Expanded detection of early fibrotic phenotypes using lobar traction bronchiolectasis in lung cancer screening

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.

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Journal
American Journal of Respiratory and Critical Care Medicine
Published
2026-02-28
DOI
https://doi.org/10.1093/ajrccm/aamag104
Primary Topic
Lung Cancer Diagnosis and Treatment
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article
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article

Expanded detection of early fibrotic phenotypes using lobar traction bronchiolectasis in lung cancer screening

Georgia Bullock, Elena Stefan, Rabiya Patel, Ethaar El-Emir et al.
American Journal of Respiratory and Critical Care Medicine
Lung Cancer Diagnosis and Treatment
article

Expanded detection of early fibrotic phenotypes using lobar traction bronchiolectasis in lung cancer screening

Georgia Bullock, Elena Stefan, Rabiya Patel, Ethaar El-Emir, Amyn Bhamani, Thea Buchan, Patricia Margarit Castelló, April Q Neville, Simranjit Mehta, Shaira Hassan, Jane Rowlands, T Wallis, Navinah Nundlall, Qin April Neville, Jonathan D. Dunbar, Helen Kiconco, Pardeep Vasudev, Antonette Andrews, Karen Parry-Billings, Kim Sorley, Nicholas Beech, Dominique Arancon, Ryoko Egashira, Ricardo McEwen, Kate H.C. Gowers, Charlotte J. C. Cash, Andrew Perugia, Geoff J. Bellingan, Vicky Bowyer, Claire Levermore, Jeannie Eng, Thomas Callender, Laura Farrelly, Rachael Sarpong, Jennifer Naftel, Brintha Selvarajah, C. C. Nestor, James Rusius, Aashna Samson, Shrinkhala Dawadi, Camilla B. Mitchell, Maureen Browne, Zahra Waheed Awan, Esther Arthur-Darkwa, Janine Zylstra, Tania Anastasiadis, Anjeli V Ketkar, Tracy Odigie, Derya Ovayolu, Kate Davies, Hasti Robbie, Kitty S. Chan, U. Patel, Karen Sennett, Suraiya Sharmin, Charlie Sayer, D. Cheng, Sofia Nnorom, Marilyn Ijeomah-Orji, Sheetal Karavadra, Mark G. Jones, Nikita Sharma, Laila Ahmed, Danny Alexander, Malavika Suresh, Jon W. Teague, Zelena A. Aziz, Z. Hanif, Sebri Hasaballa, J.F. McCabe, Samanjit S Hare, Eleanor Hellier, Judy Airebamen, Christine Hosein, Sylvia Patricia Enes, Andrew Crossingham, Tanita Limani, Lynsey Gallagher, Sara Lock, Alice Cotton, Julian McKee, Moksud Miah, Tunku Aziz, Mamta Ruparel, Kaylene Phua, Robert Chapman, Daisuke Yamada, Chimtom Nwaosu, Rosie Dapaah Tweneboah, Nick Screaton, Magali Taylor, Gulistan Keskinbicak, Joseph Jacob, Domminique Arancon, Houda Benmebarek, Sam Hare, Nazim Miah, Fahiza Chowdhury, Fahmida Hoque, Sam M Janes, Shummi Begum, Celia Snell, Ya-Fei Li, Adefiola Olabode, Arjun Nair, Tanya Patrick, Kylie Gyertson, Elodie Murali, Olufunmilola Ajayi, Fabia Ruggiero, Ali Mohammed, Stephen Ellis, Columbus Ife, Alberto Villanueva, Henna Makwana, Anna Sikorska, Sumiya Mahey, Marie Calligaris, Milica Rajkov, Rowan Faiers, Anthony Edey, Paul Robinson, Terry O'Shaughnessy, Harriet Sorrell, Sarah Marguerie, Farhida Begum, Graham Robinson, Fanta Bojang, Sahana Uthayakumar, Theepan Visakan, Burcu Ozaltin, Oluwadara Akerewusi, Monika Sommerrey, Mehran Azimbagirad, Helen Victoria Bowyer, Shanshan Wang, Mark Clark, Lucas Clarke, Zaheer Mangera, Syeda Anam Hussain, Jhanara Begum, Trisha Enes, Laura Green, Miguel Costa Ferreira, Hina Pervez, Stuart Marnham, Neil Songsong, Gulten Geneci, Paul Hickey, Yee Chin Lee
article en

Abstract

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.

American Journal of Respiratory and Critical Care Medicine
University College London Hospitals NHS Foundation Trust (GB), Hawassa University (ET), Hawkeye Community College (US), NIHR Southampton Biomedical Research Centre (GB), Living Streets (GB), University of Southampton (GB), University College London (GB)
Good health and well-being
Openalex Percentile: Top 26%
Lung Cancer Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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