Significant Abnormalities Other than Lung Cancer in Korean Lung Cancer CT Screening

Soon Ho Yoon; Junghee Hong; Eui Jin Hwang; Heekyung Kim; Hyun-ju Lim; Young Joo Suh; Hyae Young Kim; Jin Mo Goo

doi:10.3348/jksr.2019.80.5.837

Journal List > J Korean Soc Radiol > v.80(5) > 1141922

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Yoon, Hong, Hwang, Kim, Lim, Suh, Kim, and Goo: Significant Abnormalities Other than Lung Cancer in Korean Lung Cancer CT Screening

Review Article

J Korean Soc Radiol 2019;80(5):837-848.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.5.837

Significant Abnormalities Other than Lung Cancer in Korean Lung Cancer CT Screening

Soon Ho Yoon, MD^1,^∗, Junghee Hong, MD¹, Eui Jin Hwang, MD¹, Heekyung Kim, MD², Hyun-ju Lim, MD³, Young Joo Suh, MD⁴, Hyae Young Kim, MD³, Jin Mo Goo, MD^1,⁵

¹Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

²Department of Radiology, Eulji University College of Medicine, Daejeon, Korea

³Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea

⁴Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

⁵Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

^∗Corresponding author Soon Ho Yoon, MD Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel 82-2-2072-2584 Fax 82-2-743-7418 E-mail yshoka@gmail.com

Received 7 May 2019 Revised 5 June 2019 Accepted 25 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A low-dose chest CT is performed for early detection of lung cancer, but the CT scan frequently shows several incidental abnormalities. Identification of the incidental findings may enable early detection of diseases other than lung cancer, thereby improving the survival of the individual undergoing screening. However, insignificant incidental abnormalities may cause unnecessary additional examination and costs. It is crucial for radiologists to appropriately comprehend and report significant incidental abnormalities other than lung cancer for successful implementation of the national lung cancer screening program in Korea.

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Fig. 1.

Visual grading of emphysema. A. Trace centrilobular emphysema (circle), involving less than 0.5% of the lung zone. B. Mild centrilobular emphysema, involving 0.5–5.0% of the lung zone. C. Moderate centrilobular emphysema, involving over 5% of the lung zone. D. Confluent emphysema. E. Advanced destructive emphysema with vascular distortion.

Fig. 2.

Representative images of interstitial lung abnormalities. A. Transverse CT in the supine position shows a mild degree of reticular opacities in the dependent portions of both the lower lobes. B. Subsequently, transverse CT in the prone position confirms that the reticulations and mild ground-glass opacities, rather than gravity-dependent opacities, indicate a mild degree of interstitial abnormality.

Table 1.

Results of the Delphi Surveys for the Korean Lung Cancer CT Screening

	1st Round		2nd Round
	Agreement (%)	Median Likert Scale	Agreement (%)	Median Likert Scale
Coronary artery calcification
– It should be the S modifier	71	8.0
⁻ If not, checkbox is needed	88	9.0
⁻ It should be visually graded	88	8.0
If it is the S modifier and visually graded, a cutoff for the positivity is
– Any grades	18	5.0
⁻ Moderate to heavy grade	82	8.0	94	8.0
⁻ Heavy grade	71	8.0	38	5.0
Emphysema
– It should be the S modifier	65	7.0	56	7.0
⁻ If not, checkbox is needed	71	9.0
⁻ It should be visually graded	59	7.0	69	7.0
If it is the S modifier and visually graded, a cutoff for the positivity is	18	4.0
– Mild or higher grades	59	7.0	69	7.0
⁻ Moderate or higher grades	⁵9	7.0	50	6.5
⁻ Confluent or higher grades
⁻ Confluent or higher grades Pneumonia and active pulmonary tuberculosis
– It should be the S modifier	100	9.0
⁻ If not, checkbox is needed	82	9.0
Extrapulmonary malignancy
– It should be the S modifier	100	9.0
⁻ If not, checkbox is needed	94	9.0
Interstitial lung abnormality
– It should be the S modifier	71	7.0
⁻ If not, checkbox is needed	76	7.0
⁻ If not, checkbox is needed 76 7.0 Large pleural or pericardial effusion
– It should be the S modifier	94	8.0
⁻ If not, checkbox is needed	82	8.0
Aneurysmal dilatation of thoracic aorta (≥ 5.5 cm)
– It should be the S modifier	82	8.0
⁻ If not, checkbox is needed	76	8.0
⁻ If not, checkbox is needed 76 8.0 A checkbox is needed for other findings such as
– Pleural plaque	35	5.0	13	4.0
⁻ Bronchiectasis	41	6.0	31	5.0
⁻ Tuberculous sequelae	59	7.0	50	6.5
⁻ Mediastinal lesions	41	6.0	31	5.0
⁻ Nonmalignant extrathoracic findings	29	5.0	¹3	3.5
⁻ Bony lesions	24	5.0	13	3.5

Table 2.

Summary of Significant Abnormalities Other than Lung Cancer in the Korean Lung Cancer CT Screening

Moderate to heavy coronary artery calcification (visual assessment)
Moderate or higher-degree emphysema (visual assessment)
Interstitial lung abnormalities
Pneumonia and active pulmonary tuberculosis
Extrapulmonary malignancy
Thoracic aortic aneurysm ≥ 5.5 cm
Large amount of pleural or pericardial effusion

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