Raj Vimal, Gupta Sumit, Sivashanmugam Tamilselvan, Barnes Daniel, Agrawal Sanjay, Bennett Jonathan A, Peake Michael D, Entwisle James J
Department of Radiology, Glenfield Hospital, University Hospitals of Leicester, Groby road, Leicester, LE3 9QP, UK.
Department of Medicine, Glenfield Hospital, University Hospitals of Leicester, Groby road, Leicester, LE3 9QP, UK.
World J Oncol. 2012 Jun;3(3):113-118. doi: 10.4021/wjon513w. Epub 2012 Jul 5.
Scanning patients early in their diagnostic journey helps in differentiating benign from malignant aetiology. There is increasing pressure on diagnostic practices for rapid diagnoses and thereby early commencement of treatment in patients suspected to have lung cancer (LC). In our practice, multi detector computed tomography (MDCT) imaging is performed in selected patients referred to the LC service prior to them seeing a chest physician in the LC clinic. This study evaluates the role of such practice and reviews its potential impact on LC services.
Prospective review of our practice from January 2007 to Apr 2007 was performed. Consecutive patients referred to the service with suspected LC were included. Chest radiograph (CXR) report and clinical information from general practitioners were reviewed and graded as high, medium or low risk for presence of LC. Patients with sufficient clinical and/or radiological concern underwent MDCT imaging prior to their clinic. Combined risk scores and modified risk scores were formulated and assessed against MDCT findings.
A total of 139 patients were referred to the service, 124 of these had pre-clinic MDCT. Fifty-three patients (43%) had malignancy, 39 (31%) had non-malignant significant abnormalities, 17 (14%) had other incidental findings and 15 (12%) were normal. Modified combined risk score was the best predictor of presence of cancer.
Pre-clinic MDCT scanning in patients with suspected LC is feasible and has a promising role in the modern care of LC patients. It also empowers physicians with additional information at the primary consultation.
在患者诊断过程的早期进行扫描有助于区分良性和恶性病因。对于疑似肺癌（LC）患者的诊断实践，快速诊断并因此尽早开始治疗的压力越来越大。在我们的实践中，在选定的转诊至LC服务的患者在LC诊所看胸科医生之前，会先进行多排螺旋计算机断层扫描（MDCT）成像。本研究评估了这种做法的作用，并回顾了其对LC服务的潜在影响。
对我们2007年1月至2007年4月的实践进行前瞻性回顾。纳入连续转诊至该服务且疑似LC的患者。回顾了胸部X光片（CXR）报告和全科医生的临床信息，并将其分为LC存在的高、中或低风险等级。有足够临床和/或放射学疑虑的患者在就诊前接受MDCT成像。制定了综合风险评分和改良风险评分，并根据MDCT结果进行评估。
共有139名患者转诊至该服务，其中124名患者在就诊前进行了MDCT检查。53名患者（43%）患有恶性肿瘤，39名（31%）有非恶性显著异常，17名（14%）有其他偶然发现，15名（12%）正常。改良综合风险评分是癌症存在的最佳预测指标。
疑似LC患者在就诊前进行MDCT扫描是可行的，在LC患者的现代护理中具有重要作用。它还能在初次会诊时为医生提供更多信息。
