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Existing classification methods may underestimate the prevalence of clinically relevant ILA phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Can a classification system for ILAs developed in a lung cancer screening setting identify clinically relevant phenotypes?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Classification criteria based on the presence and lobar extent of traction bronchiolectasis (TBe) were developed internally by expert consensus. Categories included: no ILA, non-fibrotic ILA (NF-ILA), fibrotic ILA (F-ILA), and undiagnosed fibrotic ILD (U-ILD). Interobserver agreement was calculated between two readers. Clinical characteristics, respiratory hospitalizations, and survival were compared between participants of different ILA grades.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Eight thousand, one hundred sixty-nine participants were included in the final analysis. TBe showed improved interobserver agreement compared to the American Thoracic Society (ATS) classification, identifying 344 participants (4%) with U-ILD, 86% more than the ATS classification. An additional 405 had F-ILA (5%) and 667 had NF-ILA (8%). Compared to participants without ILA, participants with U-ILD had a higher rate of respiratory hospitalization (IRR\u2009=\u20094.4, 95% CI 2.7-7.5, P\u2009&amp;lt;\u2009.001) and increased risk of death (aHR\u2009=\u20092.4, 95% CI 1.9-3.0, P\u2009&amp;lt;\u2009.001). Increasing ILA grade was associated with higher modified Medical Research Council dyspnea scores (OR\u2009=\u20091.1, 95% CI 1.0-1.1, P\u2009=\u2009.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a lung cancer screening setting, an ILA scoring system focused on lobar TBe identifies more high-risk participants and demonstrates improved interobserver concordance than the ATS classification. TBe identifies participants with a respiratory phenotype who may warrant further investigation and follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamag104","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:53:03Z","timestamp":1772283183000},"page":"1129-1139","source":"Crossref","is-referenced-by-count":1,"title":["Expanded detection of early fibrotic phenotypes using lobar traction bronchiolectasis in lung cancer screening"],"prefix":"10.1093","volume":"212","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9906-4298","authenticated-orcid":false,"given":"Daryl O","family":"Cheng","sequence":"first","affiliation":[{"name":"Satsuma Lab, Hawkes\u2019 Institute, University College London , London,","place":["United Kingdom"]},{"name":"Lungs for Living Research Centre, University College London , London,","place":["United 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