Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, Hasegawa M, Yamanda T, Kubo K, Hanamura K, Asakura K
Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan.
Lancet. 1998 Apr 25;351(9111):1242-5. doi: 10.1016/S0140-6736(97)08229-9.
The incidence of and mortality from lung cancer have increased steadily. Most lung cancers are not localised when first detected, but early detection is mandatory to improve prognosis. Since curable early cases are hard to visualise with conventional chest radiography, a new diagnostic means must be found. We assessed whether population-based mass screening with a spiral computed tomography scanner could contribute substantially to detection of smaller cancers, and decrease mortality.
In 1996, we screened in a mobile unit 5483 individuals from the general population of Matsumoto, Japan, aged between 40 years and 74 years who had undergone annual chest radiography (miniature fluorophotography) and cytological assessment of sputum. All participants had a low-dose X-ray spiral computed tomography (CT) scan of the thorax; 3967 also underwent miniature fluorophotography. We compared smokers and non-smokers. Further assessments were done for probably benign but suspicious lesions; suspicion of cancer; and indeterminate small nodules by chest radiography and conventional CT, with additional transbronchial biopsy when possible. Thoracotomy was recommended when it was strongly suspected that the patients had lung cancer.
19 patients were diagnosed as having lung cancer--14 with suspicion of lung cancer, three with benign but suspicious lesions, and two with indeterminate small nodules. 18 cases were surgically confirmed, and one was clinically diagnosed. The mean size of lesions was 17 mm (range 6-47). In four of 19 patients, lung abnormality was seen on CT and miniature fluorophotography. The lung-cancer detection rate with CT was 0.48%, significantly higher than the 0.03-0.05% for standard mass assessments done previously in the same area. CT missed one case that was found solely on a sputum cytology examination.
Our results show that miniature fluorophotography or conventional chest radiography, which have been the main diagnostic techniques for lung cancer, showed few small cancers. CT was more accurate in mass screening for lung cancer and led to early detection and an accurate diagnosis of lung cancer, and should be considered in future health plans.
肺癌的发病率和死亡率一直在稳步上升。大多数肺癌在首次检测时并非局限性病变，但早期检测对于改善预后至关重要。由于用传统胸部X线摄影很难发现可治愈的早期病例，因此必须找到一种新的诊断方法。我们评估了基于人群的螺旋计算机断层扫描扫描仪大规模筛查是否能对较小癌症的检测有实质性贡献，并降低死亡率。
1996年，我们在一个移动单位对来自日本松本市普通人群的5483名年龄在40岁至74岁之间的个体进行了筛查，这些个体每年都进行胸部X线摄影（微型荧光摄影）和痰液细胞学评估。所有参与者都接受了胸部低剂量X线螺旋计算机断层扫描（CT）；3967人还进行了微型荧光摄影。我们比较了吸烟者和非吸烟者。对可能为良性但可疑的病变、疑似癌症以及胸部X线摄影和传统CT检查发现的不确定小结节进行了进一步评估，如有可能还进行了经支气管活检。当强烈怀疑患者患有肺癌时，建议进行开胸手术。
19名患者被诊断为患有肺癌——14名疑似肺癌，3名良性但可疑病变，2名不确定小结节。18例经手术确诊，1例临床诊断。病变的平均大小为17毫米（范围6 - 47毫米）。19名患者中有4名在CT和微型荧光摄影中均发现肺部异常。CT的肺癌检测率为0.48%，显著高于该地区之前进行的标准大规模评估的0.03 - 0.05%。CT漏诊了1例仅通过痰液细胞学检查发现的病例。
我们的结果表明，一直作为肺癌主要诊断技术的微型荧光摄影或传统胸部X线摄影发现的小癌症很少。CT在肺癌大规模筛查中更准确，能实现肺癌的早期检测和准确诊断，应在未来的健康计划中予以考虑。
