Diederich S, Wormanns D, Heindel W
Institut für Klinische Radiologie, Universitätsklinikum, Albert-Schweitzer-Str. 33, 48129 Münster.
Radiologe. 2002 Aug;42(8):608-11. doi: 10.1007/s00117-002-0772-8.
Lung cancer is the leading cause of death from malignancy. Due to a lack of early symptoms patients usually undergo therapy at advanced tumor stages when prognosis is poor. Feasibility studies of low-dose spiral CT screening of heavy smokers have shown that many small, resectable lung cancers can be diagnosed at early stages using simple diagnostic algorithms based on size and attenuation of detected pulmonary nodules with a small proportion of invasive procedures for benign lesions. Preliminary results of repeat screening confirms small size and favourable stage distribution of detected cancers, using even simpler diagnostic algorithms: additional diagnostic procedures are only required in new or growing nodules whereas follow-up with low-dose CT is sufficient in nodules that appear unchanged to exclude slow growth. However, mortality reduction by lung cancer screening with low-dose CT has yet to be demonstrated. Several randomised controlled trials are under way to assess possible mortality reduction by comparison of mortalities in a screening group and a control group. It is hoped that through international cooperation data from these trials can be pooled to allow for statistically significant conclusions as early as possible.
肺癌是恶性肿瘤致死的主要原因。由于缺乏早期症状，患者通常在肿瘤晚期才接受治疗，此时预后较差。对重度吸烟者进行低剂量螺旋CT筛查的可行性研究表明，使用基于检测到的肺结节大小和密度的简单诊断算法，许多可切除的小肺癌能够在早期被诊断出来，且只有一小部分良性病变需要进行侵入性检查。重复筛查的初步结果证实了所检测到的癌症体积小且分期分布良好，使用的诊断算法甚至更简单：仅对新出现或增大的结节需要额外的诊断程序，而对于大小未变的结节，进行低剂量CT随访就足以排除缓慢生长。然而，低剂量CT肺癌筛查降低死亡率的效果尚未得到证实。目前正在进行多项随机对照试验，通过比较筛查组和对照组的死亡率来评估是否可能降低死亡率。希望通过国际合作，能够尽早汇总这些试验的数据，得出具有统计学意义的结论。
