Management of Lung Nodules Detected by Volume CT Scanning
Management of Lung Nodules Detected by Volume CT Scanning
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DOI：
10.1056/nejmoa0906085
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发表时间：
2009-12-03
影响因子：
158.5
通讯作者：
de Koning, Harry J.
中科院分区：
文献类型：
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作者：
van Klaveren, Rob J.;Oudkerk, Matthijs;de Koning, Harry J.
使用多探测器计算机断层扫描（CT）在肺癌筛查试验中涉及肺癌风险增加的受试者突出了临床医生的问题，即当CT检测到非钙化肺结节时，决定最佳的行动方案。我们使用软件来评估非钙化结节根据其体积或体积倍增时间。生长定义为两次扫描之间体积增加至少25%。如果结节的体积小于50 mm 3，如果结节在50至500 mm 3之间，但在3个月的随访CT中没有生长，或者如果已经生长的结节的体积倍增时间为400天或更长，则第一轮筛选试验被认为是阴性的。分别有2.6%和1.8%的参与者检测结果呈阳性。在第一轮中，筛查的灵敏度为94.6%（95%置信区间[CI]，86.5至98.0），阴性预测值为99.9%（95% CI，99.9至100.0）。在第一轮筛查结果为阴性的7361例受试者中，20例肺癌在随访2年后被检出。结论在接受三轮CT扫描筛查的肺癌高危受试者中，根据体积和体积倍增时间评估非钙化肺结节，在第一轮测试阴性后1年和2年发现肺癌的几率分别为1/1000和3/1000。（当前对照试验编号，ISRCTN 63545820。）
BACKGROUNDThe use of multidetector computed tomography (CT) in lung-cancer screening trials involving subjects with an increased risk of lung cancer has highlighted the problem for the clinician of deciding on the best course of action when noncalcified pulmonary nodules are detected by CT.METHODSA total of 7557 participants underwent CT screening in years 1, 2, and 4 of a randomized trial of lung-cancer screening. We used software to evaluate a noncalcified nodule according to its volume or volume-doubling time. Growth was defined as an increase in volume of at least 25% between two scans. The first-round screening test was considered to be negative if the volume of a nodule was less than 50 mm(3), if it was 50 to 500 mm3 but had not grown by the time of the 3-month follow-up CT, or if, in the case of those that had grown, the volume-doubling time was 400 days or more.RESULTSIn the first and second rounds of screening, 2.6% and 1.8% of the participants, respectively, had a positive test result. In round one, the sensitivity of the screen was 94.6% (95% confidence interval [CI], 86.5 to 98.0) and the negative predictive value 99.9% (95% CI, 99.9 to 100.0). In the 7361 subjects with a negative screening result in round one, 20 lung cancers were detected after 2 years of follow-up.CONCLUSIONSAmong subjects at high risk for lung cancer who were screened in three rounds of CT scanning and in whom noncalcified pulmonary nodules were evaluated according to volume and volume-doubling time, the chances of finding lung cancer 1 and 2 years after a negative first-round test were 1 in 1000 and 3 in 1000, respectively. (Current Controlled Trials number, ISRCTN63545820.)