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Lung Function and Emphysema in a Large Lung Cancer Case Series

Crisanti, Maria Cecilia (2011) Lung Function and Emphysema in a Large Lung Cancer Case Series. Master's Thesis, University of Pittsburgh.

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    Abstract

    Chronic obstructive pulmonary disease (COPD) is the most frequent chronic disease in developed countries and is predicted to be the third cause of death in 2020. Lung cancer is the leading cause of cancer death both in men and women. A vast majority of patients diagnosed with lung cancer have COPD, a history of tobacco use, or both. Shared inflammatory pathways may govern the pathogenesis of COPD and lung cancer. Several studies imply a relationship between COPD and lung cancer, but there is very limited information in the literature about emphysema and lung cancer risk. The Carinal Registry is a prospectively collected case series of patients diagnosed with lung cancer at the University of Pittsburgh. Among other data, it contains information on COPD that was acquired from the medical record (yes/no entry). Our goal was to evaluate the data quality and decide if the COPD variable could be used to score for emphysema. For this purpose, we adapted a subjective, semi-quantitative, visual emphysema scoring method (VESM) to score emphysema severity on CT scans and compared this emphysema severity score with the presence or absence of emphysema as defined in the Carinal Registry. We defined the best CT to score emphysema to be obtained preferably within one year preoperatively, with lung edge-enhancing reconstruction algorithm. Training in VESM showed high reproducibility scores and high sensitivity of the trainee to detect emphysema when compared to the standard expert score. Our results showed that there was poor correlation between the COPD status as recorded from the COPD variable from medical records and the VESM. The VESM was a more accurate measure of COPD status among lung cancer patients enrolled in the Carinal Registry. Moreover, we compared the distribution of COPD among lung cancer patients and the community adapted from Wilson et al. manuscript who carried out a community based screening study for lung cancer among smokers. Our results showed that the distribution of COPD was similar among both populations, suggesting the possibility of an underlying common pathway of lung cancer and emphysema. Public Health Significance:The public health significance of this study is clearly explained by the high frequency of both emphysema and lung cancer and the dismal prognosis of lung cancer. We have studied a sample of a large case series of lung cancer patients and scored their emphysema severity with a semi-quantitative method based on CT scan reading. We have also compared this method with simply retrieving emphysema data from the medical record and assessed the validity of these methods. All the above mentioned are very important reasons that can affect the public health as well as research purposes.


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    Item Type: University of Pittsburgh ETD
    ETD Committee:
    ETD Committee TypeCommittee MemberEmail
    Committee ChairWeissfeld, Joeljwepid@pitt.edu
    Committee MemberDiergaarde, Brendadiergaardeb@upmc.edu
    Committee MemberWilson, JohnJWW@pitt.edu
    Title: Lung Function and Emphysema in a Large Lung Cancer Case Series
    Status: Unpublished
    Abstract: Chronic obstructive pulmonary disease (COPD) is the most frequent chronic disease in developed countries and is predicted to be the third cause of death in 2020. Lung cancer is the leading cause of cancer death both in men and women. A vast majority of patients diagnosed with lung cancer have COPD, a history of tobacco use, or both. Shared inflammatory pathways may govern the pathogenesis of COPD and lung cancer. Several studies imply a relationship between COPD and lung cancer, but there is very limited information in the literature about emphysema and lung cancer risk. The Carinal Registry is a prospectively collected case series of patients diagnosed with lung cancer at the University of Pittsburgh. Among other data, it contains information on COPD that was acquired from the medical record (yes/no entry). Our goal was to evaluate the data quality and decide if the COPD variable could be used to score for emphysema. For this purpose, we adapted a subjective, semi-quantitative, visual emphysema scoring method (VESM) to score emphysema severity on CT scans and compared this emphysema severity score with the presence or absence of emphysema as defined in the Carinal Registry. We defined the best CT to score emphysema to be obtained preferably within one year preoperatively, with lung edge-enhancing reconstruction algorithm. Training in VESM showed high reproducibility scores and high sensitivity of the trainee to detect emphysema when compared to the standard expert score. Our results showed that there was poor correlation between the COPD status as recorded from the COPD variable from medical records and the VESM. The VESM was a more accurate measure of COPD status among lung cancer patients enrolled in the Carinal Registry. Moreover, we compared the distribution of COPD among lung cancer patients and the community adapted from Wilson et al. manuscript who carried out a community based screening study for lung cancer among smokers. Our results showed that the distribution of COPD was similar among both populations, suggesting the possibility of an underlying common pathway of lung cancer and emphysema. Public Health Significance:The public health significance of this study is clearly explained by the high frequency of both emphysema and lung cancer and the dismal prognosis of lung cancer. We have studied a sample of a large case series of lung cancer patients and scored their emphysema severity with a semi-quantitative method based on CT scan reading. We have also compared this method with simply retrieving emphysema data from the medical record and assessed the validity of these methods. All the above mentioned are very important reasons that can affect the public health as well as research purposes.
    Date: 29 June 2011
    Date Type: Completion
    Defense Date: 31 March 2011
    Approval Date: 29 June 2011
    Submission Date: 04 April 2011
    Access Restriction: No restriction; Release the ETD for access worldwide immediately.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Master's Thesis
    Refereed: Yes
    Degree: MS - Master of Science
    URN: etd-04042011-145023
    Uncontrolled Keywords: emphysema; lung cancer
    Schools and Programs: Graduate School of Public Health > Epidemiology
    Date Deposited: 10 Nov 2011 14:34
    Last Modified: 13 Apr 2012 14:23
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-04042011-145023/, etd-04042011-145023

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