Early Lung Cancer Action Project: overall design and findings from baseline screening
Early Lung Cancer Action Project: overall design and findings from baseline screening
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DOI：
10.1016/s0140-6736(99)06093-6
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发表时间：
1999-07-10
期刊：
影响因子：
168.9
通讯作者：
Smith, JP
中科院分区：
文献类型：
--
作者：
Henschke, CI;McCauley, DI;Smith, JP
背景：早期肺癌行动计划(ELCAP)旨在评估肺癌高危人群通过低剂量计算机断层扫描(Low-Gate CT)进行基线和年度重复筛查的情况。方法ELCAP招募了1000名无症状志愿者，年龄在60岁或以上，吸烟至少10年，没有癌症病史，医学上适合接受胸部手术。在结构访谈和知情同意后，每个参与者都做了胸部X光检查和低剂量CT检查。筛查发现的非钙化肺结节的诊断性调查是根据ELCAP的建议进行的，其中包括对最小的非钙化结节进行短期高分辨率CT随访。基线时，233名(23%[95%；CI 21-26])的参与者通过低剂量CT发现了非钙化结节，相比之下，胸片发现了68名(7%[5-9])。CT检出恶性病变27例(2.7%[1.8-3.8])，胸片检出7例(0.7%[0.3-1.3])，分期恶性病变23例(2.3%[1.5-3.3])和4例(0.4%[0.1-0.9])。在27例CT检测到的癌症中，26例是可以切除的。233名无钙化结节的参与者中有28人接受了活组织检查；27人有恶性的非钙化结节，1人有良性结节。另外三名患者根据ELCAP的建议接受了活检；所有患者都有良性的非钙化结节。没有一名参与者因良性结节而接受开胸手术。解释低剂量CT可以极大地提高发现小的非钙化结节的可能性，从而在更早和更有可能治愈的阶段发现肺癌。尽管假阳性的CT结果很常见。它们可以在很少使用侵入性诊断程序的情况下进行管理。
Background The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience.Methods ELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules.Findings Non-calcified nodules were detected in 233 (23% [95%; CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2.7% [1.8-3.8]) by CT and seven (0.7% [0.3-1.3]) by chest radiography, and stage malignant disease in 23 (2.3% [1.5-3.3]) and four (0.4% [0.1-0.9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule.Interpretation low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common. they can be managed with little use of invasive diagnostic procedures.