UDK: 616.24-007.63-073.756.8:004
www.doi.org/10.67214/mk4e4641
Dimitrijevikj K., Pejkovska S., Karkinski D., Angelovska I., Momchilovikj S.
University Clinic of Pulmonology and Allergology, Faculty of Medicine, Skopje, North Macedonia
Abstract
Objective: Computed tomography (CT) plays a central role in the early detection and characterization of lung neoplasms and allows simultaneous assessment of structural lung diseases such as emphysema. The aim isto determine the prevalence of emphysema in patients with CT-detected pulmonary neoplastic lesions and to evaluate its association with tumor size, morphology, and anatomical distribution.
Materials and Methods: This retrospective observational study was conducted at the University Clinic of Pulmonology and Allergology. A total of 1045 thoracic CT examinations performed between August 2025 and January 2026 using a PHILIPS Incisive CT scanner protocol optimized for thoracic imaging were reviewed. One hundred patients with CT-detected lung neoplasms were included.
Demographic characteristics, emphysema subtype, tumor features, and associated CT findings were analyzed. Emphysema was assessed visually and classified by subtype. Statistical analysis included chi-square testing, t-tests, Mann–Whitney U tests, ANOVA, and multivariable logistic regression.
Results: Lung neoplasms were identified in 9.6% of CT examinations. Emphysema was detected in 48% of patients, predominantly of the centrilobular type. The mean tumor size was 52.4 ± 22.1 mm, with a predominance of the upper lobe and central segment. No statistically significant associations were observed between emphysema and tumor size, morphology, lobar distribution, or segmental localization. Male sex was associated with increased odds of emphysema (OR ≈ 2.4), although the association did not reach statistical significance. The regression model showed limited explanatory power (Pseudo R² = 0.066).
Conclusion: Emphysema frequently coexists with lung neoplasms in tertiary clinical practice. However, within the limitations of this retrospective imaging-based study, emphysema was not associated with measurable differences in CT tumor phenotype. Emphysema should be regarded primarily as a background risk substrate rather than a determinant of tumor imaging characteristics.
Keywords: CT; emphysema; prevalence; neoplastic lesions; lungs.
References:
- Aberle DR, Adams AM, Berg CD, Black WC, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873.
- de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382(6):503-513.
doi:10.1056/NEJMoa1911793. - Zhao YR, Ru Zhao Y, Xie X, de Koning HJ, Mali WP, Vliegenthart R, Oudkerk M. NELSON lung cancer screening study. Cancer Imaging. 2011;11:S79-84.
- De Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, Seijo LM, Pueyo JC, Villanueva A, Lozano MD, Montes U, Montuenga L, Zulueta JJ. Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest. 2007 Dec;132(6):1932-8.
doi: 10.1378/chest.07-1490. PMID: 18079226. - Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, Wilson J, Leader JK, Siegfried JM, Shapiro SD, Sciurba FC. Association of radiographic emphysema and airflow obstruction with lung cancer. Am J Respir Crit Care Med. 2008 Oct 1;178(7):738-44. doi: 10.1164/rccm.200803-435OC. Epub 2008 Jun 19. PMID: 18565949; PMCID: PMC2556456..
- Lynch DA, Austin JH, Hogg JC, Grenier PA, Kauczor HU, Bankier AA, et al. CT-definable subtypes of chronic obstructive pulmonary disease: a statement of the Fleischner Society. Radiology. 2015;277(1):192-205.
doi:10.1148/radiol.2015141579 - Cohen D, Hondelink LM, Solleveld-Westerink N, Uljee SM, Ruano D, Cleton-Jansen AM, et al. Optimizing mutation and fusion detection in NSCLC by sequential DNA and RNA sequencing. J Thorac Oncol. 2020;15(6):1000-1014.
doi:10.1016/j.jtho.2020.01.019. - Maldonado F, Bartholmai BJ, Swensen SJ, Midthun DE, Decker PA, Jett JR. Are airflow obstruction and radiographic evidence of emphysema risk factors for lung cancer? A nested case-control study using quantitative emphysema analysis. Chest. 2010 Dec;138(6):1295-302. doi: 10.1378/chest.09-2567. Epub 2010 Mar 26. PMID: 20348193.
- Agarwal AK, Raja A, Brown BD. Chronic obstructive pulmonary disease. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559281/ (cited 2026 Jun 21).
- Mannino DM. Epidemiology and global impact of chronic obstructive pulmonary disease. Semin Respir Crit Care Med. 2005 Apr;26(2):204-10. doi: 10.1055/s-2005-869539. PMID: 16088437.
- Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009 Aug;34(2):380-6. doi: 10.1183/09031936.00144208. Epub 2009 Feb 5. PMID: 19196816.
- Oudkerk M, Liu S, Heuvelmans MA, Walter JE, Field JK. Lung cancer LDCT screening and mortality reduction – evidence, pitfalls and future perspectives. Nat Rev Clin Oncol. 2021 Mar;18(3):135-151. doi: 10.1038/s41571-020-00432-6. Epub 2020 Oct 12. PMID: 33046839.
- Kovalchik SA, Tammemagi M, Berg CD, Caporaso NE, Riley TL, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med. 2013;369(3):245-254. doi:10.1056/NEJMoa1301851.
- Becker N, Motsch E, Trotter A, Heussel CP, Dienemann H, Schnabel PA, Kauczor HU, Maldonado SG, Miller AB, Kaaks R, Delorme S. Lung cancer mortality reduction by LDCT screening-Results from the randomized German LUSI trial. Int J Cancer. 2020 Mar 15;146(6):1503-1513. doi: 10.1002/ijc.32486. Epub 2019 Jun 20. PMID: 31162856.
- Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, et al. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117