent idiopathic pulmonary fibrosis or atypical asbestosis? — R.L. Attanoos, F.S. Alchami, et al. (2016)

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