Diagnostic evaluation following a positive lung screening chest radiograph in the Prostate, Lung, Colorectal, Ovarian (PLCO) Cancer Screening Trial.
Diagnostic evaluation following a positive lung screening chest radiograph in the Prostate, Lung, Colorectal, Ovarian (PLCO) Cancer Screening Trial.
复制标题
在前列腺癌、肺癌、结直肠癌、卵巢癌 (PLCO) 癌症筛查试验中，肺部筛查胸部 X 光片呈阳性后进行诊断评估。
DOI：
10.1016/j.lungcan.2013.07.017
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Prorok,PhilipC
中科院分区：
文献类型：
--
作者：
Hocking,WilliamG;Tammemagi,MartinC;Commins,John;Oken,MartinM;Kvale,PaulA;Hu,Ping;Ragard,LawrenceR;Riley,TomL;Pinsky,Paul;Beck,ThomasM;Prorok,PhilipC
肺癌是癌症死亡的主要原因。前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验 (PLCO) 的目的之一是确定每年筛查胸部 X 光片是否可以降低肺癌死亡率。我们招募了 154,900 名年龄在 55 至 74 岁之间的个人； 77,445 人被随机分配到干预组，并在 3 或 4 年内每年接受一次胸部 X 光检查。筛查呈阳性的参与者在其主治医师的指导下接受了诊断评估。评估了癌症的诊断或排除方法、从筛查到诊断的间隔以及预测诊断测试的因素。 17% 的参与者出现了一次或多次阳性筛查。 3% 的筛查结果呈阳性，其中 54% 的癌症呈阳性。活检的可能性与肿块、吸烟、年龄和肺癌家族史有关。超过一半的人在进行胸部X光检查或计算机断层扫描/磁共振成像后停止诊断测试。在第二次或随后的阳性筛查后，与之前的放射线照片相比，评估停止了一半以上。在 308 例筛查发现的癌症中，47.7% 是通过开胸/胸腔镜诊断，27.6% 是针吸活检，20.1% 是支气管镜检查，2.9% 是纵隔镜检查。 84% 的筛查检测肺癌是在 6 个月内确诊的。阳性筛查后及时进行了诊断评估。所有病例均通过组织活检或细胞学诊断肺癌。在通过临床或放射学评估对阳性筛查检查进行评估时，除了 1.4% 的需要组织活检的人外，其他所有患者都被排除在外。
Lung cancer is the major cause of cancer mortality. One of the aims of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) was to determine if annual screening chest radiographs reduce lung cancer mortality. We enrolled 154,900 individuals, aged 55–74 years; 77,445 were randomized to the intervention arm and received an annual chest radiograph for 3 or 4 years. Participants with a positive screen underwent diagnostic evaluation under guidance of their primary physician. Methods of diagnosis or exclusion of cancer, interval from screen to diagnosis, and factors predicting diagnostic testing were evaluated. One or more positive screens occurred in 17% of participants. Positive screens resulted in biopsy in 3%, with 54% positive for cancer. Biopsy likelihood was associated with a mass, smoking, age, and family history of lung cancer. Diagnostic testing stopped after a chest radiograph or computed tomography/magnetic resonance imaging in over half. After a second or subsequent positive screen, evaluation stopped after comparison to prior radiographs in over half. Of 308 screen-detected cancers, the diagnosis was established by thoracotomy/thoracoscopy in 47.7%, needle biopsy in 27.6%, bronchoscopy in 20.1% and mediastinoscopy in 2.9%. Eighty-four percent of screen-detected lung cancers were diagnosed within 6 months. Diagnostic evaluations following a positive screen were conducted in a timely fashion. Lung cancer was diagnosed by tissue biopsy or cytology in all cases. Lung cancer was excluded during evaluation of positive screening examinations by clinical or radiographic evaluation in all but 1.4% who required a tissue biopsy.