Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
Department of Radiology, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
Ann Thorac Surg. 2022 Jul;114(1):241-247. doi: 10.1016/j.athoracsur.2021.06.070. Epub 2021 Jul 30.
Lung cancer screening with low-dose computed tomography has demonstrated at least a 20% decrease in lung cancer-specific mortality, but it has the potential harm of unnecessary invasive procedures performed because of false-positive results. This study reports the outcomes of a structured multidisciplinary lung cancer screening program in an area of endemic histoplasmosis.
A retrospective review of patients undergoing lung cancer screening from December 2012 to March 2019 was conducted. Findings suggestive of lung cancer were presented to a multidisciplinary thoracic tumor board. Patients were assigned to interval imaging follow-up, additional diagnostic imaging, or referral for an invasive procedure. Invasive procedures were then compared between benign and malignant diseases.
A total of 4087 scans were performed on 2129 patients; 372 (9.1%) were suspicious and were presented to a multidisciplinary thoracic tumor board. Ultimately, 108 procedures were performed: 55 bronchoscopies, 7 percutaneous biopsies, and 46 operations. A total of 25 patients (1.2%) underwent bronchoscopy resulting in benign pathologic findings, significantly associated with an indication of an endobronchial lesion (P = .01). All percutaneous biopsy specimens revealed malignancy. Five patients (0.2%) who underwent resection had benign disease. Lung cancer was diagnosed in 67 patients (3.1% of the entire cohort), 46 of whom had stage I or II disease.
Lung cancer screening in a structured, multidisciplinary program successfully identifies patients with early-stage lung cancer with limited unnecessary surgical interventions. Patients with isolated endobronchial lesions should undergo short interval imaging follow-up to avoid bronchoscopy for benign disease. Future studies to minimize unnecessary procedures could incorporate biomarkers and advanced imaging analysis into risk assessment models.
低剂量计算机断层扫描肺癌筛查可使肺癌特异性死亡率降低至少 20%，但它可能会因为假阳性结果而导致不必要的侵袭性操作。本研究报告了在地方性组织胞浆菌病地区进行的结构化多学科肺癌筛查计划的结果。
对 2012 年 12 月至 2019 年 3 月期间进行肺癌筛查的患者进行了回顾性审查。将提示肺癌的发现提交给多学科胸肿瘤委员会。患者被分配进行间隔成像随访、额外的诊断性成像或转介进行侵袭性操作。然后比较了侵袭性操作在良性和恶性疾病之间的结果。
共对 2129 名患者进行了 4087 次扫描；372 次（9.1%）扫描结果可疑，提交给多学科胸肿瘤委员会。最终，进行了 108 项操作：55 次支气管镜检查、7 次经皮活检和 46 次手术。共有 25 名患者（1.2%）接受支气管镜检查，结果为良性病理发现，与支气管内病变的指征显著相关（P =.01）。所有经皮活检标本均显示恶性肿瘤。5 名患者（0.2%）接受了切除术，结果为良性疾病。67 名患者（整个队列的 3.1%）被诊断为肺癌，其中 46 名患者患有 I 期或 II 期疾病。
在结构化的多学科计划中进行肺癌筛查可成功识别出患有早期肺癌的患者，且手术干预的数量有限。孤立性支气管内病变的患者应进行短间隔成像随访，以避免对良性疾病进行支气管镜检查。未来的研究可以将生物标志物和先进的成像分析纳入风险评估模型，以尽量减少不必要的操作。
