Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA.
J Thorac Cardiovasc Surg. 2011 Mar;141(3):688-93. doi: 10.1016/j.jtcvs.2010.08.045. Epub 2010 Oct 8.
Low-dose chest computed tomography (CT) is being evaluated in several national trials as a screening modality for the early detection of lung cancer. The goal of the present study was to determine whether lung cancer screening could be done while minimizing the number of benign biopsy specimens taken in an area endemic for histoplasmosis.
The subjects were recruited by letters mailed to area physicians and local advertisement. The inclusion criteria were age older than 50 years and at least a 20 pack-year smoking history. The exclusion criteria were symptoms suggestive of lung cancer or a history of malignancy in the previous 5 years. The participants completed a questionnaire and underwent a chest CT scan at baseline and annually for 5 years. The management of positive screening results was determined using a defined algorithm: annual follow-up CT scan for nodules less than 5 mm; 6-month follow-up CT scan for nodules 5 to 7 mm; review by our multidisciplinary tumor board for nodules 8 to 12 mm; and biopsy for nodules greater than 12 mm.
A total of 132 patients were recruited. Of the 132 patients, 61% had positive baseline CT findings and 22% had positive findings on the annual CT scans. Six cancers were detected. Of these 6 patients, 5 had stage I disease and underwent lobectomy, and 1 had stage IIIA disease and underwent induction chemotherapy and radiotherapy followed by lobectomy. All patients were alive and disease free at a mean follow-up of 41.7 ± 18.6 months. No biopsies were performed for benign lesions. Also, no cancers were missed when the protocol was followed.
Screening with CT can be done effectively in an area endemic for histoplasmosis while minimizing benign biopsies.
低剂量胸部计算机断层扫描（CT）作为肺癌早期检测的筛查方法，正在几项国家试验中进行评估。本研究的目的是确定在组织胞浆菌病流行地区进行肺癌筛查时，能否通过最小化良性活检标本数量来实现这一目标。
通过向该地区的医生和当地广告邮寄信件来招募受试者。纳入标准为年龄大于 50 岁且吸烟史至少 20 包年。排除标准为有肺癌症状或过去 5 年内有恶性肿瘤病史。参与者完成了一份问卷，并在基线和每年进行 5 年的胸部 CT 扫描。阳性筛查结果的管理使用定义的算法确定：结节小于 5 毫米的每年随访 CT 扫描；结节 5 至 7 毫米的每 6 个月随访 CT 扫描；结节 8 至 12 毫米的由我们的多学科肿瘤委员会进行审查；结节大于 12 毫米的进行活检。
共招募了 132 名患者。在这 132 名患者中，61%的患者基线 CT 检查结果阳性，22%的患者每年 CT 扫描结果阳性。发现了 6 例癌症。这 6 名患者中，5 名患有 I 期疾病并接受了肺叶切除术，1 名患有 IIIA 期疾病并接受了诱导化疗和放疗，随后进行了肺叶切除术。所有患者在平均随访 41.7±18.6 个月时均存活且无疾病。未对良性病变进行活检。此外，按照方案进行筛查时没有遗漏癌症。
在组织胞浆菌病流行地区，通过 CT 进行筛查可以有效地进行，同时可以最大限度地减少良性活检。
