Kauczor Hans-Ulrich, Bonomo Lorenzo, Gaga Mina, Nackaerts Kristiaan, Peled Nir, Prokop Mathias, Remy-Jardin Martine, von Stackelberg Oyunbileg, Sculier Jean-Paul
Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany,
Eur Radiol. 2015 Sep;25(9):2519-31. doi: 10.1007/s00330-015-3697-0. Epub 2015 May 1.
Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low-dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. Minimum requirements include: standardised operating procedures for low-dose image acquisition, computer-assisted nodule evaluation, and positive screening results and their management; inclusion/exclusion criteria; expectation management; and smoking cessation programmes. Further refinements are recommended to increase quality, outcome and cost-effectiveness of lung cancer screening: inclusion of risk models, reduction of effective radiation dose, computer-assisted volumetric measurements and assessment of comorbidities (chronic obstructive pulmonary disease and vascular calcification). All these requirements should be adjusted to the regional infrastructure and healthcare system, in order to exactly define eligibility using a risk model, nodule management and a quality assurance plan. The establishment of a central registry, including a biobank and an image bank, and preferably on a European level, is strongly encouraged.
• Lung cancer screening using low dose computed tomography reduces mortality. • Leading US medical societies recommend large scale screening for high-risk individuals. • There are no lung cancer screening recommendations or reimbursed screening programmes in Europe as of yet. • The European Society of Radiology and the European Respiratory Society recommend lung cancer screening within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. • High risk, eligible individuals should be enrolled in comprehensive, quality-controlled longitudinal programmes.
肺癌是最常见的致命性癌症，一旦病情进展，生存率很低。年度低剂量计算机断层扫描已显示出在筛查肺癌高危个体方面具有生存获益。基于现有证据，欧洲放射学会和欧洲呼吸学会建议在临床试验中的综合、质量保证的纵向项目中，或在经认证的多学科医疗中心的常规临床实践中进行肺癌筛查。最低要求包括：低剂量图像采集的标准化操作程序、计算机辅助结节评估、阳性筛查结果及其管理；纳入/排除标准；预期管理；以及戒烟项目。建议进一步完善以提高肺癌筛查的质量、结果和成本效益：纳入风险模型、降低有效辐射剂量、计算机辅助体积测量以及合并症（慢性阻塞性肺疾病和血管钙化）评估。所有这些要求都应根据区域基础设施和医疗保健系统进行调整，以便使用风险模型、结节管理和质量保证计划准确界定资格。强烈鼓励建立一个中央登记处，包括生物样本库和图像库，最好是在欧洲层面。
• 使用低剂量计算机断层扫描进行肺癌筛查可降低死亡率。• 美国主要医学学会建议对高危个体进行大规模筛查。• 截至目前，欧洲尚无肺癌筛查建议或报销筛查项目。• 欧洲放射学会和欧洲呼吸学会建议在临床试验中的综合、质量保证的纵向项目中，或在经认证的多学科医疗中心的常规临床实践中进行肺癌筛查。• 高危合格个体应纳入综合、质量控制的纵向项目。
