Rydzak Chara E, Armato Samuel G, Avila Ricardo S, Mulshine James L, Yankelevitz David F, Gierada David S
1 Mallinckrodt Institute of Radiology, Washington University School of Medicine , St. Louis, MO , USA.
2 Department of Radiology, University of Chicago , Chicago, IL , USA.
Br J Radiol. 2018 Oct;91(1090):20170401. doi: 10.1259/bjr.20170401. Epub 2017 Oct 27.
After years of assessment through controlled clinical trials, low-dose CT screening for lung cancer is becoming part of clinical practice. As with any cancer screening test, those undergoing lung cancer screening are not being evaluated for concerning signs or symptoms, but are generally in good health and proactively trying to prevent premature death. Given the resultant obligation to achieve the screening aim of early diagnosis while also minimizing the potential for morbidity from workup of indeterminate but ultimately benign screening abnormalities, careful implementation of screening with conformance to currently recognized best practices and a focus on quality assurance is essential. In this review, we address the importance of each component of the screening process to optimize the effectiveness of CT screening, discussing options for quality assurance at each step. We also discuss the potential added advantages, quality assurance requirements and current status of quantitative imaging biomarkers related to lung cancer screening. Finally, we highlight suggestions for improvements and needs for further evidence in evaluating the performance of CT screening as it transitions from the research trial setting into daily clinical practice.
经过多年通过对照临床试验进行的评估，低剂量CT肺癌筛查正成为临床实践的一部分。与任何癌症筛查测试一样，接受肺癌筛查的人并非因其有可疑体征或症状而接受评估，而是通常身体健康，并积极预防过早死亡。鉴于既要实现早期诊断这一筛查目标，又要尽量减少对不确定但最终为良性的筛查异常情况进行检查所带来的发病风险，按照目前公认的最佳实践仔细实施筛查并注重质量保证至关重要。在本综述中，我们阐述了筛查过程各组成部分对于优化CT筛查效果的重要性，讨论了每一步骤的质量保证选项。我们还讨论了与肺癌筛查相关的定量成像生物标志物的潜在附加优势、质量保证要求及现状。最后，我们强调了在评估CT筛查从研究试验环境过渡到日常临床实践中的性能时的改进建议和进一步证据的需求。
