Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins University School of Medicine, Baltimore, Maryland, and Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland.
Arthritis Care Res (Hoboken). 2023 Oct;75(10):2142-2150. doi: 10.1002/acr.25114. Epub 2023 Apr 19.
To inform guidance for cancer detection in patients with idiopathic inflammatory myopathy (IIM), we evaluated the diagnostic yield of computed tomography (CT) imaging for cancer screening/surveillance within distinct IIM subtypes and myositis-specific autoantibody strata.
We conducted a single-center, retrospective cohort study in IIM patients. Overall diagnostic yield (number of cancers diagnosed/number of tests performed), percentage of false positives (number of biopsies performed not leading to cancer diagnosis/number of tests performed), and test characteristics were determined on CT of the chest and abdomen/pelvis.
Within the first 3 years since IIM symptom onset, a total of 9 of 1,011 (0.9%) chest CT scans and 12 of 657 (1.8%) abdomen/pelvis CT scans detected cancer. Diagnostic yields for both CT of the chest and CT of the abdomen/pelvis were highest in dermatomyositis, specifically anti-transcription intermediary factor 1γ (2.9% and 2.4% for CT of the chest and abdomen/pelvis, respectively). The highest percentage of false positives was in patients with antisynthetase syndrome (ASyS) (4.4%) and immune-mediated necrotizing myopathy (4.4%) on CT of the chest, and ASyS (3.8%) on CT of the abdomen/pelvis. Patients ages <40 years old at IIM onset had both low diagnostic yields (0% and 0.5%) and high false-positive rates (1.9% and 4.4%) for CT of the chest and abdomen/pelvis, respectively.
In a tertiary referral cohort of IIM patients, CT imaging has a wide range of diagnostic yield and frequency of false positives for contemporaneous cancer. These findings suggest that cancer detection strategies targeted according to IIM subtype, autoantibody positivity, and age may maximize cancer detection while minimizing the harms and costs of over-screening.
为了为特发性炎性肌病（IIM）患者的癌症检测提供指导，我们评估了在不同的 IIM 亚型和肌炎特异性自身抗体分层中，计算机断层扫描（CT）成像在癌症筛查/监测中的诊断收益。
我们进行了一项单中心、回顾性队列研究，纳入了 IIM 患者。总体诊断收益（诊断癌症的数量/进行的检查数量）、假阳性率（未导致癌症诊断的活检数量/进行的检查数量）和检查特征是通过胸部和腹部/骨盆 CT 确定的。
在 IIM 症状出现后的前 3 年内，总共 1011 次胸部 CT 扫描中有 9 次（0.9%）和 657 次腹部/骨盆 CT 扫描中有 12 次（1.8%）检测到癌症。胸部 CT 和腹部/骨盆 CT 的诊断收益在皮肌炎中最高，特别是抗转录中介因子 1γ（胸部 CT 为 2.9%和 2.4%，腹部/骨盆 CT 为 2.4%）。假阳性率最高的是抗合成酶综合征（ASyS）患者（胸部 CT 为 4.4%）和免疫介导的坏死性肌病（4.4%），腹部/骨盆 CT 为 ASyS（3.8%）。在 IIM 发病时年龄<40 岁的患者，胸部和腹部/骨盆 CT 的诊断收益均较低（分别为 0%和 0.5%），假阳性率较高（分别为 1.9%和 4.4%）。
在一个三级转诊的 IIM 患者队列中，CT 成像对同期癌症具有广泛的诊断收益和假阳性率。这些发现表明，根据 IIM 亚型、自身抗体阳性和年龄制定的癌症检测策略，可能最大限度地提高癌症检测率，同时最小化过度筛查的危害和成本。
