Abstract Rationale Idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) are often diagnosed with multiyear delays from symptom onset, leading to worse survival and quality of life. Although antifibrotics improve outcomes, initiation is frequently delayed. Many patients first show interstitial lung abnormalities (ILAs) on CTs obtained for other reasons, creating an opportunity for systematic detection with outreach to shorten the diagnostic pathway. This study screened CT reports for ILA, identified patients meeting ILD/IPF/PPF criteria, assessed whether clinically recognized, and compared symptoms in those engaged through outreach versus routine referral. Methods All CT reports between 6/1-8/1/2023, at Lahey and Beverly Hospitals (N = 36,856) were screened with mPower™ NLP platform (Microsoft, Redmond,WA) for ILA-related terms. Flagged CTs were read by a pulmonologist to classify ILA (Fleischner,2020) and UIP pattern (ATS,2018). 412 patients with ILA were identified. A subgroup (n = 165) not followed by pulmonary within 2 years was further studied, divided into 2 cohorts (See Figure): Cohort E (Engaged) consisted of a subset that underwent systematic outreach whereby PCPs received engagement letters/referral orders and patients notification letters; Cohort NE (Not Engaged) entered via routine referral. Patients met ILD criteria per ATS ILA guidelines and for presumptive IPF if CT UIP score was probable/typical, without underlying etiology. Data was abstracted from EMR. Continuous variables were summarized as mean±SD and proportions compared using Fisher’s exact test (p 0.05). Analyses were descriptive; censored on 6/12/2025. Results The cohort mean age was 73.6±9.4 years; 51% men. 60 patients (36%) met ILD criteria, with 26/39 (67%) from cohort E vs. 34/126 (27%) from cohort NE (p 0.001), including 30 presumptive IPF and 6 possible PPF. The 34 ILD patients in cohort NE (56.7%) never underwent pulmonary evaluation, remaining unrecognized. In cohort E, of 26 meeting ILD criteria, 19 were clinically recognized. Thirteen met IPF and one PPF criteria--5 were clinically recognized. No IPF/PPF patients had been started on antifibrotics. Outreach contacted 57 PCPs, yielding 30 referrals (52.6%), and 21 patients (37%) seen in the Lung Health Clinic. Symptom burden was lower in cohort E vs. NE: cough+dyspnea 5% vs 53% (p = 0.0012), cough alone 20% vs 53% (p = 0.048). Conclusion ILA screening of CT reports identified many patients meeting ILD, IPF, and PPF criteria who would otherwise remain unrecognized. Outreach patients presented with lower symptom burden than those routinely referred, demonstrating earlier capture in the disease course. Despite identification, no patients had been started on antifibrotic therapy, underscoring persistent recognition and treatment gaps. This abstract is funded by: B4 Symptoms
Patel et al. (Fri,) studied this question.