Division of Thoracic Oncology, DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland.
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland.
Ann Thorac Surg. 2018 Jun;105(6):1627-1632. doi: 10.1016/j.athoracsur.2018.01.075. Epub 2018 Mar 1.
Lung cancer has high incidence and high mortality burden, particularly because it is typically diagnosed in later stages. The National Lung Screening Trial demonstrated a lung cancer-specific mortality benefit in high-risk current and former smokers with yearly low-dose chest computed tomography (CT). Lung cancer screening is thus recommended, but it is unclear whether the results of the National Lung Screening Trial can be replicated in community settings.
A retrospective review was performed of the lung screening program over its first 5 years, 2012 to 2016. Patients' demographics, initial screening results, follow-up, and management results were analyzed in relation to the National Lung Screening Trial results. Annual adherence was defined as returning for imaging within 1 year + 90 days.
A total of 1,241 persons underwent initial screening over the 5-year period; 78.6% of findings were benign, and only annual repeat low-dose chest CT was recommended. A total of 29 cancers were identified in 26 participants (2%), of which 72% were stage I. The annual adherence rate to repeat imaging after a low-risk baseline scan was 37%, and the any follow-up rate was 51% despite programmatic efforts to follow screening recommendations. When positive findings required more intensive evaluation, most commonly by repeat chest CT scan, adherence was 88%. A total of 1.1% of all participants had invasive biopsies for benign results. Complications of biopsy were minimal.
This review demonstrates that a community-based program can approximate the results of the National Lung Screening Trial in detecting early lung cancers. Further study of the adherence phenomenon is essential.
肺癌发病率和死亡率高，尤其是因为通常在晚期才被诊断出来。国家肺癌筛查试验表明，每年进行一次低剂量胸部 CT 检查可降低高危现吸烟者和前吸烟者的肺癌特异性死亡率。因此推荐进行肺癌筛查，但尚不清楚国家肺癌筛查试验的结果是否能在社区环境中复制。
对 2012 年至 2016 年的肺筛查项目进行了为期 5 年的回顾性研究。分析了患者的人口统计学资料、初次筛查结果、随访和管理结果与国家肺癌筛查试验结果的关系。年度依从性定义为在 1 年+90 天内进行影像学复查。
在 5 年期间，共有 1241 人进行了初始筛查；78.6%的结果为良性，仅推荐每年进行重复低剂量胸部 CT 检查。在 26 名参与者中（2%）共发现 29 例癌症，其中 72%为 I 期。低危基线扫描后重复成像的年度依从率为 37%，尽管有计划遵循筛查建议，但任何随访率为 51%。当阳性结果需要更密集的评估时，最常见的是重复胸部 CT 扫描，其依从率为 88%。共有 1.1%的所有参与者因良性结果进行了侵入性活检。活检的并发症很少。
本回顾性研究表明，社区为基础的方案可以在检测早期肺癌方面接近国家肺癌筛查试验的结果。进一步研究依从性现象至关重要。
