Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers
Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers
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DOI：
10.1007/s00330-003-2200-5
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发表时间：
2004-04-01
影响因子：
5.9
通讯作者：
Wormanns, D
中科院分区：
文献类型：
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作者：
Diederich, S;Thomas, M;Wormanns, D
本研究的目的是分析在重度吸烟者中使用低辐射剂量螺旋计算机断层扫描筛查肺癌的前瞻性单臂可行性研究的发病率结果。817名吸烟者（吸烟史大于等于40年，大于等于20包年）接受了基线低剂量CT检查。CT形态提示恶性的结节，建议行活检。对于其他病变，建议采用低剂量CT随访。每年对所有研究参与者进行重复CT检查。817名受试者中668名（81.8%）每年接受重复CT检查，随访时间共计1735年。随访显示，792例受试者中有11例基线CT显示非钙化结节生长。11个生长结节中有8个进行了活检，其中7个为肺癌。174例新发结节中，3例为肺癌。筛查出的10例肺癌均为非小细胞癌（IA期6例，IB期1例，IIIA期1例，IV期2例）。在两次年度CT扫描间隔的12个月内，由于症状诊断出5例癌症（2例小细胞肺癌：1例局限性疾病，1例广泛疾病，3例中央/支气管内非小细胞肺癌，2例IIIA期，1例IIIB期）。肺癌的发病率低于患病率，筛查检测到的癌症较小，筛查检测到的肿瘤中有70%（10分之7）为I期。只有27%（15分之4）的侵入性手术是针对良性病变进行的；然而，在人群中诊断出的所有癌症中，33%（15例中的5例）是症状诊断的癌症（3例中枢性NSCLC，均为III期，2例SCLC），这表明了CT筛查的局限性。
The aim of this study was analysis of incidence results in a prospective one-arm feasibility study of lung cancer screening with low-radiation-dose spiral computed tomography in heavy smokers. Eight hundred seventeen smokers (greater than or equal to40 years, greater than or equal to20 pack years of smoking history) underwent baseline low-dose CT. Biopsy was recommended in nodules >10 mm with CT morphology suggesting malignancy. In all other lesions follow-up with low-dose CT was recommended. Annual repeat CT was offered to all study participants. Six hundred sixty-eight (81.8%) of the 817 subjects underwent annual repeat CT with a total of 1735 follow-up years. Follow-up of non-calcified nodules present at baseline CT demonstrated growth in 11 of 792 subjects. Biopsy was performed in 8 of 11 growing nodules 7 of which represented lung cancer. Of 174 new nodules, 3 represented lung cancer. The 10 screen-detected lung cancers were all non-small cell cancer (6 stage IA, 1 stage IB, 1 stage IIIA, 2 stage IV). Five symptom-diagnosed cancers (2 small cell lung cancer: 1 limited disease, 1 extensive disease, 3 central/endobronchial non-small cell lung cancer, 2 stage IIIA, 1 stage IIIB) were diagnosed because of symptoms in the 12-month interval between two annual CT scans. Incidence of lung cancer was lower than prevalence, screen-detected cancers were smaller, and stage I was found in 70% (7 of 10) of screen-detected tumors. Only 27% (4 of 15) of invasive procedures was performed for benign lesions; however, 33% (5 of 15) of all cancers diagnosed in the population were symptom-diagnosed cancers (3 central NSCLC, all stage III, 2 SCLC) demonstrating the limitations of CT screening.