Mott Timothy F
Department of Family Medicine Naval Hospital Pensacola, 6000 West Highway 98, Pensacola, FL 32512.
FP Essent. 2018 Jan;464:17-22.
Low-dose computed tomography (CT) scan is the only modality currently considered acceptable for lung cancer screening in high-risk populations. Screening recommendations vary. The US Preventive Services Task Force recommends annual low-dose CT scan to screen high-risk patients (ie, asymptomatic patients ages 55 to 80 years with a 30 pack-year smoking history and who currently smoke or have quit within the previous 15 years). The American Academy of Family Physicians recommends a shared decision-making discussion between the clinician and patient regarding the benefits and potential harms of screening. Medicare covers lung cancer screening to age 77 years as part of a shared decision-making visit and when offered in conjunction with smoking cessation. Approximately 320 high-risk patients who smoke need to be screened annually over 3 years to prevent 1 death from lung cancer. The false-positive rate is 96%. Solitary pulmonary nodules or masses identified on screening or incidentally on other imaging should be managed based on appearance and size and the clinical risk factors of the patient, in accordance with guidelines.
低剂量计算机断层扫描（CT）是目前唯一被认为适用于高危人群肺癌筛查的方法。筛查建议各不相同。美国预防服务工作组建议对高危患者（即年龄在55至80岁之间、有30包年吸烟史且目前仍在吸烟或在过去15年内戒烟的无症状患者）进行年度低剂量CT扫描筛查。美国家庭医生学会建议临床医生与患者就筛查的益处和潜在危害进行共同决策讨论。医疗保险将77岁以下人群的肺癌筛查作为共同决策就诊的一部分，并在与戒烟相结合时予以覆盖。每年大约需要对320名吸烟的高危患者进行3年的筛查，以预防1例肺癌死亡。假阳性率为96%。根据指南，对于在筛查中或在其他影像学检查中偶然发现的孤立性肺结节或肿块，应根据其外观、大小以及患者的临床风险因素进行处理。
