Benefits and harms in the National Lung Screening Trial: expected outcomes with a modern management protocol.
Benefits and harms in the National Lung Screening Trial: expected outcomes with a modern management protocol.
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国家肺部筛查试验的好处和危害：现代管理方案的预期结果。
DOI：
10.1016/s2213-2600(19)30136-5
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Johansson,Mattias
中科院分区：
文献类型：
--
作者：
Robbins,HilaryA;Callister,Matthew;Sasieni,Peter;Quaife,SamanthaL;Cheung,LiC;Brennan,Paul;Katki,HormuzdA;Berg,ChristineD;Baldwin,David;Johansson,Mattias
肺癌筛查正在世界范围内受到越来越多的关注，无论是在医学界还是在普通公众中。多项随机试验--包括美国国家肺部筛查试验(NLST)、意大利多中心肺部检测试验和荷兰-比利时Nelson试验的初步结果--已经提供了确凿的证据，表明低剂量CT筛查可以降低肺癌死亡率。然而，任何筛查计划都是有利有弊的，准确地向患者和公众传达这些信息是一个复杂的挑战。在美国，尽管美国预防服务工作组提出了全国性的建议，但符合条件的人(年龄55-80岁，至少吸烟30包，戒烟不超过15年)的肺部筛查接受率很低。在英国和整个欧洲，研究界一直在争论是否、何时以及如何实施筛查。最近，英格兰国家卫生服务宣布计划在10个地点推出低剂量CT筛查。这引发了担心放映危害的评论员的分歧，并最终引发了对BBC电视节目《新闻之夜》的讨论。鉴于辩论的复杂性，初级保健提供者很难理解和解释筛查对患者的好处和坏处。已经开发和发布了多种图形工具来帮助这种对话，每个工具都基于NLST，其他定制的图形已经在试点研究中使用。然而，一些发布的图形可能会产生误导，所有这些图形都代表了基于NLST协议的结果，该协议现在已有近20年的历史。美国(LUNG-RADS版本1.0)和英国(英国胸科协会)的当前协议在重要方面与NLST协议不同。特别是，他们将许多小的肺结节归类为阴性筛查，这可以大大减少假阳性的数量，以及随后对额外扫描和侵入性程序的需求。我们聘请了一个国际肺部筛查专家小组，目的是收集和提供有关NLST样低剂量CT筛查的益处和危害的准确和平衡的信息。为了反映当代的实践，我们分析了来自NLST的个体水平数据，以表示如果使用肺部RADS来管理低剂量CT发现，将会观察到的结果。NLST低剂量CT组包括26722名参与者，他们每年接受三次筛查，然后再跟踪大约4年。对NLST筛查的肺-RADS分类进行了回顾，并在前面进行了描述。我们定义了肺-RADS
Lung cancer screening is receiving increasing attention worldwide, both in the medical community and the general public. Multiple randomised trials—including the US National Lung Screening Trial (NLST), the Multicentric Italian Lung Detection trial, and preliminary results from the Dutch-Belgian NELSON trial—have provided definitive evidence that low-dose CT screening can reduce lung cancer mortality.However, any screening programme is associated with both benefits and harms, and accurately communicating these to patients and the general public is a complex challenge. In the USA, despite a national recommendation from the US Preventive Services Task Force, uptake of lung screening among eligible people (aged 55–80 years, at least 30 pack-years smoked, and no more than 15 quityears) is low. In the UK and throughout Europe, there has been debate in the research community about whether, when, and how screening should be implemented. Most recently, England’s National Health Service announced a planned rollout of low-dose CT screening at ten sites. This prompted disagreement from commentators concerned about the harms of screening and ultimately to a discussion on the BBC television programme, Newsnight. Given the complexity of the debate, it is difficult for primary care providers to understand and explain the benefits and harms of screening to their patients. Multiple graphical tools have been developed and published to aid this conversation, each based on the NLST, and other bespoke graphics have been used in pilot studies. However, some of the published graphics can be misleading, and all represent outcomes based on the NLST protocol, which is now nearly 20 years old. Current protocols in the USA (Lung-RADS version 1.0) and the UK (British Thoracic Society) differ from the NLST protocol in important ways. In particular, they categorise many small pulmonary nodules as negative screens, which can substantially reduce the number of false-positives and the subsequent need for additional scans and invasive procedures. We engaged an international group of lung screening experts with the goal of assembling and providing accurate and balanced information on the benefits and harms of NLST-like low-dose CT screening. To reflect contemporary practice, we analysed individual-level data from the NLST to represent outcomes that would have been observed if Lung-RADS had been used to manage low-dose CT findings. The NLST low-dose CT arm comprised 26722 participants who were offered three annual screens, then followed for approximately 4 additional years. The Lung-RADS classification of NLST screens was done retrospectively and has been described previously. We defined Lung-RADS