The prevalence and characterisation of lung nodules in Hodgkin lymphoma survivors: a study to inform a future lung cancer screening programme


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Rachel Broadbent, Sean Tenant, Mohammed Elshafei, John Radford

Abstract

Background

Survivors of Hodgkin lymphoma (HL) are at excess risk of developing lung cancer and may benefit from lung cancer screening (LCS). HL treatments cause radiologically evident lung toxicity which may lead to investigation of benign nodules detected through screening. We investigated, for the first time, the prevalence and size of lung nodules in HL survivors.

Method

We included patients treated for HL at our institution and sourced the most recent CT thorax scan >5 years post-treatment. Lung nodules were characterised according to BTS guidelines and hypothetical screening outcomes described. We used electronic patient records to collect data on chemotherapy regimens, radiation treatment and smoking history.

Results

96/396 (24%) HL patients had a CT thorax >5 years since treatment and were included. The median age was 41 (range 31-83). 84 had classical HL and 11 had nodular lymphocyte predominant HL. The year of diagnosis ranged from 1964 to 2013. The median time from end of treatment to the included scan was 14 months (range 5-43). 59/96 (61%) had lung nodules of any size. 10/96 (10%) had size significant nodule/s (≥5mm or 80mm3); 4/10 had nodule/s meriting a lung cancer referral and 6/10 had nodules meriting a 3-month interval scan. The presence of lung nodules was not associated with radiation to the lung, receipt of bleomycin or smoking. Scans also revealed other respiratory pathology (bronchiectasis) and incidental findings (thyroid nodules).

Conclusion

We found 10% of HL survivors had lung nodules on CT thorax which would merit a further scan or lung cancer referral had the scan been performed for LCS. This figure could be used in future LCS trials to estimate the proportion of those screened who would require investigations to rule out lung cancer. Scans were performed in symptomatic patients and the prevalence may be different in asymptomatic survivors undergoing LCS.

Impact statement

Our study results provide an estimation, for the first time, of the proportion of Hodgkin lymphoma survivors who would require a further scan to rule out lung cancer, or a referral for lung cancer, within a future pilot lung cancer screening programme.