Tang Wei, Wu Ning, Huang Yao, Wang Jianwei, Zhao Shijun, Xu Zhijian, Zhang Kai, Jiang Yong, Cai Qiang, Zhou Lina, Li Meng, Tao Dandan, Liu Xiaomeng, Wang Yujie
Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
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Zhonghua Zhong Liu Za Zhi. 2014 Jul;36(7):549-54.
To report the results of low-dose computed tomography (LDCT) screening for early lung cancer in 4 690 asymptomatic participants at the Cancer Hospital, Chinese Academy of Medical Sciences between July 2007 and June 2012.
After informed consent and questionnaire forms were obtained, 4 690 asymptomatic participants ≥ 40 years underwent chest low dose spiral CT scanning. According to the National Comprehensive Cancer Network (NCCN) guideline for lung cancer screening (version 1.1, 2012), all participants were assigned to three groups, namely high-risk, moderate-risk and low-risk groups. In terms of gender, smoking history and second-hand tobacco smoking exposure history, two other groups named male and female never-smoker groups who were exposed to second-hand tobacco smoking were designated. The positive results were identified as at least one solid or part-solid nodule measuring ≥ 5 mm, or non-solid nodule ≥ 8 mm in diameter. LDCT scanning protocol, criteria of management according to the size and consistency of pulmonary nodules were compliant with the International Early Lung Cancer Active Program (I-ELCAP). TNM staging of all lung cancers were based on the clinical evidence and pathological findings.
In various risk status group of the participants, the percentage of positive results of baseline CT were 27.0% (86/319), 19.3% (199/1 029) and 11.3% (377/3 342), respectively. A total of 26 participants (27 lesions) were diagnosed as lung cancer (11 in men, 15 in women). The detection rate of lung cancer was 0.6% (26/4 690). Besides a SCLC (limited-disease, LD), 25 cases (76.0%) were stage I including 24 NSCLC and one cacinoid on baseline LDCT and the surgical resection rate was 88.5% (23/26). The diameter of resected cancers was 6.9-29.5 mm (median, 16.3 mm). For female never smokers aged 40 years or older who were exposed to second-hand smoking, the detection rate of lung cancer was higher than that of the high-risk and male never smokers who were exposed to second-hand smoking (1.4% vs. 0.9%, 0.4%).
The results indicate that LDCT can detect small lung cancers and most of the cancers are detected at an early stage. Emphasis should be placed on the non-smoking female individuals who are exposed to second-hand smoking in China.
报告2007年7月至2012年6月期间中国医学科学院肿瘤医院对4690名无症状参与者进行低剂量计算机断层扫描（LDCT）筛查早期肺癌的结果。
在获得知情同意书和调查问卷后，4690名年龄≥40岁的无症状参与者接受了胸部低剂量螺旋CT扫描。根据美国国立综合癌症网络（NCCN）肺癌筛查指南（2012年第1.1版），所有参与者被分为三组，即高危组、中危组和低危组。根据性别、吸烟史和二手烟暴露史，另外指定了两组，即暴露于二手烟的男性和女性从不吸烟组。阳性结果定义为至少有一个实性或部分实性结节，直径≥5mm，或直径≥8mm的非实性结节。LDCT扫描方案、根据肺结节大小和实性情况的处理标准均符合国际早期肺癌行动计划（I-ELCAP）。所有肺癌的TNM分期均基于临床证据和病理结果。
在参与者的不同风险状态组中，基线CT阳性结果的百分比分别为27.0%（86/319）、19.3%（199/1029）和11.3%（377/3342）。共有26名参与者（27个病灶）被诊断为肺癌（男性11例，女性15例）。肺癌检出率为0.6%（26/4690）。除1例小细胞肺癌（局限期，LD）外，25例（76.0%）为I期，包括24例非小细胞肺癌和1例基线LDCT上的类癌，手术切除率为88.5%（23/26）。切除的癌灶直径为6.9 - 29.5mm（中位数，16.3mm）。对于40岁及以上暴露于二手烟的女性从不吸烟者，肺癌检出率高于高危组和暴露于二手烟的男性从不吸烟者（1.4%对0.9%，0.4%）。
结果表明LDCT能够检测出小肺癌，且大多数癌症在早期被检测到。在中国，应重视暴露于二手烟的非吸烟女性个体。
