Karakteristik Penderita PPOK yang Terdeteksi Kanker Paru Berdasarkan Lung-RADS

Abstract

Background: Cigarette smoking is the leading cause of both COPD and lung cancer. Indonesia ranks fifth globally in smoking prevalence, and data from the basic health research survey indicate that smoking initiation increasingly occurs at younger ages. Therefore, lung cancer screening among COPD patients in Indonesia is particularly important. In Indonesia, the Indonesian Society of Respirology (PDPI) and the Indonesian Association for the Study of Thoracic Oncology (IASTO) jointly developed a lung cancer risk scoring system adapted to the characteristics of the local population. A total score greater than 17 is defined as indicating a high risk for lung cancer. According to the PDPI–IASTO recommendations, screening should begin at a younger age, reflecting national data showing earlier smoking onset in the Indonesian population. This system incorporates COPD as a significant risk factor, reflecting the growing recognition of COPD patients as a priority target for screening programs. However, data describing LDCT screening outcomes and Lung-RADS classification patterns in Southeast Asian COPD populations remain scarce. Our case series aim to address this knowledge gap by describing lung-RADS 3–4 findings in a high-risk COPD patient. Objective: This study aimed to evaluate the characteristics of COPD patients who were detected with lung cancer based on Lung-RADS classification in LDCT. Methods: This descriptive observational study with a case series design included 33 COPD patients at high risk for lung cancer who underwent LDCT at Haji Adam Malik Hospital, Medan, between October 2024 and May 2025. Clinical data, spirometry, lung cancer risk scores from the IASTO-PDPI questionnaire, and LDCT findings were collected and analyzed. Results: Among COPD outpatients with a PDPI–IASTO lung cancer risk score >17 who underwent LDCT screening, 9% demonstrated Lung-RADS category 4 findings. Three patients with Lung-RADS 4A–4B had severe airflow limitation (GOLD 3–4) and nodules with solid or subsolid morphology, frequently accompanied by airway-centric changes or calcifications suggestive of prior or suspected tuberculosis. Management included short-interval LDCT surveillance and selective tissue sampling. During the observation period, no definitive lung cancer diagnosis was established; one patient had benign histopathology, while the remaining patients showed radiological stability on follow-up imaging. Conclusion: In high-risk COPD patients undergoing LDCT screening, LungRADS 4 findings do not invariably indicate lung cancer. In this case series, suspicious nodules were frequently associated with post-infectious or inflammatory changes, particularly tuberculosis-related sequelae, and no definitive malignancy was confirmed during follow-up. Lung-RADS provided a valuable framework for standardized triage, supporting short-interval surveillance for indeterminate lesions and escalation to tissue sampling for persistent or progressive findings. These results highlight the importance of a stepwise, individualized approach integrating local infectious disease burden, procedural risk, and shared decision-making in lung cancer screening programs for COPD patients.