Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
BMJ Open Respir Res. 2020 Feb;7(1). doi: 10.1136/bmjresp-2019-000455.
The improvement of low-dose CT (LDCT) lung cancer screening selection criteria could help to include more individuals who have lung cancer, or in whom lung cancer will develop, while avoiding significant cost increase. We evaluated baseline results of LDCT lung cancer screening in a population with a heterogeneous risk profile for lung cancer.
LDCT lung cancer screening was implemented alongside a preventive health programme in a private hospital in Brazil. Individuals older than 45 years, smokers and former smokers, regardless of tobacco exposure, were included. Patients were classified according to the National Lung Screening Trial (NLST) eligibility criteria and to PLCO 6-year lung cancer risk. Patient characteristics, CT positivity rate, detection rate of lung cancer and false-positive rate were assessed.
LDCT scans of 472 patients were evaluated and three lung adenocarcinomas were diagnosed. CT positivity rate (Lung-RADS 3/4) was significantly higher (p=0.019) in the NLST group (10.1% (95% CI, 5.9% to 16.9%)) than in the non-NLST group (3.6% (95% CI, 2.62% to 4.83%)) and in the PLCO high-risk group (14.3% (95% CI, 6.8% to 27.7%)) than in the PLCO low-risk group (3.7% (95% CI, 2.9% to 4.8%)) (p=0.016). Detection rate of lung cancer was also significantly higher (p=0.018) among PLCO high-risk patients (5.7% (95% CI, 2.5% to 12.6%)) than in the PLCO low-risk individuals (0.2% (95% CI, 0.1% to 1.1%)). The false-positive rate for NLST criteria (16.4% (95% CI, 13.2% to 20.1%)) was higher (p<0.001) than for PLCO criteria (7.6 (95% CI, 5.3% to 10.5%)).
Our study indicates a lower performance when screening low-risk individuals in comparison to screening patients meeting NLST criteria and PLCO high-risk patients. Also, incorporating PLCO 6-year lung cancer risk ≥0.0151 as an eligibility criterion seems to increase lung cancer screening effectiveness.
提高低剂量 CT（LDCT）肺癌筛查选择标准有助于纳入更多患有肺癌或即将患上肺癌的个体，同时避免成本显著增加。我们评估了在肺癌风险异质人群中进行 LDCT 肺癌筛查的基线结果。
LDCT 肺癌筛查与巴西一家私立医院的预防保健计划同时进行。纳入标准为年龄大于 45 岁、吸烟者和曾经吸烟者，无论其吸烟暴露情况如何。根据美国国家肺癌筛查试验（NLST）入选标准和 PLCO6 年肺癌风险对患者进行分类。评估患者特征、CT 阳性率、肺癌检出率和假阳性率。
评估了 472 例 LDCT 扫描，诊断出 3 例肺腺癌。NLST 组 CT 阳性率（Lung-RADS3/4）显著高于非 NLST 组（10.1%（95%CI，5.9%至 16.9%））（p=0.019）和 PLCO 高风险组（14.3%（95%CI，6.8%至 27.7%））（p=0.016），高于 3.6%（95%CI，2.62%至 4.83%）和 3.7%（95%CI，2.9%至 4.8%）（p=0.016）。PLCO 高风险患者的肺癌检出率（5.7%（95%CI，2.5%至 12.6%））也显著高于 PLCO 低风险患者（0.2%（95%CI，0.1%至 1.1%））（p=0.018）。NLST 标准的假阳性率（16.4%（95%CI，13.2%至 20.1%））高于 PLCO 标准（7.6%（95%CI，5.3%至 10.5%））（p<0.001）。
与筛查符合 NLST 标准和 PLCO 高风险患者相比，我们的研究表明对低危个体进行筛查的性能较低。此外，将 PLCO6 年肺癌风险≥0.0151 纳入入选标准似乎可以提高肺癌筛查的效果。
