Callol Luis, Roig Francisco, Cuevas Alfredo, de Granda Jose Ignacio, Villegas Francisco, Jareño Javier, Arias Eva, Albiach Jose M
Servicio de Neumología, Hospital Central de la Defensa, Glorieta del Ejército s/n, 28047 Madrid, Spain.
Lung Cancer. 2007 May;56(2):217-21. doi: 10.1016/j.lungcan.2007.01.010. Epub 2007 Feb 20.
An evaluation is made of the effectiveness of low-dose computed tomography (LDCT) in diagnosing early stage lung cancer in the Autonomous Community of Madrid (Spain).
The study comprised subjects over 50 years of age who were active smokers (or who had stopped smoking up to 6 months previously) who smoked more than 30 cigarettes daily for at least 15 years, or 20 cigarettes daily for 20 years, or more than 10packs/year and in contact with asbestos at work. The study group was evaluated using LDCT. For all participants in whom LDCT showed no pathological findings, or in those cases classified as benign, a new LDCT scan was performed 2 years after the first. In case of doubt regarding the benign nature of the findings, an assessment algorithm was applied.
Among the initial 482 candidates in the study group, 466 LDCT scans were performed at baseline, revealing 9 extrapulmonary lesions and 114 pulmonary lesions in 98 subjects. The latter raised diagnostic doubts in 32 cases; of these, 15 were confirmed as benign by high resolution computed tomography (HRCT). In the remaining 17 cases, stage IAp adenocarcinoma was diagnosed at baseline (0.2%). With LDCT after 2 years, an additional four adenocarcinomas were diagnosed-all in stage IAp (0.98%). The complete study, including prevalence cut-off and incidence calculation after 2 years, resulted in the diagnosis of five cancers (1.1%) and two false positive cases (28%).
The use of low-dose computed tomography in risk groups is valid for the early diagnosis of bronchogenic cancer. Nevertheless, significant problems remain, particularly those associated with false positive interpretations. The results of randomized studies on lung cancer mortality such as the US NLST trial and the Dutch-Belgian NELSON trial have to be awaited before any conclusion regarding the effectiveness of LDCT screening can be drawn.
对低剂量计算机断层扫描（LDCT）在西班牙马德里自治区早期肺癌诊断中的有效性进行评估。
该研究纳入年龄超过50岁的现吸烟者（或在过去6个月内戒烟者），他们每天吸烟超过30支至少15年，或每天吸烟20支达20年，或每年吸烟超过10包且工作中接触石棉。研究组采用LDCT进行评估。对于所有LDCT未显示病理结果或分类为良性的参与者，在首次扫描2年后进行新的LDCT扫描。如果对检查结果的良性性质存在疑问，则应用评估算法。
在研究组最初的482名候选者中，466例在基线时进行了LDCT扫描，发现9例肺外病变和98名受试者中的114例肺部病变。后者中有32例引起诊断疑问；其中15例经高分辨率计算机断层扫描（HRCT）确认为良性。在其余17例中，基线时诊断为IAp期腺癌（0.2%）。2年后进行LDCT检查，又诊断出4例腺癌，均为IAp期（0.98%）。完整的研究，包括2年后的患病率截断值和发病率计算，共诊断出5例癌症（1.1%）和2例假阳性病例（28%）。
在高危人群中使用低剂量计算机断层扫描对支气管源性癌的早期诊断是有效的。然而，仍存在重大问题，特别是与假阳性解读相关的问题。在得出关于LDCT筛查有效性的任何结论之前，必须等待诸如美国国家肺癌筛查试验（NLST）和荷兰 - 比利时NELSON试验等肺癌死亡率随机研究的结果。
