Medical University of South Carolina, Charleston, 29425, USA.
Ann Intern Med. 2011 Oct 18;155(8):537-9. doi: 10.7326/0003-4819-155-8-201110180-00364. Epub 2011 Sep 5.
After the publication of the NLST (National Lung Screening Trial) results, physicians will be faced with whether to begin ordering low-dose computed tomography (LDCT) of the chest to screen for lung cancer in patients with a history of tobacco use. Despite the encouraging reduction in deaths observed by using LDCT in the NLST study population, recommending adoption of lung cancer screening in general practice is premature. Lessons learned from prostate and breast cancer screening should remind us that the reductions in deaths expected with screening are unfortunately not as readily achievable as initially believed. Furthermore, the potential harms of false-positive findings on chest computed tomography are very real. The morbidity and even mortality associated with invasive diagnostic testing and surgical resection due to false- and true-positive findings on computed tomography are likely to increase when the approach taken in the NLST is applied in non-specialty care settings and among the population at highest risk, namely, those with smoking-related comorbid conditions. Although the NLST results are perhaps encouraging, they do not tell us enough that we can be sure that patients who undergo LDCT in an attempt to find early-stage lung cancer will have more benefit than harm.
NLST（国家肺癌筛查试验）结果公布后，医生将面临是否开始为有吸烟史的患者开胸部低剂量计算机断层扫描（LDCT）来筛查肺癌。尽管 NLST 研究人群中使用 LDCT 观察到死亡率令人鼓舞地降低，但在一般实践中推荐采用肺癌筛查还为时过早。从前列腺癌和乳腺癌筛查中吸取的教训应该提醒我们，预期的筛查死亡率降低并不像最初想象的那样容易实现。此外，胸部计算机断层扫描假阳性结果的潜在危害是真实存在的。由于计算机断层扫描的假阳性和真阳性结果导致的侵入性诊断测试和手术切除相关的发病率，甚至死亡率，在 NLST 所采用的方法应用于非专业护理环境和高危人群（即有吸烟相关合并症的人群）时，可能会增加。尽管 NLST 的结果可能令人鼓舞，但它们并没有告诉我们足够的信息，使我们能够确定接受 LDCT 试图发现早期肺癌的患者受益大于危害。
