The Pittsburgh Lung Screening Study (PLuSS) Outcomes within 3 Years of a First Computed Tomography Scan
The Pittsburgh Lung Screening Study (PLuSS) Outcomes within 3 Years of a First Computed Tomography Scan
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DOI：
10.1164/rccm.200802-336oc
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发表时间：
2008-11-01
影响因子：
24.7
通讯作者：
Siegfried, Jill M.
中科院分区：
文献类型：
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作者：
Wilson, David O.;Weissfeld, Joel L.;Siegfried, Jill M.
基本原理：计算机断层扫描（CT）筛查肺癌的作用是有争议的，目前正在研究中，尚未完全阐明。目的：报告匹兹堡肺筛查研究（PLuSS）中50至79岁的当前和既往吸烟者的胸部低辐射剂量CT首次和1年重复筛查结果以及3年结局。方法：通知受试者筛选CT结果后，受试者接受研究医生和私人医生的诊断建议。从最初的筛查开始追踪受试者长达三年，我们获得了记录诊断程序、肺癌诊断和死亡的医疗记录。测量和主要结果：3，642名和3，423名受试者进行了最初和重复筛查。共有1，477人（3，624人中的40.6%）在初次筛查时被告知非钙化肺结节，在重复筛查之前，821人（1，477人中的55.6%，3，642人中的22.5%）获得了一项或多项后续诊断成像研究（CT、正电子发射断层扫描[PET]或PET-CT）。追踪确定了80例肺癌受试者，包括初始筛选时观察到的53例肿瘤受试者。总体而言，36例受试者（占筛选的3，642例受试者的1.0%）在初始或重复筛选时因异常转诊，接受了导致非癌症最终诊断的重大胸部外科手术（开胸术、电视辅助胸腔镜手术[VATS]、正中胸骨切开术或纵隔镜检查）。在82名接受开胸手术或VATS以排除肺结节恶性肿瘤的受试者中，28名（34.1%）接受了非癌症的最终诊断。40 69（58%）与非小细胞肺癌的受试者有I期疾病在diagnosis.Conclusions：虽然导致早期肺癌的发现，CT筛查也导致了许多诊断的后续程序，包括主要的胸外科手术与非癌症的结果。
Rationale: The role of computed tomography (CT) screening for lung cancer is controversial, currently under study, and not yet fully elucidated.Objectives: To report findings from initial and 1-year repeat screening low-radiation-dose CT of the chest and 3-year outcomes for 50- to 79-year-old current and ex-smokers in the Pittsburgh Lung Screening Study (PLuSS).Methods: Notified of findings on screening CT, subjects received diagnostic advice from both study and personal physicians. Tracking subjects for up to three years since initial screening, we obtained medical records to document diagnostic procedures, lung cancer diagnoses, and deaths.Measurements and Main Results: 3,642 and 3,423 subjects had initial and repeat screening. A total of 1,477 (40.6% of 3,624) were told about noncalcified lung nodules on the initial screening and, before repeat screening, 821 (55.6% of 1,477,22.5% of 3,642) obtained one or more subsequent diagnostic imaging studies (CT, positron emission tomography [PET], or PET-CT). Tracking identified 80 subjects with lung cancer, including 53 subjects with tumor seen at initial screening. In all, 36 subjects (1.0% of the 3,642 screened), referred for abnormalities on either the initial or repeat screening, had a major thoracic surgical procedure (thoracotomy, video-assisted thoracoscopic surgery [VATS], median sternotomy, or mediastinoscopy) leading to a noncancer final diagnosis. Out of 82 subjects with thoracotomy or VATS to exclude malignancy in a lung nodule, 28 (34.1%) received a noncancer final diagnosis. Forty of 69 (58%) subjects with non-small cell lung cancer had stage I disease at diagnosis.Conclusions: Though leading to the discovery of early stage lung cancer, CT screening also led to many diagnostic follow-up procedures, including major thoracic surgical procedures with noncancer outcomes.