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Emphysema affects the number and appearance of solitary pulmonary nodules identified in chest low-dose computed tomography: a study on high risk lung cancer screenees recruited in Silesian District.

INTRODUCTION
Chest low-dose computed tomography (LDCT) has recently been proven to be an effective regimen for lung cancer screening.


OBJECTIVES
  The aim of our study was to assess the interrelation between the occurrence of emphysema and pulmonary nodules (SPNs) in first-round screening LDCT.


PATIENTS AND METHODS
A total of 601 asymptomatic volunteers with a smoking history have undergone LDCT. 523 patients were assigned to one of the group: [E]- emphysema without nodules (n=103); [E+N]-emphysema co-existing with nodules (n=96); [N]-nodules without emphysema (n=142); [NENN]-no nodules and no emphysema (n=182). The influence of emphysema and demographic factors on profile of SPNs was assessed.


RESULTS
Patients in the E+N group were older than in the group N (median age 65 vs 63 years, P=0.001) and they were smoking more (median pack-years 37.5 vs 30.5, P=0.003). Emphysema was detected in 199/523 (38.0%) subjects, while nodules in 238/523 (45.5%) ones. The number of nodules in the E+N group was 390/96 patients, and in the N group was 540/142 patients. It makes 4.1 nodule per patient in the E+N group vs 3.8 nodule per patient in the N group. Multiple SPNs, about different size and morphology, make up 93.3% in E+N group. 2.9% cancers/238 patients with nodules, were present in similar number in both groups-4.2 per 100 of patients in E+N group and 2.1 per 100 in N group (P=0.44).


CONCLUSIONS
Emphysema was more frequently associated with multiple SPNs, of different morphology, among elderly patients with higher number of pack-years of smoking.