Department of Thoracic Surgery, Providence Cancer Institute, Portland, Oregon
Pulmonology East, The Oregon Clinic, Portland, Oregon.
Ann Fam Med. 2020 May;18(3):243-249. doi: 10.1370/afm.2519.
To address doubts regarding National Lung Screening Trial (NLST) generalizability, we analyzed over 6,000 lung cancer screenings (LCSs) within a community health system.
Our LCS program included 10 sites, 7 hospitals (2 non-university tertiary care, 5 community) and 3 free-standing imaging centers. Primary care clinicians referred patients. Standard criteria determined eligibility. Dedicated radiologists interpreted all LCSs, assigning Lung Imaging Reporting and Data System (Lung-RADS) categories. All category 4 Lung-RADS scans underwent multidisciplinary review and management recommendations. Data was prospectively collected from November 2013 through December 2018 and retrospectively analyzed.
Of 4,666 referrals, 1,264 individuals were excluded or declined, and 3,402 individuals underwent initial LCS. Second through eighth LCSs were performed on 2,758 patients, for a total of 6,161 LCSs. Intervention rate after LCS was 14.6% (500 individuals) and was most often additional imaging. Invasive interventions (n = 226) were performed, including 141 diagnostic procedures and 85 surgeries in 176 individuals (procedure rate 6.6%). Ninety-five lung cancers were diagnosed: 84 non-small cell (stage 1: 60; stage 2: 7; stage 3: 9; stage 4: 8), and 11 small cell lung cancers. The procedural adverse event rate was 23/226 (10.1%) in 21 patients (0.6% of all screened individuals). Pneumothorax (n = 10) was the most frequent, 6 requiring pleural drainage. There were 2 deaths among 85 surgeries or 2.3% surgical mortality.
Our LCS experience in a community setting demonstrated lung cancer diagnosis, stage shift, intervention frequency, and adverse event rate similar to the NLST. This study confirms that LCS can be performed successfully, safely, and with equivalence to the NLST in a community health care setting.
为了解决对全国肺癌筛查试验（NLST）普遍性的疑虑，我们分析了一个社区卫生系统内的 6000 多次肺癌筛查（LCS）。
我们的 LCS 计划包括 10 个地点，7 家医院（2 家非大学三级保健医院，5 家社区医院）和 3 家独立的成像中心。初级保健临床医生转介患者。标准标准确定了资格。专门的放射科医生解释了所有的 LCS，并分配了肺成像报告和数据系统（Lung-RADS）类别。所有 4 级 Lung-RADS 扫描均进行了多学科审查和管理建议。数据从 2013 年 11 月至 2018 年 12 月前瞻性收集，并进行了回顾性分析。
在 4666 次转介中，有 1264 人被排除或拒绝，3402 人接受了初始 LCS。2758 名患者进行了第二至第八次 LCS，总共进行了 6161 次 LCS。LCS 后的干预率为 14.6%（500 人），最常见的是额外的影像学检查。进行了 226 次侵入性干预（n = 226），包括 141 例诊断程序和 176 例中的 85 例手术（程序率 6.6%）。诊断出 95 例肺癌：84 例非小细胞肺癌（1 期：60 例；2 期：7 例；3 期：9 例；4 期：8 例），11 例小细胞肺癌。226 例中有 23 例（21 名患者，占所有筛查患者的 0.6%）发生了手术不良事件。气胸（n = 10）最常见，6 例需要胸腔引流。85 例手术中有 2 例死亡，手术死亡率为 2.3%。
我们在社区环境中的 LCS 经验表明，肺癌的诊断、分期转移、干预频率和不良事件发生率与 NLST 相似。这项研究证实，LCS 可以在社区医疗保健环境中成功、安全地进行，与 NLST 等效。
