University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA.
Lung. 2015 Feb;193(1):135-9. doi: 10.1007/s00408-014-9671-9. Epub 2014 Dec 11.
The National Lung Screening Trial (NLST) in 2011 showed that low-dose CT (LDCT) screening in high-risk groups reduces lung cancer deaths. Major professional organizations, as well as the U.S. Preventative Services Task Force, have endorsed LDCT screening in these select populations. However, major questions remain about whether widespread deployment of CT screening can achieve results similar to the NLST, especially in the community setting.
A prospective cohort study was initiated in November 2010. Participants at least 50 years old and with at least 20 pack-years of smoking history underwent LDCT screening in a community setting.
One hundred and fifty four participants underwent LDCT screening with median follow-up of 2.7 years. Compared with the NLST, there was a higher rate of positive screening tests (35.7 vs. 27.3 %), higher false positive rate (100 vs. 96.4 %), and poor adherence (43 vs. 95 %). Invasive diagnostic follow-up was uncommon and uncomplicated. No interval lung cancer was detected. Late follow-up was mostly attributed to participant or primary care provider preference (67.5 %), participants lost to follow-up (17.5 %), and lack of insurance (10 %).
These findings highlight the potential challenges of generalizing the NLST mortality benefits in the broad deployment of CT screening. Our results support current recommendations that LDCT screening be performed in a highly structured and integrated setting.
2011 年的国家肺癌筛查试验（NLST）表明，在高危人群中进行低剂量 CT（LDCT）筛查可降低肺癌死亡率。主要专业组织以及美国预防服务工作组都支持在这些特定人群中进行 LDCT 筛查。然而，关于是否可以广泛部署 CT 筛查来获得与 NLST 相似的结果，特别是在社区环境中，仍存在许多重大问题。
一项前瞻性队列研究于 2010 年 11 月启动。参与者年龄至少为 50 岁，且吸烟史至少 20 包年，在社区环境中进行 LDCT 筛查。
154 名参与者接受了 LDCT 筛查，中位随访时间为 2.7 年。与 NLST 相比，筛查阳性率更高（35.7% vs. 27.3%），假阳性率更高（100% vs. 96.4%），且依从性较差（43% vs. 95%）。侵入性诊断性随访并不常见且无并发症。未发现间隔期肺癌。后续随访主要归因于参与者或初级保健提供者的偏好（67.5%）、参与者失访（17.5%）和缺乏保险（10%）。
这些发现强调了在广泛部署 CT 筛查中推广 NLST 降低死亡率益处的潜在挑战。我们的研究结果支持目前的建议，即应在高度结构化和整合的环境中进行 LDCT 筛查。
