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Kwun Fong
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ES08 - The Solitary Pulmonary Nodule (ID 243)
- Event: WCLC 2020
- Type: Educational Session
- Track: Diagnostics and Interventional Pulmonology
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 16:45 - 17:45, Scientific Program Auditorium
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ES08.05 - Targeting the SPN (ID 4108)
16:45 - 17:45 | Presenting Author(s): Kwun Fong
- Abstract
- Presentation
Abstract not provided
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P44 - Screening and Early Detection - Association of Lung Cancer with other Chronic Diseases (ID 180)
- Event: WCLC 2020
- Type: Posters
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P44.05 - Bone Density Measures Out-Perform Clinical Risk Scores in Detection of Vertebral Fractures in a Lung Cancer Screening Cohort (ID 3435)
00:00 - 00:00 | Author(s): Kwun Fong
- Abstract
Introduction
Screening with low-dose chest computed tomography (LDCT) can reduce lung cancer mortality. Detection of comorbidities which share risk factors, such as older age and smoking, can add value to lung cancer screening. Osteoporosis is a promising candidate because vertebral bone mineral density (BMD) and vertebral fractures (VF) can be assessed from LDCT images. We assessed the accuracy of two BMD measurement methods to correctly classify participants with significant VF on baseline CT scans and compared this to validated clinical risk models (FRAX and Garvan tools).
Methods
595 lung screening participants (aged 55-80 with a current or recent smoking history) underwent baseline LDCT at a single International Lung Cancer Screening Trial (ILST) site (Queensland, Australia). A trained reader analysed scans for 1) significant VF (loss of vertebral height ≥25% in one or more vertebra using the semiquantitative Genant method) and 2) BMD using two methods [1st lumbar vertebra Hounsfield Unit attenuation value (L1HU) and gold-standard volumetric quantitative CT (QCT)]. Low BMD thresholds were defined as <110HU and <120mg/cm3 respectively. Osteoporotic fracture risk scores were calculated using FRAX and Garvan risk calculators, using baseline questionnaires. Threshold 10-year predicted risk of hip fracture >3% and/or any other fracture >20% defined ‘high risk’ individuals. Discrimination was compared using area under the Receiver Operating Characteristic curves (AUROC). Proportions were tested using Chi-Square; means were compared using t-test.
Results
492 complete cases were analysed (mean age 64.9[SD=6.4], 59% male, table 1). 27%(n=131) of participants were deemed ‘high risk’. Significant VF were prevalent in 35%(n=170) of participants. 57%(n=280) had low QCT BMD compared to 42%(n=205) defined by L1HU. Participants with low QCT BMD were significantly older than those with normal QCT BMD (mean age 66.4[SD=6.3] and 62.9[SD=5.9] respectively, p<0.0001). L1HU classified low BMD excellently compared to QCT (AUROC 0.943 (95%CI:0.92-0.96), figure 1A). BMD methods classified prevalent VF moderately well (AUROC L1HU 0.636, QCT 0.660, figure 1B). Clinical risk scores had statistically significantly lower performance than L1HU in correctly classifying prevalent VF (AUROC Garvan 0.493(p= 0.00146), FRAX 0.495(p= 0.00167), figure 1B). L1HU (threshold <110HU) had sensitivity 0.553 and specificity 0.655 in correctly classifying prevalent VF.
Conclusion
In this lung cancer screening cohort, VF and low BMD were highly prevalent. BMD methods out-performed clinical risk scores in classifying participants with moderate to severe prevalent VF. The L1HU method, validated against gold-standard QCT, could be applied to LDCT scans to opportunistically detect occult osteoporosis in people undergoing lung cancer screening.
