Expanded detection of early fibrotic phenotypes using lobar traction bronchiolectasis in lung cancer screening
Expanded detection of early fibrotic phenotypes using lobar traction bronchiolectasis in lung cancer screening
Rationale: lung cancer screening regularly identifies participants with interstitial lung abnormalities (ILA). Existing classification methods may underestimate the prevalence of clinically relevant ILA phenotypes.
Objectives: can a classification system for ILAs developed in a lung cancer screening setting identify clinically relevant phenotypes?
Methods: classification criteria based on the presence and lobar extent of traction bronchiolectasis (TBe) were developed internally by expert consensus. Categories included: no ILA, non-fibrotic ILA (NF-ILA), fibrotic ILA (F-ILA), and undiagnosed fibrotic ILD (U-ILD). Interobserver agreement was calculated between two readers. Clinical characteristics, respiratory hospitalisations, and survival were compared between participants of different ILA grades.
Measurements and Main Results: 8,169 participants were included in the final analysis. TBe showed improved interobserver agreement compared to the American Thoracic Society (ATS) classification, identifying 344 participants (4%) with U-ILD, 86% more than the ATS classification. An additional 405 had F-ILA (5%) and 667 had NF-ILA (8%). Compared to participants without ILA, participants with U-ILD had a higher rate of respiratory hospitalisation (IRR = 4.4, 95% CI 2.7–7.5, P < .001) and increased risk of death (aHR = 2.4, 95% CI 1.9–3.0, P < .001). Increasing ILA grade was associated with higher modified Medical Research Council dyspnoea scores (OR = 1.1, 95% CI 1.0–1.1, P = .02).
Conclusions: in a lung cancer screening setting, an ILA scoring system focused on lobar traction bronchiolectasis identifies more high-risk participants and demonstrates improved interobserver concordance than the ATS classification. TBe identifies participants with a respiratory phenotype who may warrant further investigation and follow up.
Cheng, Daryl O.
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Yamada, Daisuke
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Azimbagirad, Mehran
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Bhamani, Amyn
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Egashira, Ryoko
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Chapman, Robert
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McCabe, John
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Wang, Shanshan
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Naftel, Jennifer
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Wallis, Timothy
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Dunbar, Jonathan
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Vasudev, Pardeep
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Nair, Arjun
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Alexander, Daniel
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Janes, Sam
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Jones, Mark
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Selvarajah, Brintha
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Jacob, Joseph
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10 March 2026
Cheng, Daryl O.
e3631bf3-221a-488d-bfd0-4f0b72fa8728
Yamada, Daisuke
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Azimbagirad, Mehran
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Bhamani, Amyn
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Egashira, Ryoko
11efde3c-2571-4ad0-9156-1e3e6e4cb97d
Chapman, Robert
8ab44509-26a3-46b0-bcee-68d83c705f29
McCabe, John
2ecfbf64-6dda-43f0-b98e-1598727a6b69
Wang, Shanshan
c609b19b-dab6-496e-b8af-4c8923563c6b
Naftel, Jennifer
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Wallis, Timothy
cf385c2a-ef94-4435-8066-31acf23f6f99
Dunbar, Jonathan
b8afd52d-7413-433f-a4e1-7ef9dc13b2c0
Vasudev, Pardeep
197c76d9-818b-44ef-ac08-edd67e97ec5e
Nair, Arjun
b82d0d3e-96dc-4d3e-bf41-8417f23ff1f1
Alexander, Daniel
b7c157fc-1ed3-4445-a892-9cef501b09ea
Janes, Sam
65aa8cb8-ea83-4bc3-a0d5-bb7a1b01958d
Jones, Mark
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Selvarajah, Brintha
8310aba0-0851-454d-9669-124b6466a4c6
Jacob, Joseph
b93a90c4-de81-4001-8f6f-bfd9f54a3d29
Cheng, Daryl O., Yamada, Daisuke, Azimbagirad, Mehran, Bhamani, Amyn, Egashira, Ryoko, Chapman, Robert, McCabe, John, Wang, Shanshan, Naftel, Jennifer, Wallis, Timothy, Dunbar, Jonathan, Vasudev, Pardeep, Nair, Arjun, Alexander, Daniel, Janes, Sam, Jones, Mark, Selvarajah, Brintha and Jacob, Joseph
(2026)
Expanded detection of early fibrotic phenotypes using lobar traction bronchiolectasis in lung cancer screening.
American Journal of Respiratory and Critical Care Medicine.
(doi:10.1093/ajrccm/aamag104).
Abstract
Rationale: lung cancer screening regularly identifies participants with interstitial lung abnormalities (ILA). Existing classification methods may underestimate the prevalence of clinically relevant ILA phenotypes.
Objectives: can a classification system for ILAs developed in a lung cancer screening setting identify clinically relevant phenotypes?
Methods: classification criteria based on the presence and lobar extent of traction bronchiolectasis (TBe) were developed internally by expert consensus. Categories included: no ILA, non-fibrotic ILA (NF-ILA), fibrotic ILA (F-ILA), and undiagnosed fibrotic ILD (U-ILD). Interobserver agreement was calculated between two readers. Clinical characteristics, respiratory hospitalisations, and survival were compared between participants of different ILA grades.
Measurements and Main Results: 8,169 participants were included in the final analysis. TBe showed improved interobserver agreement compared to the American Thoracic Society (ATS) classification, identifying 344 participants (4%) with U-ILD, 86% more than the ATS classification. An additional 405 had F-ILA (5%) and 667 had NF-ILA (8%). Compared to participants without ILA, participants with U-ILD had a higher rate of respiratory hospitalisation (IRR = 4.4, 95% CI 2.7–7.5, P < .001) and increased risk of death (aHR = 2.4, 95% CI 1.9–3.0, P < .001). Increasing ILA grade was associated with higher modified Medical Research Council dyspnoea scores (OR = 1.1, 95% CI 1.0–1.1, P = .02).
Conclusions: in a lung cancer screening setting, an ILA scoring system focused on lobar traction bronchiolectasis identifies more high-risk participants and demonstrates improved interobserver concordance than the ATS classification. TBe identifies participants with a respiratory phenotype who may warrant further investigation and follow up.
Text
aamag104
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Accepted/In Press date: 17 December 2025
Published date: 10 March 2026
Identifiers
Local EPrints ID: 511327
URI: http://eprints.soton.ac.uk/id/eprint/511327
ISSN: 1073-449X
PURE UUID: ef7fd208-b9fb-4149-89d2-da288ac5f1cf
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Date deposited: 12 May 2026 16:33
Last modified: 13 May 2026 01:42
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Contributors
Author:
Daryl O. Cheng
Author:
Daisuke Yamada
Author:
Mehran Azimbagirad
Author:
Amyn Bhamani
Author:
Ryoko Egashira
Author:
Robert Chapman
Author:
John McCabe
Author:
Shanshan Wang
Author:
Jennifer Naftel
Author:
Timothy Wallis
Author:
Jonathan Dunbar
Author:
Pardeep Vasudev
Author:
Arjun Nair
Author:
Daniel Alexander
Author:
Sam Janes
Author:
Brintha Selvarajah
Author:
Joseph Jacob
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