Ikeda Norihiko, Hayashi Aeru, Miura Yoshifumi, Okunaka Tetsuya, Okuzawa Ken, Tsuboi Masahiro, Kato Yasufumi, Suga Yasuhiro, Kato Harubumi
Department of Thoracic Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2005 Dec;11(6):363-6.
Previous lung cancer screening trials in the United States (US) employing chest X ray and sputum cytology did not demonstrate reductions in lung cancer mortality. However, recent case control studies in Japan demonstrated a decrease in lung cancer mortality in the computed tomography (CT) screened group. Lung cancer screening using chest CT detected more cancers at an earlier stage than chest X ray. Before CT screening is widely performed, lung cancer mortality reduction should be proved in a scientific manner. The problem of a much higher false positive rate of this method should be solved. The subtypes of adenocarcinoma; bronchioloalveolar carcinoma (BAC) tends to show specific CT findings called ground glass opacity (GGO) and a favorable prognosis can be expected. BAC is usually invisible by chest X ray and detected only by CT. Recent studies have shown the proportion of GGO is strongly related to biological malignancy of small adenocarcinoma. Based on this fact, thoracic surgeons wish to identify the possibility of limited resection for minimally invasive cancers. Lung cancer researchers are interested in evaluating the nature of small adenocarcinoma as well as the carcinogenic process. A comprehensive understanding of screening-detected cancers including the CT images, pathology and genetic analysis is necessary for optimum management of such nodules.
美国此前采用胸部X光和痰细胞学检查的肺癌筛查试验并未显示肺癌死亡率有所降低。然而，日本最近的病例对照研究表明，计算机断层扫描（CT）筛查组的肺癌死亡率有所下降。与胸部X光相比，使用胸部CT进行肺癌筛查能在更早阶段发现更多癌症。在广泛开展CT筛查之前，应以科学的方式证明其能降低肺癌死亡率。该方法假阳性率高得多的问题也应得到解决。腺癌的亚型；细支气管肺泡癌（BAC）往往会显示出一种名为磨玻璃影（GGO）的特定CT表现，并且可以预期有较好的预后。BAC通常在胸部X光下不可见，只有通过CT才能检测到。最近的研究表明，GGO的比例与小腺癌的生物学恶性程度密切相关。基于这一事实，胸外科医生希望确定对微浸润癌进行有限切除的可能性。肺癌研究人员有兴趣评估小腺癌的性质以及致癌过程。对于此类结节的最佳管理，全面了解包括CT图像、病理学和基因分析在内的筛查发现的癌症是必要的。
