Identification of Chronic Obstructive Pulmonary Disease in Lung Cancer Screening Computed Tomographic Scans

被引:125
作者
Mets, Onno M. [1 ]
Buckens, Constantinus F. M. [2 ]
Zanen, Pieter [3 ]
Isgum, Ivana [4 ]
van Ginneken, Bram [4 ,5 ]
Prokop, Mathias [1 ,6 ]
Gietema, Hester A. [1 ]
Lammers, Jan-Willem J. [3 ]
Vliegenthart, Rozemarijn [7 ]
Oudkerk, Matthijs [7 ]
van Klaveren, Rob J. [8 ]
de Koning, Harry J. [9 ]
Mali, Willem P. Th M. [1 ]
de Jong, Pim A. [1 ]
机构
[1] Univ Med Ctr Utrecht, Dept Radiol, NL-3508 GA Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Dept Pulmonol, NL-3508 GA Utrecht, Netherlands
[4] Univ Med Ctr Utrecht, Image Sci Inst, NL-3508 GA Utrecht, Netherlands
[5] Radboud Univ Nijmegen, Med Ctr, Diagnost Image Anal Grp, NL-6525 ED Nijmegen, Netherlands
[6] Radboud Univ Nijmegen, Med Ctr, Dept Radiol, NL-6525 ED Nijmegen, Netherlands
[7] Univ Groningen, Univ Med Ctr Groningen, Dept Radiol, NL-9713 AV Groningen, Netherlands
[8] Lievensberg Ziekenhuis, Dept Pulmonol, Bergen Op Zoom, Netherlands
[9] Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2011年 / 306卷 / 16期
关键词
COPD; DIAGNOSIS; MORTALITY;
D O I
10.1001/jama.2011.1531
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Smoking is a major risk factor for both cancer and chronic obstructive pulmonary disease (COPD). Computed tomography (CT)-based lung cancer screening may provide an opportunity to detect additional individuals with COPD at an early stage. Objective To determine whether low-dose lung cancer screening CT scans can be used to identify participants with COPD. Design, Setting, and Patients Single-center prospective cross-sectional study within an ongoing lung cancer screening trial. Prebronchodilator pulmonary function testing with inspiratory and expiratory CT on the same day was obtained from 1140 male participants between July 2007 and September 2008. Computed tomographic emphysema was defined as percentage of voxels less than -950 Hounsfield units (HU), and CT air trapping was defined as the expiratory: inspiratory ratio of mean lung density. Chronic obstructive pulmonary disease was defined as the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) of less than 70%. Logistic regression was used to develop a diagnostic prediction model for airflow limitation. Main Outcome Measures Diagnostic accuracy of COPD diagnosis using pulmonary function tests as the reference standard. Results Four hundred thirty-seven participants (38%) had COPD according to lung function testing. A diagnostic model with CT emphysema, CT air trapping, body mass index, pack-years, and smoking status corrected for overoptimism (internal validation) yielded an area under the receiver operating characteristic curve of 0.83 (95% CI, 0.81-0.86). Using the point of optimal accuracy, the model identified 274 participants with COPD with 85 false-positives, a sensitivity of 63% (95% CI, 58%-67%), specificity of 88% (95% CI, 85%-90%), positive predictive value of 76% (95% CI, 72%-81%); and negative predictive value of 79% (95% CI, 76%-82%). The diagnostic model showed an area under the receiver operating characteristic curve of 0.87 (95% CI, 0.86-0.88) for participants with symptoms and 0.78 (95% CI, 0.76-0.80) for those without symptoms. Conclusion Among men who are current and former heavy smokers, low-dose inspiratory and expiratory CT scans obtained for lung cancer screening can identify participants with COPD, with a sensitivity of 63% and a specificity of 88%. JAMA. 2011;306(16):1775-1781
引用
收藏
页码:1775 / 1781
页数:7
相关论文
共 30 条
  • [1] Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening
    Aberle, Denise R.
    Adams, Amanda M.
    Berg, Christine D.
    Black, William C.
    Clapp, Jonathan D.
    Fagerstrom, Richard M.
    Gareen, Ilana F.
    Gatsonis, Constantine
    Marcus, Pamela M.
    Sicks, JoRean D.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (05) : 395 - 409
  • [2] NEW LOOK AT STATISTICAL-MODEL IDENTIFICATION
    AKAIKE, H
    [J]. IEEE TRANSACTIONS ON AUTOMATIC CONTROL, 1974, AC19 (06) : 716 - 723
  • [3] EFFECTS OF SMOKING INTERVENTION AND THE USE OF AN INHALED ANTICHOLINERGIC BRONCHODILATOR ON THE RATE OF DECLINE OF FEV(1) - THE LUNG HEALTH STUDY
    ANTHONISEN, NR
    CONNETT, JE
    KILEY, JP
    ALTOSE, MD
    BAILEY, WC
    BUIST, AS
    CONWAY, WA
    ENRIGHT, PL
    KANNER, RE
    OHARA, P
    OWENS, GR
    SCANLON, PD
    TASHKIN, DP
    WISE, RA
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1994, 272 (19): : 1497 - 1505
  • [4] Prevalence, severity and underdiagnosis of COPD in the primary care setting
    Bednarek, M.
    Maciejewski, J.
    Wozniak, M.
    Kuca, P.
    Zielinski, J.
    [J]. THORAX, 2008, 63 (05) : 402 - 407
  • [5] Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know
    Brenner, DJ
    Doll, R
    Goodhead, DT
    Hall, EJ
    Land, CE
    Little, JB
    Lubin, JH
    Preston, DL
    Preston, RJ
    Puskin, JS
    Ron, E
    Sachs, RK
    Samet, JM
    Setlow, RB
    Zaider, M
    [J]. PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 2003, 100 (24) : 13761 - 13766
  • [6] Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper
    Celli, BR
    MacNee, W
    Agusti, A
    Anzueto, A
    Berg, B
    Buist, AS
    Calverley, PMA
    Chavannes, N
    Dillard, T
    Fahy, B
    Fein, A
    Heffner, J
    Lareau, S
    Meek, P
    Martinez, F
    McNicholas, W
    Muris, J
    Austegard, E
    Pauwels, R
    Rennard, S
    Rossi, A
    Siafakas, N
    Tiep, B
    Vestbo, J
    Wouters, E
    ZuWallack, R
    [J]. EUROPEAN RESPIRATORY JOURNAL, 2004, 23 (06) : 932 - 946
  • [7] Cohen P., 2013, Applied MultipleRegression/Correlation Analysis for the Behavioral Sciences, DOI [DOI 10.4324/9780203774441, 10.4324/9780203774441]
  • [8] The European Union conference on chronic respiratory disease: purpose and conclusions
    Decramer, M.
    Sibille, Y.
    Bush, A.
    Carlsen, K-H.
    Rabe, K. F.
    Clancye, L.
    Turnbull, A.
    Nemery, B.
    Simonds, A.
    Troosters, T.
    [J]. EUROPEAN RESPIRATORY JOURNAL, 2011, 37 (04) : 738 - 742
  • [9] Treatment of COPD: the sooner the better?
    Decramer, Marc
    Cooper, Christopher B.
    [J]. THORAX, 2010, 65 (09) : 837 - 841
  • [10] Efron B., 1993, INTRO BOOTSTRAP, DOI 10.1007/978-1-4899-4541-9