Results of initial low-dose computed tomographic screening for lung cancer.
Results of initial low-dose computed tomographic screening for lung cancer.
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DOI：
10.1056/nejmoa1209120
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发表时间：
2013-05-23
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影响因子：
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通讯作者：
Baum S
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作者：
National Lung Screening Trial Research Team;Church TR;Black WC;Aberle DR;Berg CD;Clingan KL;Duan F;Fagerstrom RM;Gareen IF;Gierada DS;Jones GC;Mahon I;Marcus PM;Sicks JD;Jain A;Baum S
肺癌是癌症死亡率的最大贡献者。国家肺部筛查试验(NLST)显示，使用低剂量螺旋计算机断层扫描(CT)而不是胸部X光检查可以降低肺癌死亡率。我们描述了NLST第一轮筛查的筛查、诊断和有限的治疗结果，以告知和改进肺癌筛查计划。从2002年8月到2004年4月，我们在33个美国中心招募了无症状的参与者，年龄在55岁到74岁之间，有至少30包年的吸烟史。参与者被随机分配接受年度筛查，使用低剂量CT或胸部X光检查，为期3年。结节或其他可疑发现被归类为阳性结果。这篇文章报道了初步筛查的结果。共有53,439名符合条件的参与者被随机分配到一个研究组(26,715名接受低剂量CT检查，26,724名接受胸部X光检查)；26,309名参与者(98.5%)和26,035名(97.4%)分别接受了筛查。低剂量CT组和放射组共有7191名(27.3%)和2387名(9.2%)筛查结果呈阳性；在各自的组中，6369名(90.4%)和2176名(92.7%)至少有一次随访诊断程序，包括5717(81.1%)和2010年(85.6%)的成像和297(4.2%)和121(5.2%)的手术。低剂量CT组有292名参与者(1.1%)被诊断为肺癌，而放射组有190名(0.7%)被诊断为肺癌(第1期158人对70人，IIB至IV期120人对112人)。低剂量CT的敏感性和特异性分别为93.8%和73.4%，胸片分别为73.5%和91.3%。NLST的初步筛查结果与现有的通过低剂量CT和胸部X光进行筛查的文献一致，表明在拥有胸部CT经验的工作人员的美国筛查中心可以降低肺癌死亡率。(由国家癌症研究所资助；NLST ClinicalTrials.gov编号，NCT00047385。)
Lung cancer is the largest contributor to mortality from cancer. The National Lung Screening Trial (NLST) showed that screening with low-dose helical computed tomography (CT) rather than with chest radiography reduced mortality from lung cancer. We describe the screening, diagnosis, and limited treatment results from the initial round of screening in the NLST to inform and improve lung-cancer– screening programs. At 33 U.S. centers, from August 2002 through April 2004, we enrolled asymptomatic participants, 55 to 74 years of age, with a history of at least 30 pack-years of smoking. The participants were randomly assigned to undergo annual screening, with the use of either low-dose CT or chest radiography, for 3 years. Nodules or other suspicious findings were classified as positive results. This article reports findings from the initial screening examination. A total of 53,439 eligible participants were randomly assigned to a study group (26,715 to low-dose CT and 26,724 to chest radiography); 26,309 participants (98.5%) and 26,035 (97.4%), respectively, underwent screening. A total of 7191 participants (27.3%) in the low-dose CT group and 2387 (9.2%) in the radiography group had a positive screening result; in the respective groups, 6369 participants (90.4%) and 2176 (92.7%) had at least one follow-up diagnostic procedure, including imaging in 5717 (81.1%) and 2010 (85.6%) and surgery in 297 (4.2%) and 121 (5.2%). Lung cancer was diagnosed in 292 participants (1.1%) in the low-dose CT group versus 190 (0.7%) in the radiography group (stage 1 in 158 vs. 70 participants and stage IIB to IV in 120 vs. 112). Sensitivity and specificity were 93.8% and 73.4% for low-dose CT and 73.5% and 91.3% for chest radiography, respectively. The NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.)