Overdiagnosis in low-dose computed tomography screening for lung cancer.
Overdiagnosis in low-dose computed tomography screening for lung cancer.
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DOI：
10.1001/jamainternmed.2013.12738
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发表时间：
2014-02-01
影响因子：
39
通讯作者：
Aberle, Denise R.
中科院分区：
文献类型：
--
作者：
Patz, Edward F., Jr.;Pinsky, Paul;Gatsonis, Constantine;Sicks, JoRean D.;Kramer, Barnett S.;Tammemaegi, Martin C.;Chiles, Caroline;Black, William C.;Aberle, Denise R.
肺癌筛查有可能降低死亡率，但除了检测侵袭性肿瘤外，筛查还将检测惰性肿瘤，否则可能不会引起临床症状。这些过度诊断病例代表了筛查的一个重要潜在危害，因为它们会产生与癌症治疗相关的额外成本、焦虑和发病率。评估国家肺筛查试验（NLST）中的过度诊断。我们使用了NLST的数据，NLST是一项随机试验，在53452名肺癌高危人群中比较了低剂量计算机断层扫描（LDCT）与胸部X射线摄影（CXR）的筛查，观察了6.4年，以估计NLST的LDCT组与CXR组相比肺癌的超额数量。我们计算了过度诊断的2个指标：通过LDCT筛查检测到的肺癌是过度诊断（PS）的概率，定义为LDCT检测到的过量肺癌除以LDCT组中通过筛查检测到的所有肺癌;以及被认为是过度诊断的病例数相对于需要筛查以防止1例肺癌死亡的人数。在随访期间，NLST的LDCT组报告了1089例肺癌，CXR组报告了969例肺癌。概率为18.5%（95% CI，5.4%-30.6%）通过LDCT筛查检出的任何肺癌均为过度诊断，22.5% LDCT检出的非小细胞肺癌为过度诊断（95%CI，9.7%~ 34.3%），（95% CI，62.2%-93.5%），LDCT检测到支气管肺泡肺癌是过度诊断。在320名参与者中，需要在NLST中进行筛查以防止1例肺癌死亡的过度诊断病例数为1.38。在NLST中LDCT检测到的所有肺癌中，超过18%似乎是惰性的，在描述LDCT筛查肺癌的风险时，应考虑过度诊断。
Screening for lung cancer has the potential to reduce mortality, but in addition to detecting aggressive tumors, screening will also detect indolent tumors that otherwise may not cause clinical symptoms. These overdiagnosis cases represent an important potential harm of screening because they incur additional cost, anxiety, and morbidity associated with cancer treatment. To estimate overdiagnosis in the National Lung Screening Trial (NLST). We used data from the NLST, a randomized trial comparing screening using low-dose computed tomography (LDCT) vs chest radiography (CXR) among 53 452 persons at high risk for lung cancer observed for 6.4 years, to estimate the excess number of lung cancers in the LDCT arm of the NLST compared with the CXR arm. We calculated 2 measures of overdiagnosis: the probability that a lung cancer detected by screening with LDCT is an overdiagnosis (PS), defined as the excess lung cancers detected by LDCT divided by all lung cancers detected by screening in the LDCT arm; and the number of cases that were considered overdiagnosis relative to the number of persons needed to screen to prevent 1 death from lung cancer. During follow-up, 1089 lung cancers were reported in the LDCT arm and 969 in the CXR arm of the NLST. The probability is 18.5% (95% CI, 5.4%–30.6%) that any lung cancer detected by screening with LDCT was an overdiagnosis, 22.5% (95% CI, 9.7%–34.3%) that a non-small cell lung cancer detected by LDCT was an overdiagnosis, and 78.9% (95% CI, 62.2%–93.5%) that a bronchioalveolar lung cancer detected by LDCT was an overdiagnosis. The number of cases of overdiagnosis found among the 320 participants who would need to be screened in the NLST to prevent 1 death from lung cancer was 1.38. More than 18% of all lung cancers detected by LDCT in the NLST seem to be indolent, and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer.
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DOI：
10.1093/jnci/djj207
发表时间：
2006-06-07
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Marcus, PM;Bergstralh, EJ;Fontana, RS
通讯作者：
Fontana, RS
影响因子：
158.5
作者：
Bleyer, Archie;Welch, H. Gilbert
通讯作者：
Welch, H. Gilbert
DOI：
10.1097/jto.0b013e318206a221
发表时间：
2011-02
期刊：
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
影响因子：
--
作者：
Travis WD;Brambilla E;Noguchi M;Nicholson AG;Geisinger KR;Yatabe Y;Beer DG;Powell CA;Riely GJ;Van Schil PE;Garg K;Austin JH;Asamura H;Rusch VW;Hirsch FR;Scagliotti G;Mitsudomi T;Huber RM;Ishikawa Y;Jett J;Sanchez-Cespedes M;Sculier JP;Takahashi T;Tsuboi M;Vansteenkiste J;Wistuba I;Yang PC;Aberle D;Brambilla C;Flieder D;Franklin W;Gazdar A;Gould M;Hasleton P;Henderson D;Johnson B;Johnson D;Kerr K;Kuriyama K;Lee JS;Miller VA;Petersen I;Roggli V;Rosell R;Saijo N;Thunnissen E;Tsao M;Yankelewitz D
通讯作者：
Yankelewitz D
影响因子：
120.7
作者：
Bach, Peter B.;Mirkin, Joshua N.;Oliver, Thomas K.;Azzoli, Christopher G.;Berry, Donald A.;Brawley, Otis W.;Byers, Tim;Colditz, Graham A.;Gould, Michael K.;Jett, James R.;Sabichi, Anita L.;Smith-Bindman, Rebecca;Wood, Douglas E.;Qaseem, Amir;Detterbeck, Frank C.
通讯作者：
Detterbeck, Frank C.
影响因子：
5.3
作者：
Dammas, S;Patz, EF;Goodman, PC
通讯作者：
Goodman, PC