Pulmonary nodules frequently stay stable over time in veterans with unexplained dyspnea
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Key takeaways:
- Pulmonary nodule stability was frequently observed on veterans’ follow-up CT scans.
- Other findings on follow-up scans include nonresolving nodules and new nodularity.
HONOLULU — Follow-up high-resolution CT scans for veterans with incidental pulmonary nodules, initially assessed for unexplained dyspnea, revealed that nodule stability is common, according to research presented at the CHEST Annual Meeting.
“Although our study was focused on understanding the presence and evolution of pulmonary nodules in post-deployment veterans with unexplained dyspnea, understanding the risks of occupational exposures to lung carcinogens is important and a detailed occupational exposures history in patients presenting to the clinic with respiratory symptoms is vital,” Richa Nahar, MD, pulmonary and critical care medicine fellow at Rutgers New Jersey Medical School, told Healio. “Clinicians in the community are encouraged to adhere to current incidental pulmonary nodule management guidelines for early detection and management of lung cancer.”
Nahar and colleagues analyzed 192 veterans (mean age, 44.8 years; 167 men) from the New Jersey War Related Illness and Injury Study Center between 2010 and 2020 who underwent a chest high-resolution CT for unexplained dyspnea to see how incidental pulmonary nodules identified during this evaluation changed over time.
This cohort included veterans previously deployed in Southwest Asia and Afghanistan, Nahar said during her presentation.
Using the VA’s electronic health record, researchers determined if patients underwent a follow-up CT and noted nodule resolution, stability or progression in these scans.
An average of 14.71 years (range, 2-28.85 years) had passed since the cohort’s last military deployment at the time of their initial evaluation.
During this evaluation, nearly half (47%; n = 91) of the assessed veterans had air trapping or mosaicism, whereas fewer had at least one pulmonary nodule (32%; n = 62). Other findings included emphysema (n = 15), ground glass opacities (n = 18), granuloma (n = 24) and interstitial lung disease (n = 25).
“To our surprise, in this highly selective small population, the incidence of pulmonary nodules was similar to the civilian population,” Nahar told Healio.
Of those with a nodule, 84% of veterans had either a single nodule or multiple nodules smaller than 6 mm, whereas the remaining veterans had larger-sized nodules (6-30 mm), she said in her presentation. One patient had a lung mass larger than 30 mm, and this was revealed to be sarcoidosis.
Within a mean follow-up of 30.59 months (range, 2.5-108 months), researchers observed a repeat chest CT among 44% (n = 84; mean age, 47.3 years; 86% men; 76% white) of veterans, including more than half (68%; n = 42) of the individuals with a previously observed nodule(s).
Notably, half of the veterans with a follow-up CT scan did not report smoking, whereas the other half reported an average of 8.7 pack-years. In this cohort, exposure to airborne hazards while deployed was common, with 95% reporting smoke exposure from open burn pits and another 95% reporting dust/sand exposure.
Researchers did not find any nodules during the initial or follow-up evaluation in 35% (n = 29) of those with follow-up imaging.
Of the 55 remaining patients, a little less than half (n = 22) had nodule stability. Nodule resolution (n = 15) and new nodularity (n =13) appeared in slightly fewer veterans, whereas an increase in size/number of nodules (n = 4) appeared infrequently.
Among those with a single nodule between 8 mm and 30 mm on the initial scan (n = 5), Nahar reported that one veteran each was diagnosed with granulomatosis with polyangiitis, adenocarcinoma of lung, sarcoidosis, a stable nodule or a resolved nodule at follow-up.
“While one patient had a large pulmonary nodule with nodule characteristics suspicious for malignancy and was diagnosed with adenocarcinoma of the lung, larger longitudinal studies are required to fully understand the impact of airborne hazards in evolution of pulmonary nodules in Veterans post-deployment,” Nahar told Healio.
“I believe that future studies will entail serial lung cancer screening evaluation in larger populations with various occupational exposures in addition to tobacco use history to understand the cumulative effect of these carcinogenic exposures in timely lung cancer detection and treatment with an aim to reduce lung cancer related mortality,” Nahar added.