Stephenson S M, Mech K F, Sardi A
Department of General Surgery, St. Agnes Healthcare, Baltimore, Maryland 21229, USA.
Am Surg. 2005 Dec;71(12):1015-7.
Computed tomography (CT) has been compared to plain radiographs and bronchial washings as a screening tool for lung cancer. In comparison with other screening modalities, CT allows detection of lung lesions at an earlier cancer stage. Technologic improvements have decreased imaging costs, thus making chest CT a more feasible option as a screening tool in the community hospital. In this study, smokers over the age of 45 years with a greater than 20 pack-year smoking history were referred for screening chest CT. Noncalcified nodules larger than 10 mm underwent CT-guided biopsy, and smaller nodules underwent follow-up CT in 3 months. Currently, patients have been followed for 4 years. The prevalence, stage, and histology of lung cancer were compared to study results from academic centers. Eighty-seven patients underwent screening chest CT. The study population was 51 per cent male with a mean age of 64 +/- 9 years. Four (3 female and 1 male) patients were biopsied and found to have lung cancer giving a prevalence of 5 per cent. Stage IA disease was found in three patients and stage IIIA disease was found in one patient. Adenocarcinoma was present in two patients, adeno-squamous carcinoma in one patient, and squamous cell carcinoma in one patient. The stage and histology of lung carcinomas in this study were comparable to studies performed at larger institutions. However, the disease prevalence was almost double the highest prevalence found in other studies. This discrepancy could be related to study size, as the patient populations were similar. Clearly, screening chest CT in the community setting is equally efficacious in the diagnosis of lung cancer at earlier stages. Following these patients beyond the 5-year mark will give some insight on the effect of screening chest CT on the mortality of lung cancer.
计算机断层扫描（CT）已被作为肺癌筛查工具与胸部X光平片和支气管灌洗进行比较。与其他筛查方式相比，CT能够在癌症更早阶段检测出肺部病变。技术进步降低了成像成本，因此使胸部CT作为社区医院的筛查工具成为更可行的选择。在本研究中，年龄超过45岁、吸烟史超过20包年的吸烟者被转诊进行胸部CT筛查。直径大于10毫米的非钙化结节接受CT引导下活检，较小的结节在3个月后进行CT随访。目前，患者已被随访4年。将肺癌的患病率、分期和组织学与学术中心的研究结果进行比较。87名患者接受了胸部CT筛查。研究人群中男性占51%，平均年龄为64±9岁。4名患者（3名女性和1名男性）接受了活检，发现患有肺癌，患病率为5%。3名患者被诊断为IA期疾病，1名患者被诊断为IIIA期疾病。两名患者为腺癌，一名患者为腺鳞癌，一名患者为鳞状细胞癌。本研究中肺癌的分期和组织学与在大型机构进行的研究相当。然而，疾病患病率几乎是其他研究中最高患病率的两倍。这种差异可能与研究规模有关，因为患者群体相似。显然，在社区环境中进行胸部CT筛查在早期肺癌诊断中同样有效。对这些患者进行超过5年的随访将有助于了解胸部CT筛查对肺癌死亡率的影响。
