Ho Helen, Williamson Christina, Regis Shawn M, Stock Cameron T, Quadri Syed M, McKee Brady J, McKee Andrea B, Servais Elliot L
Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass.
Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass; Tufts University School of Medicine, Boston, Mass.
J Thorac Cardiovasc Surg. 2021 Mar;161(3):790-802.e2. doi: 10.1016/j.jtcvs.2020.08.109. Epub 2020 Sep 8.
Lung cancer screening with low-dose chest computed tomography improves survival. However, concerns about overdiagnosis and unnecessary interventions persist. We reviewed our lung cancer screening program to determine the rate of surgery and invasive procedures for nonmalignant disease.
We reviewed all patients undergoing lung cancer screening from January 2012 to June 2017 with follow-up through January 2019. Patients with suspicious findings (Lung CT Screening Reporting and Data System 4) were referred for further evaluation.
Of 3280 patients screened, 345 (10.5%) had Lung CT Screening Reporting and Data System 4 findings. A total of 311 patients had complete follow-up, of whom 93 (29.9%) were diagnosed with lung cancer. Eighty-three patients underwent lung surgery (2.5% of screened patients). Forty patients underwent lobectomy (48.2%), 3 patients (3.6%) underwent bilobectomy, and 40 patients (48.2%) underwent sublobar resection. Fourteen patients underwent surgery for benign disease (0.43% of screened patients). Fifty-four patients, 5 with benign disease, had at least 1 invasive diagnostic procedure but never underwent surgery. The incidence of any invasive intervention for nonmalignant disease was 0.95% (31/3280 patients). There were no postprocedural deaths within 60 days. Twenty-five patients (0.76%) underwent stereotactic body radiation therapy; 19 patients (76%) had presumed lung cancer without pretreatment pathologic confirmation.
Surgical resection for benign disease occurred in 0.43% of patients undergoing lung cancer screening. The combined incidence of any invasive diagnostic or therapeutic intervention, including surgical resection, for benign disease was only 0.95%. Periprocedural complications were rare. These results indicate that concern over unnecessary interventions is overstated and should not hinder adoption of lung cancer screening. A multidisciplinary team approach, including thoracic surgeons, is critical to maintain an appropriate rate of interventions in lung cancer screening.
低剂量胸部计算机断层扫描进行肺癌筛查可提高生存率。然而，对过度诊断和不必要干预的担忧依然存在。我们回顾了我们的肺癌筛查项目，以确定非恶性疾病的手术率和侵入性检查率。
我们回顾了2012年1月至2017年6月期间所有接受肺癌筛查的患者，并随访至2019年1月。有可疑发现（肺部CT筛查报告和数据系统4级）的患者被转诊进行进一步评估。
在3280例接受筛查的患者中，345例（10.5%）有肺部CT筛查报告和数据系统4级的发现。共有311例患者完成了随访，其中93例（29.9%）被诊断为肺癌。83例患者接受了肺部手术（占筛查患者的2.5%）。40例患者接受了肺叶切除术（48.2%），3例（3.6%）接受了双肺叶切除术，40例（48.2%）接受了肺段以下切除术。14例患者因良性疾病接受了手术（占筛查患者的0.43%）。54例患者，其中5例为良性疾病，至少接受了1次侵入性诊断检查，但从未接受手术。非恶性疾病的任何侵入性干预发生率为0.95%（31/3280例患者）。60天内无术后死亡病例。25例患者（0.76%）接受了立体定向体部放疗；19例患者（76%）被推测患有肺癌，但未进行预处理病理确诊。
在接受肺癌筛查的患者中，0.43%的患者因良性疾病接受了手术切除。包括手术切除在内的良性疾病的任何侵入性诊断或治疗干预的综合发生率仅为0.95%。围手术期并发症很少见。这些结果表明，对不必要干预的担忧被夸大了，不应妨碍肺癌筛查的采用。包括胸外科医生在内的多学科团队方法对于在肺癌筛查中维持适当的干预率至关重要。
