Mascalchi Mario, Picozzi Giulia, Puliti Donella, Gorini Giuseppe, Mantellini Paola, Sali Lapo
Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, 50100 Florence, Italy.
Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and Network in Oncology (ISPRO), 50139 Florence, Italy.
Diagnostics (Basel). 2022 Sep 27;12(10):2326. doi: 10.3390/diagnostics12102326.
Annual screening of lung cancer (LC) with chest low-dose computed tomography (CT) and screening of colorectal cancer (CRC) with CT colonography every 5 years are recommended by the United States Prevention Service Task Force. We review epidemiological and pathological data on LC and CRC, and the features of screening chest low-dose CT and CT colonography comprising execution, reading, radiation exposure and harm, and the cost effectiveness of the two CT screening interventions. The possibility of combining chest low-dose CT and CT colonography examinations for double LC and CRC screening in a single CT appointment is then addressed. We demonstrate how this approach appears feasible and is already reasonable as an opportunistic screening intervention in 50-75-year-old subjects with smoking history and average CRC risk. In addition to the crucial role Computer Assisted Diagnosis systems play in decreasing the test reading times and the need to educate radiologists in screening chest LDCT and CT colonography, in view of a single CT appointment for double screening, the following uncertainties need to be solved: (1) the schedule of the screening CT; (2) the effectiveness of iterative reconstruction and deep learning algorithms affording an ultra-low-dose CT acquisition technique and (3) management of incidental findings. Resolving these issues will imply new cost-effectiveness analyses for LC screening with chest low dose CT and for CRC screening with CT colonography and, especially, for the double LC and CRC screening with a single-appointment CT.
美国预防服务工作组建议每年用胸部低剂量计算机断层扫描（CT）筛查肺癌（LC），每5年用CT结肠成像筛查结直肠癌（CRC）。我们回顾了关于LC和CRC的流行病学和病理学数据，以及筛查胸部低剂量CT和CT结肠成像的特点，包括执行、解读、辐射暴露与危害，以及这两种CT筛查干预措施的成本效益。接着探讨了在一次CT检查中联合进行胸部低剂量CT和CT结肠成像检查以同时筛查LC和CRC的可能性。我们证明了这种方法在有吸烟史且结直肠癌风险平均的50 - 75岁受试者中作为一种机会性筛查干预措施似乎是可行的且已经合理。除了计算机辅助诊断系统在缩短检查解读时间以及在培训放射科医生进行胸部低剂量CT和CT结肠成像筛查方面所起的关键作用外，鉴于一次CT检查进行双重筛查，还需要解决以下不确定性问题：（1）筛查CT的时间表；（2）迭代重建和深度学习算法在提供超低剂量CT采集技术方面的有效性；（3）偶然发现的处理。解决这些问题将意味着对用胸部低剂量CT筛查LC、用CT结肠成像筛查CRC，尤其是对一次检查同时筛查LC和CRC进行新的成本效益分析。
