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Objective:
Low-dose CT (LDCT) for the early detection of lung cancer may detect and qualitatively assess the extent of emphysema. We developed a qualitative emphysema scoring system in our LDCT lung cancer screening program. The purpose of this study is to determine a potential relationship between our qualitative emphysema scoring system, the age at which smoking began, and total cumulative pack-years of smoking.

Materials and Methods:
Following Institutional Review Board (IRB) approval, we conducted a retrospective review of all LDCTs performed in our lung cancer screening program between January 2013 and June 2021. Patient age, sex, smoking status, pack-years, and emphysema score were acquired from electronic medical records. Our radiologists developed a qualitative centrilobular emphysema scoring system on LDCT studies. Score: 0: no emphysema. Score 1: <25% of lung affected. Score 2: >25% but <50% of lung affected. Score 3: >50% of lung affected. Results were collected and analyzed from 984 participants (mean age 66.20) producing a total of 1,857 observations, a portion of patients having multiple visits.

Results:
We found a significant difference between pack-years and emphysema scores (F3,1480 = 4.20, p = 0.0057). The higher the emphysema score, the greater the cumulative pack years. Posthoc tests show a significant difference in pack years and emphysema scores of 1 and 2 and scores 1 and 3. We found no significant difference between the age at which patients began smoking and emphysema scores (2 = 1.80, 1 d.f., p = 0.1798). Our study shows a relationship between total cumulative pack and increasing emphysema scores. We found no significant difference between the age at which patients began smoking and emphysema scores.

Conclusion:
We found no significant difference between the age at which patients began smoking and emphysema scores.