CAJ | 학술논문

目的探讨采用低剂量CT(LDCT)进行肺癌筛查的筛查效果.方法 4 690例无症状者(≥40岁)接受肺LDCT检查,将受检人群分为高危组、中危组和低危组,并根据性别、吸烟和被动吸烟史分为女性被动吸烟暴露组(FN组)和男性被动吸烟暴露组(MN组).分析各组受检者采用低剂量CT筛查肺癌的筛查效果.结果高危组、中危组和低危组的基线LDCT阳性检出率分别为27.0％(86/319)、19.3％ (199/1 029)和11.3％ (377/3 342).26例受检者检出肺癌病灶27个,肺癌检出率为0.6％,其中男11例,女15例.24例非小细胞肺癌和1例类癌中,经术后病理证实23例(24个病灶),肿瘤大小为6.9～29.5 mm,中位值为16.3 mm.Ⅰ期肺癌19例,早诊率为76.0％ (19/25).1例局限期小细胞肺癌经支气管镜证实.高危组、中危组和低危组的肺癌检出率差异无统计学意义(P =0.054).FN组的肺癌检出率为1.4％,MN组为0.4％,高危组为0.9％.结论 LDCT肺癌早诊率达76.0％.肺癌筛查时应重视有被动吸烟暴露史≥40岁女性的筛查.
목적 탐토채용저제량CT(LDCT)진행폐암사사적사사효과.방법 4 690례무증상자(≥40세)접수폐LDCT검사,장수검인군분위고위조、중위조화저위조,병근거성별、흡연화피동흡연사분위녀성피동흡연폭로조(FN조)화남성피동흡연폭로조(MN조).분석각조수검자채용저제량CT사사폐암적사사효과.결과 고위조、중위조화저위조적기선LDCT양성검출솔분별위27.0％(86/319)、19.3％ (199/1 029)화11.3％ (377/3 342).26례수검자검출폐암병조27개,폐암검출솔위0.6％,기중남11례,녀15례.24례비소세포폐암화1례유암중,경술후병리증실23례(24개병조),종류대소위6.9～29.5 mm,중위치위16.3 mm.Ⅰ기폐암19례,조진솔위76.0％ (19/25).1례국한기소세포폐암경지기관경증실.고위조、중위조화저위조적폐암검출솔차이무통계학의의(P =0.054).FN조적폐암검출솔위1.4％,MN조위0.4％,고위조위0.9％.결론 LDCT폐암조진솔체76.0％.폐암사사시응중시유피동흡연폭로사≥40세녀성적사사.
Objective To report the results of low-dose computed tomography (LDCT) screening for early lung cancer in 4 690 asymptomatic participants at the Cancer Hospital,Chinese Academy of Medical Sciences between July 2007 and June 2012.Methods After informed consent and questionnaire forms were obtained,4 690 asymptomatic participants ≥ 40 years underwent chest low dose spiral CT scanning.According to the National Comprehensive Cancer Network (NCCN) guideline for lung cancer screening (version 1.1,2012),all participants were assigned to three groups,namely high-risk,moderaterisk and low-risk groups.In terms of gender,smoking history and second-hand tobacco smoking exposure history,two other groups named male and female never-smoker groups who were exposed to second-hand tobacco smoking were designated.The positive results were identified as at least one solid or part-solid nodule measuring ≥5 mm,or non-solid nodule ≥8 mm in diameter.LDCT scanning protocol,criteria of management according to the size and consistency of pulmonary nodules were compliant with the International Early Lung Cancer Active Program (I-ELCAP).TNM staging of all lung cancers were based on the clinical evidence and pathological findings.Results In various risk status group of the participants,the percentage of positive results of baseline CT were 27.0％ (86/319),19.3 ％ (199/1 029) and 11.3 ％ (377/3 342),respectively.A total of 26 participants (27 lesions) were diagnosed as lung cancer (11 in men,15 in women).The detection rate of lung cancer was 0.6％ (26/4 690).Besides a SCLC (limited-disease,LD),25 cases (76.0％) were stage Ⅰ including 24 NSCLC and one cacinoid on baseline LDCT and the surgical resection rate was 88.5％ (23/26).The diameter of resected cancers was 6.9-29.5 mm (median,16.3 mm).For female never smokers aged 40 years or older who were exposed to second-hand smoking,the detection rate of lung cancer was higher than that of the high-risk and male never smokers who were exposed to second-hand smoking (1.4％ vs.0.9％,0.4％).Conclusions The results indicate that LDCT can detect small lung cancers and most of the cancers are detected at an early stage.Emphasis should be placed on the non-smoking female individuals who are exposed to second-hand smoking in China.