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High-resolution computed tomography of the chest for the screening, re-screening and follow-up of systemic sclerosis-associated interstitial lung disease: a EUSTAR-SCTC survey
C. Bruni1, L. Chung2, A.M. Hoffmann-Vold3, S. Assassi4, A. Gabrielli5, D. Khanna6, E.J. Bernstein7, O. Distler8
- Division of Rheumatology, Department Experimental and Clinical Medicine, AOU Careggi, University of Florence, Italy, and Department of Rheumatology, University Hospital Zurich, University of Zurich, Switzerland. cosimobruni85@gmail.com
- Department of Medicine and Dermatology, Division of Immunology and Rheumatology, Stanford University School of Medicine and Palo Alto, VA Health Care System, Palo Alto, CA, USA.
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway.
- Division of Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy.
- University of Michigan, Scleroderma Program, Ann Arbor, MI, USA.
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Switzerland.
on behalf of the EUSTAR and SCTC collaborators
CER15361
2022 Vol.40, N°10
PI 1951, PF 1955
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PMID: 35819810 [PubMed]
Received: 22/11/2021
Accepted : 14/02/2022
In Press: 30/06/2022
Published: 17/10/2022
Abstract
OBJECTIVES:
High-resolution computed tomography (HRCT) of the chest is the gold standard to diagnose interstitial lung disease (ILD). A prior survey reported that fewer than 60% of SSc-treating rheumatologists order an HRCT for ILD screening in newly diagnosed SSc patients. Since then, efforts were initiated to increase awareness of HRCT as a screening tool. Aim of the present study was to assess efficacy of these awareness programs.
METHODS:
European Scleroderma Trials and Research (EUSTAR) and Scleroderma Clinical Trials Consortium (SCTC) members answered a survey about the use of HRCT at diagnosis, the re-screening of patients with a negative baseline HRCT, and the follow-up of HRCT positive SSc-ILD patients. When HRCT was not routinely requested, additional details were collected.
RESULTS:
Among 205 physician responders, 95.6% would perform an HRCT at SSc diagnosis: 64.9% as routine screening for ILD (65.4% of SSc referral and 63.6% of non-referral physicians) and 30.7% upon clinical suspicion (95.2% in case of crackles on auscultation). Among non-screening physicians, clinical and ethical concerns were major driving factors for not ordering HRCTs. During follow-up, 79.0% of responders would repeat HRCTs in baseline negative cases: 14.1% as routine screening and 64.9% for diagnostic purposes. Finally, 93.2% of responders would repeat a chest HRCT after SSc-ILD diagnosis: 36.6% as yearly routine and 56.6% according to clinical evaluation.
CONCLUSIONS:
The use of baseline HRCT for the screening of SSc-ILD has slightly increased, but awareness programs should be adapted for further improvement. HRCT use in re-screening and follow-up may benefit from validated algorithms.
