Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Interstitial Lung Abnormality in Asian Population

  • Gong Yong Jin (Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School)
  • Received : 2023.08.10
  • Accepted : 2023.12.17
  • Published : 2024.04.30
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Abstract

Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentally on chest computed tomography (CT) that can be show a wide range of diseases, from subclinical lung fibrosis to early pulmonary fibrosis including definitive usual interstitial pneumonia. To clear up confusion about ILA, the Fleischner society published a position paper on the definition, clinical symptoms, increased mortality, radiologic progression, and management of ILAs based on several Western cohorts and articles. Recently, studies on long-term outcome, risk factors, and quantification of ILA to address the confusion have been published in Asia. The incidence of ILA was 7% to 10% for Westerners, while the prevalence of ILA was about 4% for Asians. ILA is closely related to various respiratory symptoms or increased rate of treatment-related complication in lung cancer. There is little difference between Westerners and Asians regarding the clinical importance of ILA. Although the role of quantitative CT as a screening tool for ILA requires further validation and standardized imaging protocols, using a threshold of 5% in at least one zone demonstrated 67.6% sensitivity, 93.3% specificity, and 90.5% accuracy, and a 1.8% area threshold showed 100% sensitivity and 99% specificity in South Korea. Based on the position paper released by the Fleischner society, I would like to report how much ILA occurs in the Asian population, what the prognosis is, and review what management strategies should be pursued in the future.

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References

  1. Chae KJ, Lim S, Seo JB, Hwang HJ, Choi H, Lynch D, et al. Interstitial lung abnormalities at CT in the Korean National Lung Cancer Screening Program: prevalence and deep learning-based texture analysis. Radiology 2023;307:e222828.
  2. Hata A, Hino T, Yanagawa M, Nishino M, Hida T, Hunninghake GM, et al. Interstitial lung abnormalities at CT: subtypes, clinical significance, and associations with lung cancer. Radiographics 2022;42:1925-39. https://doi.org/10.1148/rg.220073
  3. Hata A, Schiebler ML, Lynch DA, Hatabu H. Interstitial lung abnormalities: state of the art. Radiology 2021;301:19-34. https://doi.org/10.1148/radiol.2021204367
  4. Lynch DA. Interstitial lung abnormality incidentally detected on CT: an important prognostic indicator. Chest 2021;159:5-6.
  5. Oh AS, Lynch DA. Interstitial lung abnormality: why should I care and what should I do about it? Radiol Clin North Am 2022;60:889-99. https://doi.org/10.1016/j.rcl.2022.06.002
  6. Lee JE, Chae KJ, Suh YJ, Jeong WG, Lee T, Kim YH, et al. Prevalence and long-term outcomes of CT interstitial lung abnormalities in a health screening cohort. Radiology 2023;306:e221172.
  7. Jin GY, Lynch D, Chawla A, Garg K, Tammemagi MC, Sahin H, et al. Interstitial lung abnormalities in a CT lung cancer screening population: prevalence and progres sion rate. Radiology 2013;268:563-71. https://doi.org/10.1148/radiol.13120816
  8. Hatabu H, Hunninghake GM, Richeldi L, Brown KK, Wells AU, Remy-Jardin M, et al. Interstitial lung abnormalities detected incidentally on CT: a Position Paper from the Fleischner Society. Lancet Respir Med 2020;8:726-37. https://doi.org/10.1016/S2213-2600(20)30168-5
  9. Hatabu H, Hunninghake GM, Lynch DA. Interstitial lung abnormality: recognition and perspectives. Radiology 2019;291:1-3. https://doi.org/10.1148/radiol.2018181684
  10. Lederer DJ, Enright PL, Kawut SM, Hoffman EA, Hunninghake G, van Beek EJ, et al. Cigarette smoking is associated with subclinical parenchymal lung disease: the Multi-Ethnic Study of Atherosclerosis (MESA)-lung study. Am J Respir Crit Care Med 2009;180:407-14. https://doi.org/10.1164/rccm.200812-1966OC
  11. Washko GR, Hunninghake GM, Fernandez IE, Nishino M, Okajima Y, Yamashiro T, et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 2011;364:897-906. https://doi.org/10.1056/NEJMoa1007285
  12. Aberle DR, DeMello S, Berg CD, Black WC, Brewer B, Church TR, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med 2013;369:920-31. https://doi.org/10.1056/NEJMoa1208962
  13. Chae KJ, Jin GY, Goo JM, Chung MJ. Interstitial lung abnormalities: what radiologists should know. Korean J Radiol 2021;22:454-63. https://doi.org/10.3348/kjr.2020.0191
  14. Patel AS, Miller E, Regis SM, Hunninghake GM, Price LL, Gawlik M, et al. Interstitial lung abnormalities in a large clinical lung cancer screening cohort: association with mortality and ILD diagnosis. Respir Res 2023;24:49.
  15. Chae KJ, Chung MJ, Jin GY, Song YJ, An AR, Choi H, et al. Radiologic-pathologic correlation of interstitial lung abnormalities and predictors for progression and survival. Eur Radiol 2022;32:2713-23. https://doi.org/10.1007/s00330-021-08378-8
  16. Hunninghake GM, Hatabu H, Okajima Y, Gao W, Dupuis J, Latourelle JC, et al. MUC5B promoter polymorphism and interstitial lung abnormalities. N Engl J Med 2013;368:2192-200. https://doi.org/10.1056/NEJMoa1216076
  17. Araki T, Putman RK, Hatabu H, Gao W, Dupuis J, Latourelle JC, et al. Development and progression of interstitial lung abnormalities in the Framingham Heart Study. Am J Respir Crit Care Med 2016;194:1514-22. https://doi.org/10.1164/rccm.201512-2523OC
  18. Putman RK, Hatabu H, Araki T, Gudmundsson G, Gao W, Nishino M, et al. Association between interstitial lung abnormalities and all-cause mortality. JAMA 2016;315:672-81. https://doi.org/10.1001/jama.2016.0518
  19. Hoyer N, Wille MM, Thomsen LH, Wilcke T, Dirksen A, Pedersen JH, et al. Interstitial lung abnormalities are associated with increased mortality in smokers. Respir Med 2018;136:77-82. https://doi.org/10.1016/j.rmed.2018.02.001
  20. Tsushima K, Sone S, Yoshikawa S, Yokoyama T, Suzuki T, Kubo K. The radiological patterns of interstitial change at an early phase: over a 4-year follow-up. Respir Med 2010;104:1712-21. https://doi.org/10.1016/j.rmed.2010.05.014
  21. Chae KJ, Jin GY, Jung HN, Kwon KS, Choi H, Lee YC, et al. Differentiating smoking-related interstitial fibrosis (SRIF) from usual interstitial pneumonia (UIP) with emphysema using CT features based on pathologically proven cases. PLoS One 2016;11:e0162231.
  22. Hunninghake GM. Interstitial lung abnormalities: erecting fences in the path towards advanced pulmonary fibrosis. Thorax 2019;74:506-11. https://doi.org/10.1136/thoraxjnl-2018-212446
  23. Peljto AL, Selman M, Kim DS, Murphy E, Tucker L, Pardo A, et al. The MUC5B promoter polymorphism is associated with idiopathic pulmonary fibrosis in a Mexican cohort but is rare among Asian ancestries. Chest 2015;147:460-4. https://doi.org/10.1378/chest.14-0867
  24. Maher TM, Bendstrup E, Dron L, Langley J, Smith G, Khalid JM, et al. Global incidence and prevalence of idiopathic pulmonary fibrosis. Respir Res 2021;22:197.
  25. Lee HE, Myong JP, Kim HR, Rhee CK, Yoon HK, Koo JW. Incidence and prevalence of idiopathic interstitial pneumonia and idiopathic pulmonary fibrosis in Korea. Int J Tuberc Lung Dis 2016;20:978-84. https://doi.org/10.5588/ijtld.16.0003
  26. Doyle TJ, Washko GR, Fernandez IE, Nishino M, Okajima Y, Yamashiro T, et al. Interstitial lung abnormalities and reduced exercise capacity. Am J Respir Crit Care Med 2012;185:756-62. https://doi.org/10.1164/rccm.201109-1618OC
  27. Sanders JL, Axelsson G, Putman R, Menon A, Dupuis J, Xu H, et al. The relationship between interstitial lung abnormalities, mortality, and multimorbidity: a cohort study. Thorax 2023;78:559-65. https://doi.org/10.1136/thoraxjnl-2021-218315
  28. Im Y, Chung MP, Lee KS, Han J, Chung MJ, Kim HK, et al. Impact of interstitial lung abnormalities on postoperative pulmonary complications and survival of lung cancer. Thorax 2023;78:183-90. https://doi.org/10.1136/thoraxjnl-2021-218055
  29. Jeong WG, Kim YH. Survival impact of fibrotic interstitial lung abnormalities in resected stage IA non-small cell lung cancer. Br J Radiol 2023;96:20220812.
  30. Kobayashi H, Wakuda K, Naito T, Mamesaya N, Omori S, Ono A, et al. Chemoradiotherapy for limited-stage small-cell lung cancer and interstitial lung abnormalities. Radiat Oncol 2021;16:52.
  31. Nakanishi Y, Masuda T, Yamaguchi K, Sakamoto S, Horimasu Y, Nakashima T, et al. Pre-existing interstitial lung abnormalities are risk factors for immune checkpoint inhibitor-induced interstitial lung disease in non-small cell lung cancer. Respir Investig 2019;57:451-9. https://doi.org/10.1016/j.resinv.2019.05.002
  32. Ahn Y, Lee SM, Choi S, Lee JS, Choe J, Do KH, et al. Automated CT quantification of interstitial lung abnormality and interstitial lung disease according to the Fleischner Society in patients with resectable lung cancer: prognostic significance. Eur Radiol 2023;33:8251-62. https://doi.org/10.1007/s00330-023-09783-x
  33. Chen A, Karwoski RA, Gierada DS, Bartholmai BJ, Koo CW. Quantitative CT analysis of diffuse lung disease. Radiographics 2020;40:28-43. https://doi.org/10.1148/rg.2020190099
  34. Li YZ, Jin GY, Chae KJ, Han YM. Quantitative assessment of airway changes in fibrotic interstitial lung abnormality patients by chest CT according to cumulative cigarette smoking. Tomography 2022;8:1024-32. https://doi.org/10.3390/tomography8020082
  35. Iwasawa T, Okudela K, Takemura T, Fukuda T, Matsushita S, Baba T, et al. Computer-aided quantification of pulmonary fibrosis in patients with lung cancer: relationship to disease-free survival. Radiology 2019;292:489-98. https://doi.org/10.1148/radiol.2019182466
  36. Bartholmai BJ, Raghunath S, Karwoski RA, Moua T, Rajagopalan S, Maldonado F, et al. Quantitative computed tomography imaging of interstitial lung diseases. J Thorac Imaging 2013;28:298-307. https://doi.org/10.1097/RTI.0b013e3182a21969
  37. Kim MS, Choe J, Hwang HJ, Lee SM, Yun J, Kim N, et al. Interstitial lung abnormalities (ILA) on routine chest CT: comparison of radiologists' visual evaluation and automated quantification. Eur J Radiol 2022;157:110564.