Libby Daniel M, Wu Ning, Lee In-Jae, Farooqi Ali, Smith James P, Pasmantier Mark W, McCauley Dorothy, Yankelevitz David F, Henschke Claudia I
Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, 407 East Seventieth St, New York, NY 10021, USA.
Chest. 2006 Apr;129(4):1039-42. doi: 10.1378/chest.129.4.1039.
Although CT screening for lung cancer results in a diagnosis of stage I > 80% of the time, benign noncalcified nodules are also found. We recognized that some nodules appeared to represent infectious bronchopneumonia or other inflammatory processes, as they resolved on follow-up CT, sometimes after antibiotic therapy. To determine the extent to which short-term CT radiographic follow-up might shorten the workup of nodules, we reviewed our experience with baseline and annual repeat CT screenings performed subsequent to the original Early Lung Cancer Action Project series.
The initial CT of 1,968 consecutive baseline and 2,343 annual repeat screenings performed from 1999 to 2002 was reviewed. We identified all those recommended for antibiotics on the initial CT who had a follow-up CT within 2 months and determined whether the nodule(s) resolved, decreased in size, remained unchanged, or grew. We then determined whether further follow-up resulted in a diagnosis of cancer.
At baseline, among the 41 individuals who had follow-up CT within 2 months of the initial CT, 12 patients (29%) had complete or partial resolution; none of them subsequently received a diagnosis of lung cancer. On annual repeat screening, among the 39 individuals who had follow-up CT within 2 months of the initial CT, 29 patients (74%) had complete or partial resolution; none of them subsequently received a diagnosis of lung cancer. Among the 29 patients with nodules at baseline that were unchanged or grew, a total of 15 cancers were subsequently diagnosed; among the 10 patients on annual repeat scanning, there were 2 cancers.
In asymptomatic individuals undergoing CT screening for lung cancer, short-term follow-up CT within 2 months with or without antibiotics may circumvent the need for further evaluation in some individuals, particularly on annual repeat screening.
尽管CT筛查肺癌时，超过80%的情况诊断为I期，但也会发现良性非钙化结节。我们认识到，一些结节似乎代表感染性支气管肺炎或其他炎症过程，因为它们在后续CT检查中消失了，有时是在抗生素治疗后。为了确定短期CT影像学随访在多大程度上可以缩短结节的检查流程，我们回顾了我们在最初的早期肺癌行动计划系列之后进行的基线和年度重复CT筛查的经验。
回顾了1999年至2002年连续进行的1968例基线CT检查和2343例年度重复筛查的初始CT。我们确定了所有在初始CT上被建议使用抗生素且在2个月内进行了随访CT的患者，并确定结节是否消失、缩小、保持不变或增大。然后我们确定进一步的随访是否导致了癌症诊断。
在基线时，在初始CT后2个月内进行随访CT的41名个体中，12名患者（29%）结节完全或部分消失；他们中没有人随后被诊断为肺癌。在年度重复筛查中，在初始CT后2个月内进行随访CT的39名个体中，29名患者（74%）结节完全或部分消失；他们中没有人随后被诊断为肺癌。在基线时结节未改变或增大的29名患者中，共有15例随后被诊断为癌症；在年度重复扫描的10名患者中，有2例癌症。
在接受肺癌CT筛查的无症状个体中，在2个月内进行短期随访CT，无论是否使用抗生素，可能会避免一些个体进行进一步评估的需要，特别是在年度重复筛查时。
