4690例无症状健康体检者低剂量CT早期肺癌筛查研究  

Results of low-dose computed tomography （LDCT）screening for early lung cancer： prevalence in 4 690 asymptomatic participants

作　　者：唐威[1] 吴宁[1] 黄遥[1] 王建卫[1] 赵世俊[1] 徐志坚[2] 张凯[2] 姜勇[3] 蔡强[4] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所影像诊断科,100021 [2]北京协和医学院中国医学科学院肿瘤医院防癌科,100021 [3]北京协和医学院中国医学科学院肿瘤医院流行病学研究室,100021 [4]山西省人民医院磁共振室

出　　处：《中华肿瘤杂志》2014年第7期549-554,共6页Chinese Journal of Oncology

基　　金：北京希望马拉松基金（2009B038、2012A07）;首都医学发展科研基金（2005-1039）

摘　　要：目的 探讨采用低剂量CT（LDCT）进行肺癌筛查的筛查效果.方法 4 690例无症状者（≥40岁）接受肺LDCT检查,将受检人群分为高危组、中危组和低危组,并根据性别、吸烟和被动吸烟史分为女性被动吸烟暴露组（FN组）和男性被动吸烟暴露组（MN组）.分析各组受检者采用低剂量CT筛查肺癌的筛查效果.结果 高危组、中危组和低危组的基线LDCT阳性检出率分别为27.0％（86/319）、19.3％ （199/1 029）和11.3％ （377/3 342）.26例受检者检出肺癌病灶27个,肺癌检出率为0.6％,其中男11例,女15例.24例非小细胞肺癌和1例类癌中,经术后病理证实23例（24个病灶）,肿瘤大小为6.9～29.5 mm,中位值为16.3 mm.Ⅰ期肺癌19例,早诊率为76.0％ （19/25）.1例局限期小细胞肺癌经支气管镜证实.高危组、中危组和低危组的肺癌检出率差异无统计学意义（P =0.054）.FN组的肺癌检出率为1.4％,MN组为0.4％,高危组为0.9％.结论 LDCT肺癌早诊率达76.0％.肺癌筛查时应重视有被动吸烟暴露史≥40岁女性的筛查.Objective To report the results of low-dose computed tomography （LDCT） screening for early lung cancer in 4 690 asymptomatic participants at the Cancer Hospital,Chinese Academy of Medical Sciences between July 2007 and June 2012.Methods After informed consent and questionnaire forms were obtained,4 690 asymptomatic participants ≥ 40 years underwent chest low dose spiral CT scanning.According to the National Comprehensive Cancer Network （NCCN） guideline for lung cancer screening （version 1.1,2012）,all participants were assigned to three groups,namely high-risk,moderaterisk and low-risk groups.In terms of gender,smoking history and second-hand tobacco smoking exposure history,two other groups named male and female never-smoker groups who were exposed to second-hand tobacco smoking were designated.The positive results were identified as at least one solid or part-solid nodule measuring ≥5 mm,or non-solid nodule ≥8 mm in diameter.LDCT scanning protocol,criteria of management according to the size and consistency of pulmonary nodules were compliant with the International Early Lung Cancer Active Program （I-ELCAP）.TNM staging of all lung cancers were based on the clinical evidence and pathological findings.Results In various risk status group of the participants,the percentage of positive results of baseline CT were 27.0％ （86/319）,19.3 ％ （199/1 029） and 11.3 ％ （377/3 342）,respectively.A total of 26 participants （27 lesions） were diagnosed as lung cancer （11 in men,15 in women）.The detection rate of lung cancer was 0.6％ （26/4 690）.Besides a SCLC （limited-disease,LD）,25 cases （76.0％） were stage Ⅰ including 24 NSCLC and one cacinoid on baseline LDCT and the surgical resection rate was 88.5％ （23/26）.The diameter of resected cancers was 6.9-29.5 mm （median,16.3 mm）.For female never smokers aged 40 years or older who were exposed to second-hand smoking,the detection rate of lung cancer was higher than that of the high-risk and male never smokers who

关 键 词：肺肿瘤 筛查 低剂量CT 烟草 非吸烟 女性 

分 类 号：R734.2[医药卫生—肿瘤]