Crucitti P, Gallo I F, Santoro G, Mangiameli G
Division of Thoracic Surgery, Department of General Surgery, Campus Bio‑Medico, University of Rome, Rome, Italy -
Minerva Chir. 2015 Dec;70(6):393-9. Epub 2015 Feb 12.
The main purpose of our project was to evaluate the prevalence of lung cancer in high risk, asymptomatic individuals in addition to quantifying the rate of surgically resectable tumors, and evaluating the role of lung cancer with low dose computed tomography (LDCT) as a tool for lung cancer screening.
Between June 2011 and March 2014, 1500 volunteers at high risk for lung cancer were enrolled in our study and underwent LDCT in our institution. The subsequent diagnostic and therapeutic steps were planned in relation to the results emerging from LDCT. To evaluate speed and type of growth, solid nodules ≤4 mm were reassessed with annual LDCT, those >4-6 mm or >6-8 mm were reassessed with LDCT in 6 or 3 months while nodules suspicious for malignancy were investigated with PET-CT or biopsy according to NCCN guidelines.
Non-calcified nodules were detected in 525 subjects (35% of population): among these 42% had a diameter ≤4 mm, 43% had a diameter >5 mm but <10 mm, 3% appeared as "ground glass" lesions, and 63 (12% of detected nodules) had malignant characteristics (irregular margins, retraction of the surrounding parenchyma, diameter >10 mm). Among the 63 patients who underwent PET-CT or biopsy, 25 cases resulted positive for lung cancer (1.7% of population). These patients underwent surgical treatment with histological detection of tumors in stages IA, IB or IIB.
Our study confirmed the emerging data on the use of LDCT as a screening tool for lung neoplasm in individuals at risk. Due to the LDCT low rate of specificity complementary biomarkers are required to properly define patients at risk and to reduce the number of further radiological examinations.
我们项目的主要目的是评估高危无症状个体中肺癌的患病率，此外还需量化可手术切除肿瘤的比例，并评估低剂量计算机断层扫描（LDCT）作为肺癌筛查工具在肺癌中的作用。
2011年6月至2014年3月期间，1500名肺癌高危志愿者参与了我们的研究，并在我们机构接受了LDCT检查。后续的诊断和治疗步骤根据LDCT检查结果进行规划。为评估生长速度和类型，直径≤4mm的实性结节每年进行一次LDCT复查，直径>4-6mm或>6-8mm的结节分别在6个月或3个月时进行LDCT复查，而可疑为恶性的结节则根据美国国立综合癌症网络（NCCN）指南进行PET-CT检查或活检。
525名受试者（占总人群的35%）检测到非钙化结节：其中42%的结节直径≤4mm，43%的结节直径>5mm但<10mm，3%表现为“磨玻璃”样病变，63个（占检测到结节的12%）具有恶性特征（边缘不规则、周围实质回缩、直径>10mm）。在63例接受PET-CT或活检的患者中，25例肺癌检测呈阳性（占总人群的1.7%）。这些患者接受了手术治疗，并对IA期、IB期或IIB期肿瘤进行了组织学检测。
我们的研究证实了有关将LDCT用作高危个体肺癌筛查工具的新数据。由于LDCT的特异性较低，需要补充生物标志物来准确界定高危患者，并减少进一步影像学检查的数量。
