低剂量螺旋CT筛查肺癌的诊断效能及价值  

Diagnostic Value on Lung Cancer Screening using Low-dose Spiral CT

作　　者：黄明刚[1] 王青[2] 齐敏[1] 吴晓红[1] 

机构地区：[1]陕西省人民医院CT/MR室,陕西西安710068 [2]陕西省人民医院放疗中心,陕西西安710068

出　　处：《实用放射学杂志》2008年第8期1030-1033,1039,共5页Journal of Practical Radiology

基　　金：陕西省社发攻关项目(编号:2004K13-G22)

摘　　要：目的探讨低剂量螺旋CT筛查早期肺癌的可行性和有效性，以及对肺癌预后的影响。方法采用SHINADZU 7800TX单螺旋CT扫描机对3005例行胸部查体人员进行低剂量螺旋CT检查的前瞻性研究，按照筛查处理原则追踪和长期CT随诊基线筛查结果，对有恶性倾向者或随诊增大者及时进行穿刺活检或手术切除。所有图像由2位放射医师采用盲法观察。结果在全部查体人群中，结节检出率为29．9％。吸烟组发现病变是非吸烟组的1．3倍，肺癌总体发生率为1．2％，其中高危人群肺癌发生率2．9％，普通人群为0．9％。低剂量螺旋CT对肺癌筛检的敏感性和特异性分别为82．9％和88．8％，且〉10mm结节肺癌的诊断效能大于〈10mm结节。35例恶性结节中肺癌34例，瘢痕癌1例；Ⅰ期肺癌19例，Ⅱ期10例，Ⅲ期4例，小细胞未分化癌局限期2例。截至2007年底，Ⅰ期肺癌平均生存期〉4年，Ⅱ期肺癌平均生存期2～3年，Ⅲ期肺癌平均生存期1～2年。结论低剂量螺旋CT对肺癌早期发现具有高敏感度和特异度，可明显提高肺癌的早期检出率，改善肺癌患者的生存状况。Objective To evaluate the possibility and efficiency of early lung cancer screening using low - dose spiral CT,and to investigate the effects of prognosis of lung cancer. Methods 3005 routine chests check - up were carried on the low - dose prospect research of the SHIMADZU 7800 TX spiral CT. According to the result by tracing and long - term CT follow - up based on the baseline screening , biopsy or surgical excisions were recommended in ＂malignant change＂ or enlarged nodules. Two doctors separately interpreted all the images blindly. Results 29.9% rate of nodules in all of cases were detected. Smoking group was 1.3 times incidence of non - smoking. A whole incidence of lung cancer was 1.2% , including 2.9% in people at high risk of lung cancer and 0.9% in common people. The sensitivity and specificity of lung cancer screening using low - dose spiral CT were 82.9% and 88.8% respectively, and the diagnostic accuracy of lung cancer screen- ing in diameter of nodules less than 10 mm was high than in ones more than 10 mm. Histologically, 33 non - small cell lung cancers （ 19 stage Ⅰ , 10 stage Ⅱ and g stageⅢ） , 2 small cell lung cancers and 1 scar carcinoma were proved based on baseline screening by biopsy or surgery. By the end of 2007, the average survival for clinical stage Ⅰ lung cancer was more than g years, clinical stage Ⅱ was 2 - 3 years and clinical stageⅢ was 1 - 2 years. Conclusion Low - dose spiral CT is of high sensitive and specificity in detecting early lung cancer. Preliminary screening study indicates that low - dose spiral CT can greatly improve the likelihood of detection for early lung cancer and situation of survival.

关 键 词：肺癌 普查 低剂量 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]