Visual and quantitative CT-based emphysema and lung cancer: a systematic review and meta-analysis

Research output: Contribution to conferenceAbstractAcademic


Purpose or Learning Objective:To investigate whether visual and quantitative CT-based emphysema are comparably associated with risk of lung cancer.
Methods or Background: PubMed, Embase and Cochrane were searched by two independent reviewers for studies on association between CT-based emphysema (visually or quantitatively assessed based on HU) and lung cancer risk. Emphysema was measured as a dichotomous and continuous variable (%Low Attenuation Area). Associations of emphysema severity (trace, mild and moderate-severe by visual and quantitative analysis) and subtype (only by visual) with lung cancer were also identified. Adjusted odds ratios, risk ratios or hazard ratios were derived and combined to estimate overall and stratified pooled ORs (pORs) with 95% confidence intervals (95%CIs).
Results or Findings: 21 out of 3,343 screened studies with 25 study subsets were included. The overall pOR for lung cancer given the presence of emphysema was 2.28 (95%CI: 2.01-2.60, I2=31.1%, 19 study subsets) in dichotomous analysis and 1.02 (95%CI: 1.01-1.02, I2=0%, 6 study subsets) per 1% increase of %LAA. Studies with visual emphysema yielded comparable results with that of quantitative CT emphysema: pOR 2.26 (95%CI: 1.94-2.64, I2=48.4%; 12 study subsets) versus pOR 2.25 (95%CI: 1.82-2.77, I2=0%; 9 study subsets), respectively. Based on 6 studies including 1,716 participants, pORs of emphysema severity for lung cancer ranged from 2.48-4.50 for visual assessment and 1.90-2.45 for quantitative CT. Compared with no emphysema, centrilobular emphysema was significantly associated with lung cancer (pOR: 2.19, 95%CI: 1.50-3.22, I2=0 %), whereas paraseptal emphysema was not (pOR: 1.12, 95%CI: 0.62-2.01, I2=65.6 %).
Conclusion: Both visual and quantitative CT-based emphysema are associated with the risk of lung cancer and this risk increases with emphysema severity. Regarding subtype, only centrilobular emphysema shows an association with lung cancer.
Original languageEnglish
Publication statusPublished - 12-Jul-2022


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