低剂量计算机断层扫描肺癌筛查：加拿大的经验

Lung cancer screening with low-dose computed tomography: Canadian experience.

作者信息

Roberts Heidi C, Patsios Demetris, Paul Narinder S, McGregor Maureen, Weisbrod Gordon, Chung Taebong, Herman Steven, Boerner Scott, Waddell Thomas, Keshavjee Shafique, Darling Gail, Pereira Andre, Kale Ashwini, Bayanati Hamid, Sitartchouk Igor, Tsao Ming, Shepherd Frances A

机构信息

Department of Medical Imaging, University Health Network, Toronto, ON.

出版信息

Can Assoc Radiol J. 2007 Oct;58(4):225-35.

PMID:18186434

Abstract

INTRODUCTION

In 2003, the Department of Medical Imaging at the University Health Network in Toronto, Ontario, became the first Canadian site of the Intemational Early Lung Cancer Action Program (I-ELCAP). We report the results from the first 1000 baseline studies.

METHODS

Between June 2003 and December 2005, we enrolled 1000 high-risk smokers (that is, smokers with a history of at least 10 pack years, or the equivalent of one pack daily for 10 years), aged 55 years or older. A low-dose helical computed tomography (CT) (40 to 60 mA, 120 kV) was performed with 1.0 mm to 1.25 mm collimation. Nodules found at baseline were followed according to the I-ELCAP protocol: (1) no noncalcified nodules (NCNs) or NCNs < or =4 mm or nonsolid nodules < 8 mm, annual repeat; (2) NCNs > or =5 mm or nonsolid nodules > or =8 mm, 3-month follow-up; or (3) nonsolid nodules > or =15 mm, antibiotics and 1-month follow-up.

RESULTS

The first 1000 study participants were aged 63 years, standard deviation (SD) 6 years, with a smoking history of 38 pack years, SD 22 pack years; 662 (66%) were former smokers, and 338 (34%) were current smokers; 453 (45%) were men, and 547 (55%) were women. Of the participants, 256 (26%) had a positive baseline low-dose computed tomography (LDCT) scan; 227 (23%) were followed after 3 months and 16 (1.6%) after 1 month; 7 (0.7%) received a contrast-enhanced CT and 6 (0.6%) an immediate CT-guided biopsy. Twenty-six invasive procedures were performed: 22 CT-guided biopsies, 1 ultrasound-guided lymph node metastasis biopsy, 1 bronchoscopic biopsy, and 2 surgeries. The malignancy rate of the invasive procedures was 85%. Overall, the malignancy prevalence is 2.2%. Of the malignancies, 20 are lung carcinomas: 19 non-small-cell lung carcinomas (NSCLCs) (14 adenocarcinoma or bronchioalveolar carcinoma [BAC], 4 squamous carcinoma, and 1 large-cell carcinoma) and 1 small-cell carcinoma; 15 (78%) of the NSCLCs are Stage I. Fourteen patients underwent surgery (1 pneumonectomy, 9 lobectomies, and 4 segmentectomies).

CONCLUSION

Our results confirm that LDCT identifies small, early-stage, resectable lung cancer in a high-risk population.

摘要

引言

2003年，安大略省多伦多大学健康网络医学影像部成为国际早期肺癌行动计划（I-ELCAP）在加拿大的首个站点。我们报告前1000例基线研究的结果。

方法

2003年6月至2005年12月期间，我们招募了1000名高危吸烟者（即有至少10包年吸烟史者，相当于每天吸一包烟持续10年），年龄在55岁及以上。采用低剂量螺旋计算机断层扫描（CT）（40至60毫安，120千伏），准直为1.0毫米至1.25毫米。根据I-ELCAP方案对基线时发现的结节进行随访：（1）无非钙化结节（NCNs）或NCNs≤4毫米或实性成分<8毫米的非实性结节，每年复查；（2）NCNs≥5毫米或实性成分≥8毫米的非实性结节，3个月随访；或（3）实性成分≥15毫米的非实性结节，给予抗生素并1个月随访。

结果

前1000名研究参与者年龄为63岁，标准差（SD）6岁，吸烟史38包年，SD 22包年；662例（66%）为既往吸烟者，338例（34%）为当前吸烟者；453例（45%）为男性，547例（55%）为女性。参与者中，256例（26%）基线低剂量计算机断层扫描（LDCT）扫描呈阳性；227例（23%）在3个月后接受随访，16例（1.6%）在1个月后接受随访；7例（0.7%）接受了增强CT检查，6例（0.6%）接受了即时CT引导下活检。实施了26项侵入性操作：22例CT引导下活检、1例超声引导下淋巴结转移活检、1例支气管镜活检和2例手术。侵入性操作的恶性率为85%。总体而言，恶性肿瘤患病率为2.2%。在恶性肿瘤中，20例为肺癌：19例非小细胞肺癌（NSCLCs）（14例腺癌或细支气管肺泡癌[BAC]、4例鳞状细胞癌和1例大细胞癌）和1例小细胞癌；15例（78%）NSCLCs为I期。14例患者接受了手术（1例全肺切除术、9例肺叶切除术和4例肺段切除术）。