肺癌低剂量螺旋CT筛查的研究进展

<正>肺癌是当前对人类威胁最大的恶性肿瘤。在全球范围内,其死亡率高居男性的首位,女性的第二位[1]。在我国及美国,其死亡率已稳居男、女性恶性肿瘤死亡率的首位[2,3]。美国2010年肺癌预期死亡病例占癌症总死亡人数的28%,超过前列腺癌、     

低剂量CT筛查肺癌之现状和展望

肺癌高居全球癌症死亡的首位.遗憾的是,因出现症状而就诊的肺癌多属晚期,预后甚差.肺癌筛查的想法可追溯到上世纪五十年代,摄胸片筛查了6000名男性志愿者,虽生存期较有症状组稍有延长,但死亡率无明显差异.随着低剂量CT检查技术的开展,于上世纪九十年代中、晚期报道,用低剂量CT筛查有较高的早期肺癌检出率.使肺癌筛查重又燃起希望.但因这些筛查试验缺乏对照组,故不足以确定低剂量CT筛查是否能降低肺癌死亡率.文献中对仍有很多争论.为确定CT筛查是否真正有益,美国全国肺癌筛查试验及NELSON试验进行之中.预计2010年可得出最终结果.肺癌筛查是一复杂的有争议的问题,通过CT筛查是否能实质性地降低肺癌死亡率,仍不清楚.尽管CT筛查充满希望,但仍存在一些问题有待解决,在采取大面积筛查前须对其有所了解.     

低剂量CT筛查降低肺癌的死亡率

背景 肺癌的侵袭性与异质性使得通过筛查降低其死亡率的努力困难重重。低剂量螺旋CT的出现改变了肺癌筛查的现状,研究表明,低剂量CT能够在早期阶段发现多种肿瘤。此项国家肺癌筛查试验（NEST）就是为确定低剂量CT筛查是否能够降低肺癌的死亡率。方法从2002年8月到2004年4月,研究者在美国的33个医疗中心共招募入组存在肺癌高风险的53454人。     

低剂量螺旋CT肺癌筛查的研究现状与进展

肺癌是最常见的恶性肿瘤之一,严重影响人民身心健康。在全世界大多数国家,其发病率和死亡率均居首位,因此对肺癌高危人群进行早期筛查的必要性与日俱增。随着低剂量螺旋CT(Low-dose computed tomography,LDCT)在各个国家的推广和应用,肺癌的死亡率明显降低,但同时也带来许多问题,如假阳性过高、过度诊断会造成患者经济和心理的双重负担;女性被动吸烟的人数越来越多,但未被纳入肺癌高危人群的筛查;肺癌筛查对高危人群的定义与标准、阳性结节的定义与标准均尚无统一指南发布等。这些问题日益突出,是现今大多数研究面临的主要困难与挑战。本文就LDCT肺癌筛查的研究现状和进展做一综述。     

低剂量CT用于肺癌筛查的Meta分析

目的 系统综述各地使用低剂量CT筛查肺癌的实践情况.方法 根据纳入与排出标准,从中英文相关数据库筛选出的36项筛查项目进行系统性分析.并且通过Meta分析计算肺癌检出率及95%置信区间,绘制森林图.结果 基线筛查的肺癌检出率为0.9%,定期筛查的肺癌发现率为0.5%,总体肺癌筛查发现率为1.3%(1.0%~1.7%);检出的肺癌病理分型以腺癌为主(52%),分期以Ⅰ期非小细胞肺癌为主(70.8%).结论 在我国医疗资源相对不足的情况下,推广低剂量CT的肺癌筛查,值得深入研究和思考.     

低剂量螺旋CT对高危人群的肺癌筛查结果分析

摘 要：［目的］ 了解低剂量螺旋CT对高危对象进行肺癌筛查的特点。［方法］ 对上海市闵行区36 924名肺癌高危人群于2014~2016年间进行低剂量螺旋CT肺癌筛查,根据筛查结果,分别按性别、年龄段进行分组,比较肺癌检出率、病理分型及临床分期。［结果］ 低剂量螺旋CT筛查共检出肺癌患者273例,总检出率为0.74%,其中男性143例,女性130例;腺癌、鳞癌、小细胞癌及未分型分别为166例、4例、9例及94例,0~1期、2~3期及4期和未分期分别为118例、22例、13例及120例。肺癌总检出率、腺癌构成比、腺癌检出率女性均高于男性。男性肺癌检出率随年龄增长呈上升趋势,女性肺癌检出率随年龄增长呈上升趋势,到70~79岁年龄段出现小幅下降,后又呈上升趋势。［结论］ 采用低剂量螺旋CT对高危人群进行肺癌筛查有助于肺癌的早期发现并提高肺癌检出率,应在该人群中积极开展。     

低剂量螺旋CT肺癌筛查研究进展

肺癌已经成为全球范围内癌症死亡的首位死因,其5年生存率很低。肺癌的筛查和早期诊断是改善肺癌生存,降低肺癌死亡率的关键。低剂量螺旋CT是近20年肺癌筛查的热点,随机对照试验研究已经证实其可降低肺癌死亡率。但目前低剂量螺旋CT筛查仍存在一些问题。本文对近年来低剂量螺旋CT能否降低肺癌死亡率的争议、随机对照试验的结果及存在的问题进行综述,并对未来低剂量螺旋CT在肺癌筛查中的应用做一展望。     

基于社区的早期肺癌低剂量螺旋CT扫描筛查上海实践初探

背景与目的：作为中国最常见的恶性肿瘤,肺癌的发病率及死亡率长期保持在较高水平。而有效改善肺癌预后,关键在于早期诊断和规范治疗。本研究密切结合上海社区医疗服务发展现状,整合各级医疗机构优势资源,探索基于上海社区的早期肺癌低剂量螺旋CT筛查路径模式。方法：2013年8月—2014年8月,针对上海市闵行区部分试点社区,以低剂量螺旋CT作为肺癌初步筛查手段,在高危人群中开展肺癌早期诊断,并结合以微创手术治疗为主的多学科综合治疗模式,构建涵盖肺癌预防、诊断、治疗、康复及随访等医疗服务措施的综合治疗立体网络。结果：筛查总人数为11332人(男性7144人,女性4188人)。其中,明确诊断恶性肿瘤29例,包括原发性肺癌27例、转移性肺癌1例和乳腺癌1例;筛查原发性肺癌发病率为238.26×10-5;0~Ⅰ期肺癌共22例,在原发性肺癌中占81.48%。结论：基于上海社区的早期肺癌低剂量螺旋CT筛查路径模式提高肺癌早期诊断率,具有可行性及有效性,可在有条件的社区及医疗卫生机构推广。     

乌鲁木齐市社区肺癌高危人群低剂量螺旋CT筛查结果分析

[目的]对乌鲁木齐市城市社区40～69岁人群开展肺癌筛查,评价筛查效果.[方法]对问卷评估的11 512名肺癌高危人群低剂量螺旋CT检查.[结果]共完成肺癌CT筛查3436人,依从性为20.4％.共发现1294人有肺内结节(37.6％),367人有阳性结节(10.7％),可疑肺癌16例(0.46％).男性阳性结节的检出率高于女性.60～69岁年龄组在阳性结节、小结节、可疑肺癌的检出率都高于其他年龄组.[结论]低剂量螺旋CT适合肺癌的高危人群筛查,有助于早期发现肺内的阳性结节和相关疾病,60岁以上人群肺癌的筛查应该引起高度重视.     

肺癌低剂量螺旋CT筛查应用现状及问题探讨

摘 要：肺癌是全球最常见的癌症死亡原因。早期肺癌检出率低是导致肺癌高死亡率的一大原因。肺癌低剂量螺旋CT（low-dose computed tomography,LDCT）筛查是目前全球公认的能够有效降低肺癌死亡率的方法。尽管LDCT已被证实在肺癌筛查中的作用,但其临床运用仍有许多问题亟需解决。全文对筛查人群的选择、肺结节管理流程的完善、肺癌预测因子的开发方面作一综述。     

Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner

The aim of this study was to evaluate the usefulness of annual screening for lung cancer by low-dose computed tomography (CT) and the characteristics of identified lung cancers. Subjects consisted of 5483 general population aged 40-74 years, who received initial CT scans in 1996, followed by repeat annual scans for most subjects in 1997 and 1998, with a total of 13 786 scans taken during 1996-1998. Work-up examinations for patients with suspicious lesions were conducted using diagnostic CTs. The initial screening in 1996 detected suspicious nodules in 279 (5.1%) of 5483 subjects, and 22 (8%) were confirmed surgically to have lung cancer. Corresponding figures in 1997 and 1998 screening studies were 173 (3.9%) of 4425 and 25 (14%) of 173, and 136 (3.5%) of 3878 and 9 (7%) of 136, respectively. The sensitivity and specificity of detecting surgically confirmed lung cancer were 55% (22/40) and 95% (4960/5199) in 1996 and 83% (25/30) and 97% (4113/4252) in 1997 screening, respectively. 88% (55/60) of lung cancers identified on screening and surgically confirmed were AJCC stage IA. Our trial allowed detection of nearly 11 times the expected annual number of early lung cancers. Repeat CT allowed the detection of more aggressive, rapidly growing lung cancers, compared to those in the initial screening.     

体检人群肺癌筛查低剂量螺旋CT检出率与成本分析

目的评价低剂量螺旋CT在体检人群中进行肺癌筛查的检出率与花费情况。方法纳入解放军总医院健康医学中心和国际医学中心2007-01-01-2011-12-31符合条件的88 596例健康体检人员数据,通过查询2010年《北京市三甲医院医疗收费手册》获得每例筛查和诊断费用,通过网络获取人均国内生产总值(gross domestic product,GDP),计算低剂量胸部CT在健康体检人群中进行肺癌筛查的早诊率和早期发现成本系数(early detection cost index,EDCI),与同期解放军总医院门诊检出肺癌的早诊率进行比较,并比较各性别、年龄段的筛查花费。结果总体肺癌检出率为95.8/10万,且随年龄的增长而快速增长。女性检出率为92.2/10万,高于男性的42.9/10万,P=0.004 4。早诊率可达到90.6%(48/53),高于同期解放军总医院门诊早诊率22.2%(371/1 666),P<0.001。发现1例肺癌患者的费用为2 375 629元,发现早期病例费用为2 623 090元,按国人GDP的EDCI为184.4,按北京市GDP的EDCI为46.8。结论低剂量螺旋CT用于体检中心肺癌筛查可将肺癌诊断时期大大提前,但其应用于全体检人群的筛查成本过大,宜先采取流行病学的危险因素初筛出高危人群,然后对这些人再进行低剂量螺旋CT胸部扫描筛查肺癌。     

Low-dose computed tomography lung cancer screening as a teachable moment for smoking cessation among African American smokers: A feasibility study

Abstract

Low-dose computed tomography (LDCT) screening may be a teachable moment for smoking cessation among African Americans. African Americans have been understudied within the context of LDCT and smoking cessation. The study objective was to evaluate the feasibility of recruiting African Americans to a future longitudinal trial and to obtain sample size estimates for that trial. Participants (N?=?18) were African Americans eligible for LDCT screening who completed a questionnaire at three time points. Self-efficacy and intention to quit smoking were compared. The results of the current study show that it is feasible to recruit African Americans eligible for LDCT.     

低剂量胸部CT筛查早期肺癌的临床应用研究

目的:探讨低剂量CT(low-dose chest CT,LDCT)胸部平扫在健康体检中筛查早期肺癌的应用效果及价值.方法:收集2018年1月至2018年12月在我院健康体检高危人群,采用低剂量胸部CT 1100例及胸部X线平片750例.结果:低剂量胸部CT与胸部X线片比较,发现肺结节病灶,阳性肺结节以及疑似肺癌的比例...     

Advances in lung cancer screening and early detection

Lung cancer is associated with a heavy cancer-related burden in terms of patients’ physical and mental health worldwide. Two randomized controlled trials, the US-National Lung Screening Trial (NLST) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON), indicated that low-dose CT (LDCT) screening results in a statistically significant decrease in mortality in patients with lung cancer, LDCT has become the standard approach for lung cancer screening. However, many issues in lung cancer screening remain unresolved, such as the screening criteria, high false-positive rate, and radiation exposure. This review first summarizes recent studies on lung cancer screening from the US, Europe, and Asia, and discusses risk-based selection for screening and the related issues. Second, an overview of novel techniques for the differential diagnosis of pulmonary nodules, including artificial intelligence and molecular biomarker-based screening, is presented. Third, current explorations of strategies for suspected malignancy are summarized. Overall, this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.     

Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography

Lung cancer screening programmes using chest X-ray and sputum cytology are routinely performed in Japan; however, the efficacy is insufficient. Screening using low-dose computed tomography (CT) is a more effective approach and has the potential to detect the disease more accurately. A total of 7183 low-dose CT screening tests for 4689 participants and 36 085 chest X-ray screening tests for 13 381 participants were conducted between August 1998 and May 2002. Sensitivity and specificity of lung cancer screening were calculated by both the detection method and the incidence method by linkage of the screening database and the Cancer Registry database. The preclinical detectable phase was assumed to be 1 year. Sensitivity and specificity by the detection method were 88.9 and 92.6% for low-dose CT and 78.3 and 97.0% for chest X-ray, respectively. Sensitivity of low-dose CT by the incidence method was 79.5%, whereas that of chest X-ray was 86.5%. Lung cancer screening using low-dose CT resulted in higher sensitivity and lower specificity than traditional screening according to the detection method. However, sensitivity by the incidence method was not as high as this. These findings demonstrate the potential for overdiagnosis in CT screening-detected cases.     

Finding needles in a haystack: annual low-dose computed tomography screening reduces lung cancer mortality in a high-risk group

Evaluation of: Aberle DR, Adams AM, Berg CD et al.; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med. 365(5), 395–409 (2011).

Lung cancer is a global health issue. Compared with other common malignancies, the prognosis is poor as many patients present with advanced disease. The National Lung Screening Trial (NLST) aimed to identify and treat early lung cancers using annual low-dose computed tomography (CT) screening in a high-risk group. When compared with chest x-ray screening, low-dose CT screening reduced lung cancer mortality by 20%; the NLST is the first lung cancer screening trial to demonstrate such a mortality benefit. However, we must wait for cost–effectiveness data from the NLST, as well as the results of ongoing European studies comparing low-dose CT with observation alone, before firm conclusions can be drawn regarding the overall benefits of introducing a CT screening program to clinical practice.     

Advances and perspectives in lung cancer imaging using multidetector row computed tomography

The introduction of multidetector row computed tomography (CT) into clinical practice has revolutionized many aspects of the clinical work-up. Lung cancer imaging has benefited from various breakthroughs in computing technology, with advances in the field of lung cancer detection, tissue characterization, lung cancer staging and response to therapy. Our paper discusses the problems of radiation, image visualization and CT examination comparison. It also reviews the most significant advances in lung cancer imaging and highlights the emerging clinical applications that use state of the art CT technology in the field of lung cancer diagnosis and follow-up.