CHECK LUNG PROTOCOL: ADDING VALUE TO LUNG CANCER SCREENING CT SCANS

Background: Lung cancer screening (LCS) via chest computed tomography (CT) scans can save lives by identifying early-stage tumors. However, most participants die of comorbid smoking-related diseases. LCS scans contain information about smoking-related conditions that is not currently systematically assessed. Identifying these common comorbid diseases on CT, through Check Lung, could increase the value of screening with minimal impact on LCS programs. We determined the prevalence of six comorbid diseases from LCS eligible scans and quantified related survival and death. Methods: We studied retrospective participants (n = 774) who met criteria for LCS screening (age > 55 years, and < 80 years, > 30 pack years smoking, current smoker or former smoker within 15 years of smoking cessation). The CT scans were automatically assessed for coronary artery calcification (CAC), skeletal muscle area (SMA), interstitial lung disease (ILD), emphysema, vertebral bone density and hepatic steatosis. Institution’s Research Ethics Committee (CAAE 58815316.9.0000.5335). Results: Overall, 86.6% of eligible CT scans had one or more of these diagnoses identified. CAC (> 100 mg) was identified in 41.9% of scans, emphysema in 66.3%, ILD in 32.2, sarcopenia in 9.9%, hepatic steatosis in 40.7% and osteoporosis in 44.2%. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46%, of participants respectively. We observed the strong significant relation between sarcopenia, CAC and mortality. The Kaplan-Meier curve with the log-rank (Mantel-Cox) test revealed statistically significant differences between survival and CAC, and sarcopenia. None statistically significant differences were found among the others evaluated comorbidities. Conclusions: LCS CT scans with Check Lung assessment identified individuals with evidence of previously undiagnosed cardiovascular disease, emphysema, ILD, sarcopenia, osteoporosis and hepatic steatosis. This protocol can potentially facilitate diagnoses of these pathologies and provide an opportunity for treatment or prevention.