Lee Pyng, Sutedja Tom G
Department of Pulmonary Medicine, Vrije Universiteit Academic Hospital, Amsterdam, The Netherlands.
Curr Opin Pulm Med. 2007 Jul;13(4):243-8. doi: 10.1097/MCP.0b013e32818b27d3.
Advances in imaging technologies are currently being explored in the attempt to reduce lung cancer morbidity and mortality by achieving stage shift. We reviewed recent important publications on lung cancer screening.
Autofluorescence bronchoscopy has established its important role in the intervention of early central airway lesions. Multidetector computed tomography (CT) and CT-positron emission tomography may facilitate diagnosis of early parenchymal lung lesions. Practical implications of screening are reaching far beyond early diagnostic efforts per se as lead-time, length-time, overdiagnosis biases combined with low specificity of screening tests undermine its cost-effectiveness in the era of healthcare budget constraints.
Advanced imaging technologies may allow early detection and prudent intervention in some individuals that harbour asymptomatic early lung cancer, but disproportional expenses may be required to sieve out many more individuals at risk to attain stage shift. Confounding co-morbidities and practical hurdles may reduce screening's efficacy as it is plausible that for the majority of smokers, lung cancer may not be the ultimate cause of suffering since 90% of them will not develop lung cancer. This fact remains true despite increased use of noninvasive and minimally invasive technologies for the maximum preservation of quality of life irrespective of whether early intervention is a success or failure.
目前正在探索成像技术的进展，试图通过实现分期转变来降低肺癌的发病率和死亡率。我们回顾了近期关于肺癌筛查的重要出版物。
自体荧光支气管镜检查在早期中央气道病变的干预中已确立其重要作用。多排螺旋计算机断层扫描（CT）和CT正电子发射断层扫描可能有助于早期肺实质病变的诊断。筛查的实际意义远不止于早期诊断本身，因为提前期、病程期、过度诊断偏差以及筛查试验的低特异性，在医疗保健预算受限的时代削弱了其成本效益。
先进的成像技术可能使一些患有无症状早期肺癌的个体得以早期发现并进行谨慎干预，但可能需要不成比例的费用来筛查更多有风险的个体以实现分期转变。混杂的合并症和实际障碍可能会降低筛查的效果，因为对于大多数吸烟者来说，肺癌可能不是最终的痛苦根源，这似乎是合理的，因为其中90%不会患肺癌。尽管越来越多地使用非侵入性和微创技术以最大程度地保留生活质量，但无论早期干预成功与否，这一事实仍然成立。
