Bastarrika Gorka, Pueyo Jesús C, Lozano María Dolores, Montuenga Luis, Zulueta Javier J
Servicio de Radiología. Clínica Universitaria. Facultad de Medicina. Universidad de Navarra. Pamplona. Spain.
Med Clin (Barc). 2003 Jun 14;121(2):41-7. doi: 10.1016/s0025-7753(03)73850-0.
Our aim is to present initial baseline data from a screening trial on low-dose spiral computed tomography (CT). We describe enrollment criteria and a diagnostic algorithm based on initial low-dose CT findings.
From September 2000 to May 2001, 150 asymptomatic smokers (age range 40-78 years; mean 55 years) were studied using non-enhanced low-dose spiral CT of the chest. Repeated short-term high resolution CT follow-up was performed for non-calcified pulmonary nodules smaller than 10 mm in diameter. Non-calcified pulmonary nodules 10 mm or larger were considered as potentially malignant and a complementary positron emission tomography (PET) exam was recommended.
54 non-calcified pulmonary nodules were found in 34 out of 141 (24.15%) symptom-free subjects. The diameter was 5 mm or shorter in 24 participants (70.6%), 6-10 mm in 7 (20.6%) and longer than 10 mm in 3 (8.8%) individuals. One patient with a non-calcified pulmonary nodule of at least 10 mm underwent a complementary PET exam, which was positive. Biopsy of this nodule demonstrated lung cancer (squamous cell carcinoma). CT follow-up over one year was decided in the other two subjects having non-calcified pulmonary nodules longer than 10 mm, as no radiographic signs indicative of malignancy were observed in the baseline scan.
Following this low-dose CT based screening programme, detection of early-stage lung cancer in asymptomatic subjects at high risk of developing the disease is feasible. Further studies are however necessary to pursue more definitive results.
我们的目的是展示一项低剂量螺旋计算机断层扫描（CT）筛查试验的初始基线数据。我们描述了纳入标准以及基于初始低剂量CT结果的诊断算法。
2000年9月至2001年5月，对150名无症状吸烟者（年龄范围40 - 78岁；平均55岁）进行了胸部非增强低剂量螺旋CT检查。对直径小于10mm的非钙化肺结节进行了重复短期高分辨率CT随访。直径10mm及以上的非钙化肺结节被视为潜在恶性，建议进行补充正电子发射断层扫描（PET）检查。
在141名无症状受试者中的34名（24.15%）发现了54个非钙化肺结节。24名参与者（70.6%）的结节直径为5mm或更短，7名（20.6%）为6 - 10mm，3名（8.8%）个体的结节直径大于10mm。一名有至少10mm非钙化肺结节的患者接受了补充PET检查，结果为阳性。该结节活检显示为肺癌（鳞状细胞癌）。另外两名有直径大于10mm非钙化肺结节的受试者决定进行为期一年的CT随访，因为在基线扫描中未观察到提示恶性的影像学征象。
按照这个基于低剂量CT的筛查方案，在有患肺癌高风险的无症状受试者中检测早期肺癌是可行的。然而，需要进一步研究以获得更明确的结果。
