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However, challenges remain in identifying clinically relevant ILAs as highlighted in a joint statement by a European multidisciplinary task force led by the European Respiratory Society (ERS). To address these challenges, we analysed ILAs identified in one of Europe\u2019s largest LCS studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Of 11\u2009635 LCS individuals, 417 screen-detected ILAs were evaluated using a new visual classification system focused on traction bronchiolectasis: non-fibrotic ILA (no traction bronchiolectasis), fibrotic ILA (traction bronchiolectasis in \u22642 lobes); undiagnosed interstitial lung disease (traction bronchiolectasis in &gt;2 lobes). Observer agreement was compared with Fleischner Society ILA classification using Cohen\u2019s Kappa. An age, sex and smoking history-matched control group allowed the examination of associations between baseline ILA\/UILD and comorbidities, forced vital capacity (FVC), hospitalisations (Student\u2019s t-tests) and mortality (univariable and multivariable Cox proportional hazards models).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Our visual ILA classification showed superior interobserver agreement (K=0.76) versus the Fleischner ILA classification (K=0.64). ILA\/UILD subjects had more prevalent comorbidities, increasing (vs controls) approximately 10 years prior to ILA\/UILD diagnosis. Compared with controls, mortality rates were 6-fold higher for UILD participants and 3-fold higher for fibrotic and non-fibrotic ILA subtypes. On multivariable Cox regression analysis, ILA\/UILD presence (HR=4.90, 95%\u2009CI =2.36 to 10.10, p&lt;0.001) showed stronger independent associations with mortality than baseline FVC (HR=0.98, 95% CI =0.96 to 1.00, p=0.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We demonstrate a new reproducible classification of clinically important ILA\/UILDs in LCS populations. We highlight that FVC shows limited associations with mortality in ILA\/UILD subjects. Increased multiorgan comorbidity in ILA\/UILD subjects highlights a need for comprehensive early multisystem evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003298","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T06:35:23Z","timestamp":1757572523000},"page":"e003298","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Differentiating clinically important interstitial lung abnormalities in lung cancer screening"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct03934866","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8342-9117","authenticated-orcid":false,"given":"Brintha","family":"Selvarajah","sequence":"first","affiliation":[{"name":"Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK"},{"name":"Oncogenes and 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