Lung cancer screening - A different paradigm
Lung cancer screening - A different paradigm
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DOI：
10.1164/rccm.200301-144oc
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发表时间：
2003-11-15
影响因子：
24.7
通讯作者：
Lam, S
中科院分区：
文献类型：
--
作者：
McWilliams, A;Mayo, J;Lam, S
胸部计算机断层扫描（CT）是检测早期肺癌的敏感方法，但假阳性率较高，并且对检测中心性浸润前癌和微浸润癌不敏感。我们的假设是，痰细胞自动定量图像细胞计数（AQC）作为第一种筛查方法可以通过识别肺癌风险最高的个体来提高检出率。共有 561 名年龄在 50 岁或以上、吸烟史超过或等于 30 包/年的自愿吸烟者进行了研究。其中，423 例痰液异型性被定义为使用 AQC 检测出 5 个或更多细胞 DNA 含量异常。 46% (259/561) 发现非钙化肺结节。在检测到的 14 种癌症中，有 13 种是通过 CT 在痰异型九的受试者中检测到的，另 4 种是通过自发荧光支气管镜检查在原位癌/微浸润癌中检测到的。仅通过 CT 就发现了一种癌症。痰细胞AQC将肺癌检出率从1.8%提高到3.1%。仅 CT 扫描就会漏掉 29% 的癌症。这种筛查模式的转变还有可能将初始 CT 扫描次数减少至少 25%，并进一步节省后续检查和治疗费用。
Thoracic computed tomography (CT) is a sensitive method for detecting early lung cancer but has a high false-positive rate and is not sensitive for detecting central preinvasive and microinvasive cancer. Our hypothesis was that automated quantitative image cytometry (AQC) of sputum cells as the first screening method may improve detection rate by identifying individuals at highest risk for lung cancer. A total of 561 volunteer current or former smokers 50 years of age or older, with a smoking history of more than or equal to 30 pack/years, were studied. Among these, 423 were found to have sputum atypia defined as five cells or more with abnormal DNA content using AQC. Noncalcified pulmonary nodules were found in 46% (259/561). Of the 14 detected cancers, 13 were detected in subjects with sputum atypia-nine by CT and four carcinoma in situ/microinvasive cancers by autofluorescence bronchoscopy. One cancer was detected by CT alone. AQC of sputum cells improved the detection rate of lung cancer from 1.8 to 3.1%. CT scan alone would have missed 29% of the cancers. This screening paradigm shift has the additional potential of reducing the number of initial CT scans by at least 25% with further savings in follow-up investigations and treatment.