Swensen Stephen J, Jett James R, Sloan Jeff A, Midthun David E, Hartman Thomas E, Sykes Anne-Marie, Aughenbaugh Gregory L, Zink Frank E, Hillman Shauna L, Noetzel Gayle R, Marks Randolph S, Clayton Amy C, Pairolero Peter C
Department of Radiology, the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Respir Crit Care Med. 2002 Feb 15;165(4):508-13. doi: 10.1164/ajrccm.165.4.2107006.
Studies suggest that screening with spiral computed tomography can detect lung cancers at a smaller size and earlier stage than chest radiography can. To evaluate low-radiation-dose spiral computed tomography and sputum cytology in screening for lung cancer, we enrolled 1,520 individuals aged 50 yr or older who had smoked 20 pack-years or more in a prospective cohort study. One year after baseline scanning, 2,244 uncalcified lung nodules were identified in 1,000 participants (66%). Twenty-five cases of lung cancer were diagnosed (22 prevalence, 3 incidence). Computed tomography alone detected 23 cases; sputum cytology alone detected 2 cases. Cell types were: squamous cell, 6; adenocarcinoma or bronchioalveolar, 15; large cell, 1; small cell, 3. Twenty-two patients underwent curative surgical resection. Seven benign nodules were resected. The mean size of the non-small cell cancers detected by computed tomography was 17 mm (median, 13 mm). The postsurgical stage was IA, 13; IB, 1; IIA, 5; IIB, 1; IIIA, 2; limited, 3. Twelve (57%) of the 21 non-small cell cancers detected by computed tomography were stage IA at diagnosis. Computed tomography can detect early-stage lung cancers. The rate of benign nodule detection is high.
研究表明，与胸部X线摄影相比，螺旋计算机断层扫描筛查能够发现更小尺寸和更早阶段的肺癌。为了评估低辐射剂量螺旋计算机断层扫描和痰细胞学检查在肺癌筛查中的作用，我们在一项前瞻性队列研究中纳入了1520名年龄在50岁及以上、吸烟史达20包年或更长时间的个体。在基线扫描一年后，在1000名参与者（66%）中发现了2244个未钙化的肺结节。确诊肺癌25例（22例为现患病例，3例为新发病例）。单纯计算机断层扫描检测出23例；单纯痰细胞学检查检测出2例。细胞类型为：鳞状细胞癌6例；腺癌或细支气管肺泡癌15例；大细胞癌1例；小细胞癌3例。22例患者接受了根治性手术切除。7个良性结节被切除。计算机断层扫描检测出的非小细胞癌的平均大小为17毫米（中位数为13毫米）。术后分期为IA期13例；IB期1例；IIA期5例；IIB期1例；IIIA期2例；局限性3例。计算机断层扫描检测出的21例非小细胞癌中，有12例（57%）在诊断时为IA期。计算机断层扫描能够检测出早期肺癌。良性结节的检出率很高。
