aDepartment of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria bRadiologie, Meander Medical Center, Ameersfoort und Radboud Universitaet, Nijmegen, the Netherlands.
Curr Opin Oncol. 2014 Mar;26(2):131-7. doi: 10.1097/CCO.0000000000000055.
The purpose of this review is to provide an update on the current data about low-dose computed tomography (LD-CT) lung cancer screening.
The National Lung Screening Trial (NLST) was the first study that provided statistical evidence that LD-CT screening for lung cancer significantly reduces lung cancer mortality by 20%. Three statistically underpowered European trials could not confirm the positive effect of LD-CT screening on lung cancer mortality. Major obstacles in lung cancer screening are overdiagnosis and the large number of false-positive results. In the NLST, more than 24% of the screens were positive, most of which (96.4%) proved to be benign in nature. Optimized protocols for the workup of detected nodules may help to reduce the number of false-positive screens.
Currently, the NLST is the only sufficiently powered trial to report a lower mortality rate with LD-CT screening. Long-term follow-up data are still anticipated on the European screening trials. Furthermore, data on the extent of the potential dangers of LD-CT screening, such as overdiagnosis, false-positive results, and the effect of cumulative radiation dose, have yet to be investigated thoroughly.
本文旨在提供关于低剂量 CT（LD-CT）肺癌筛查的最新数据。
国家肺癌筛查试验（NLST）是首个提供统计学证据表明 LD-CT 筛查可显著降低 20%肺癌死亡率的研究。三项统计学上效力不足的欧洲试验未能证实 LD-CT 筛查对肺癌死亡率的积极影响。肺癌筛查的主要障碍是过度诊断和大量假阳性结果。在 NLST 中，超过 24%的筛查结果为阳性，其中大多数（96.4%）被证实为良性。优化检测到的结节的工作流程方案可能有助于减少假阳性筛查的数量。
目前，NLST 是唯一一项报告 LD-CT 筛查可降低死亡率的充分有力的试验。欧洲筛查试验仍在等待长期随访数据。此外，LD-CT 筛查的潜在危害程度的数据，如过度诊断、假阳性结果和累积辐射剂量的影响，尚未得到充分研究。
