Comparison of lung cancer occurring in fibrotic versus non-fibrotic lung on chest CT

Q: What was the study’s primary purpose?

To evaluate the behavior of lung nodules occurring in pulmonary fibrosis and compare them with nodules in non-fibrotic lung parenchyma.

Q: How were patients and nodules assessed?

A retrospective review identified consecutive chest CT reports mentioning fibrosis, then the largest nodule was measured in the longest dimension and re-evaluated at follow-up when available; doubling time was calculated.

Q: What did the results show about cancer risk in fibrotic vs non-fibrotic nodules?

Pathology-proven cancer was more frequent in nodules in fibrotic lung than in non-fibrotic lung (34% vs 15%), and small (1–6 mm) fibrotic nodules showed a much higher cancer proportion (10.2% vs 0.8%).

Sep 21, 2026

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Evaluate the behavior of lung nodules arising in pulmonary fibrosis areas and compare them with nodules in non-fibrotic lung parenchyma using a retrospective chest CT and electronic medical record review. Identify 4500 consecutive patients with reports mentioning fibrosis and measure the largest nodule, reassessing at follow-up and calculating doubling time. Document histology when cancer develops. Results show cancer is more common in fibrotic-region nodules, with notably higher biopsy-proven rates for small nodules.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Introduction

Lung cancer screening outcomes

Fibrosis and cancer risk

Differences in tumor biology

Salvatore et al. Journal of Translational Medicine (2024) 22:67 [https://doi.org/10.1186/s12967-023-04645-y](https://doi.org/10.1186/s12967-023-04645-y) Journal of Translational Medicine RESEARCH Open Access Comparison of lung cancer occurring in fibrotic versus non-fibrotic lung on chest CT Mary M. Salvatore 1*, Yucheng Liu1, Boyu Peng1, Hao Yun Hsu 1, Anjali Saqi2, Wei‑Yann Tsai3, Cheng‑Shiun Leu3 and Sachin Jambawalikar1 Abstract Purpose Evaluate the behavior of lung nodules occurring in areas of pulmonary fibrosis and compare them to pul‑ monary nodules occurring in the non‑fibrotic lung parenchyma. Methods This retrospective review of chest CT scans and electronic medical records received expedited IRB approval and a waiver of informed consent. 4500 consecutive patients with a chest CT scan report containing the word fibrosis or a specific type of fibrosis were identified using the system M*Model Catalyst (Maplewood, Minnesota, U. S.) . The largest nodule was measured in the longest dimension and re‑evaluated, in the same way, on the follow‑up exam if multiple time points were available. The nodule doubling time was calculated. If the patient developed cancer, the histologic diagnosis was documented. Results Six hundred and nine patients were found to have at least one pulmonary nodule on either the first or the second CT scan. 274 of the largest pulmonary nodules were in the fibrotic tissue and 335 were in the non‑ fibrotic lung parenchyma. Pathology proven cancer was more common in nodules occurring in areas of pulmo‑ nary fibrosis compared to nodules occurring in areas of non‑fibrotic lung (34% vs 15%, p < 0. 01) . Adenocarcinoma was the most common cell type in both groups but more frequent in cancers occurring in non‑fibrotic tissue. In the non‑fibrotic lung, 1 of 126 (0 . 8%) of nodules measuring 1 to 6 mm were cancer. In contrast, 5 of 49 (10 . 2%) of nod‑ ules in fibrosis measuring 1 to 6 mm represented biopsy‑proven cancer (p < 0. 01) . The doubling time for squamous cell cancer was shorter in the fibrotic lung compared to non‑fibrotic lung, however, the difference was not statisti‑ cally significant (p = 0 . 24) . 15 incident lung nodules on second CT obtained ≤ 18 months after first CT scan was found in fibrotic lung and eight (53%) were diagnosed as cancer. Conclusions Nodules occurring in fibrotic lung tissue are more likely to be cancer than nodules in the nonfibroticlung. Incident pulmonary nodules in pulmonary fibrosis have a high likelihood of being cancer. Keywords Pulmonary fibrosis, Lung cancer, Pulmonary nodules, Doubling time, Lung cancer screening *Correspondence: Mary M. Salvatore [ms5680@cumc.columbia.edu](ms5680@cumc.columbia.edu) 1 Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032, USA 2 Department of Pathology, Columbia University Irving Medical Center, New York, NY, USA 3 Department of Biostatistics, Columbia University, New York, NY, USA Introduction Lung cancer screening has decreased lung cancer mortality and all-cause mortality because of earlier diagnosis and treatment [1, 2]. Henschke et al. found that 23% of 1000 patients who had a 10-year smoking history had at least one lung nodule on baseline chest CT and 27 had cancer [3]. Cancers found on initial screening were slower growing than cancers found on follow-up imaging; the mean volume doubling time for non-small cell lung cancers identified on follow-up screening was © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative

FAQs

What was the study’s primary purpose?

To evaluate the behavior of lung nodules occurring in pulmonary fibrosis and compare them with nodules in non-fibrotic lung parenchyma.

How were patients and nodules assessed?

A retrospective review identified consecutive chest CT reports mentioning fibrosis, then the largest nodule was measured in the longest dimension and re-evaluated at follow-up when available; doubling time was calculated.

What did the results show about cancer risk in fibrotic vs non-fibrotic nodules?

Pathology-proven cancer was more frequent in nodules in fibrotic lung than in non-fibrotic lung (34% vs 15%), and small (1–6 mm) fibrotic nodules showed a much higher cancer proportion (10.2% vs 0.8%).

Sep 21, 2026

Uploaded by Jiven