“必选项目”体检、随访在恶性肿瘤筛查路径中的应用

Using essential health check-up items and follow-ups for malignant tumor screening

目的探讨健康体检人群中早期发现恶性肿瘤性价比高的筛查路径。方法回顾性分析我院20122016年应用“必选项目”体检人群280477例。具体4个步骤，首先，各科医生对健康体检人群“必选项目”常规检查；第二，主检医生筛选出恶性肿瘤高危病例，推荐专项筛查；第三，主检医生判断恶性肿瘤疑似病例、推荐专科进一步就诊和随访对象；第四，随访医生督促恶性肿瘤疑似病例专科就诊、记录结果，对随访对象定期健康教育、督促复查和专科就诊等。结果病理诊断恶性肿瘤517例，在健康体检人群中的检Ⅲ率184／100000（1．84‰），在随访人群中的检出率2023／100000（20．23‰）；检出前5位依次为甲状腺癌140例（0．499‰）、肺癌120（0．428％。）、乳腺癌35例（0．374‰）。肾癌55例（0．196‰）和前列腺癌33例（0．177‰）。结论定期“必选项目”体检、专项筛查、专科就诊和随访是在健康体检人群中早期发现恶性肿瘤性价比高的筛查路径。

Objective To explore cost effective means for early detection of malignant tumors in individuals undergoing health check-up. Methods This was a retrospective study involving 280,477 parlicipants who had undergone health check-up including essential items from 2012 to 2016 at the Health Assessment and Intervention Research Center of Jiangsu Province. The protocol was composed of four steps. First, essential items were decided and conducted for all health examination participants. Second,cases with a high risk of malignant tumors were collected and additional tests were specified. Third, suspected malignant tumor cases were identified and recommendations for referrals and follow up were made. Finally, physicians in charge of follow-up would urge suspected cases to visit an oncologist, update case files, give regular instructions, and track recall results. Results There were 517 microscopically confirmed cases of malignant tumors,representing a detection rate of 184/100,000 （1.84‰）in individuals seeking regular health check-up and of 2,023/100,000 （20.23‰）in those receiving follow ups. The five most prevalent malignant tumors were thyroid cancer （140 cases or 0. 499X0）, lung cancer（ 120 cases or 0.428‰）,breast cancer（35 cases or 0.374‰）, kidney cancer（S5 cases or 0. 196‰）and prostate cancer（33 cases or 0. 177%0）. Conclusions Essential examination items in combination with subsequent special tests, specialist referrals and follow ups are a cost-effective way for early detection of malignant tumors in people seeking regular health examinations.