P162 incidental interstitial lung abnormalities identified within a lung cancer screening programme: initial experience within a pilot UK site

Naftel, J., Hunter, E., Marshall, B., Limbrey, R., Spinks, K., Fletcher, S., Shambrook, J., Wallis, T., Dunbar, J. and Jones, M. (2024) P162 incidental interstitial lung abnormalities identified within a lung cancer screening programme: initial experience within a pilot UK site. Thorax, 79 (Suppl. 2), [A204]. (doi:10.1136/thorax-2024-BTSabstracts.323).

Abstract

Background: in 2020, a Targeted Lung Health Check (TLHC) lung cancer screening pilot launched at our University hospital. Eligible patients (aged 55 to 74) identified at high-risk of lung cancer proceed to low-dose CT (LDCT) chest. In individuals undergoing a LDCT, a significant proportion have incidental findings including interstitial lung abnormalities (ILAs) generating onward referrals. Our aim was to evaluate the outcomes of those referred from screening to an interstitial lung disease (ILD) service.

Methods: retrospective analysis of patients referred to the local ILD service via the TLHC programme between August 2020-August 2023. This included patients with an ILA ≥5% lung volume affected or potentially clinically significant respiratory bronchiolitis-interstitial lung disease (RB-ILD). Electronic case notes were reviewed to ascertain patient demographics and outcomes.

Results: of 7307 patients undergoing LDCT, 2.4% (n=176) were referred to the ILD service (ILA n=126, RB-ILD n=50). Of those with an ILA, 64.3% (n=81) were male with a mean age of 71.0 years. 71.4% (n=90) were ex-smokers with a 41.0 mean pack year history. Baseline lung function was preserved (FEV1% predicted 92.3%, FVC% predicted 95%) whilst gas transfer was reduced (TLCO% predicted 69.6%). 11.9% (n=15) commenced anti-fibrotics and 2.4% (n=3) started immunosuppression. 0.8% (n=1) died, 24.6% (n=31) were discharged, 48.4% (n=61) remain under respiratory follow-up, 7.9% (n=10) were lost to or declined follow-up and 4.0% (n=5) are awaiting assessment.

Individuals with RB-ILD had a mean age of 66.4 years and 46.0% (n=23) were male. 76.0% (n=38) were current smokers with a 45.9 mean pack year history. Lung function testing identified obstructive spirometry (FEV1% predicted 86.5%, FVC% predicted 98.9%) with preserved gas transfer (TLCO% predicted 84.4%). 12% (n=6) remain under respiratory follow up, 74.0% (n=37) were discharged, and 14% (n=7) were lost to or declined follow-up.

Conclusion: the TLHC programme generates a significant workload for ILD services but presents an opportunity for early disease intervention. Improved understanding of risk factors for ILA progression is required to better predict those at risk of progression requiring specialist review and follow-up.

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Contributors

Author: S. Fletcher

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